Permit 4 CITY OF TIGARD SEWER CONNECTION PERMIT
8 ' COMMUNITY DEVELOPMENT Permit #: SWR2013 00127
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/22/2013
Parcel: 2S109DA13600
Jurisdiction: Tigard
Site address: 15154 SW SUMMERVIEW DR
Project: Arlington Heights, Lot 55 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 55
Project Description: Sewer connection for new SF.
Contractor: Owner: COLUMBIA STATE BANK
BY JECK, AL
17800 SE MILL PLAIN BLVD, STE 10
VANCOUVER, WA 98683
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/22/2013 $4,665.00
Sewer Inspection - Residential 07/22/2013 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $4,700.00
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable
law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to OUNC by . ng 51 2.1987 oor 1.800.332.2344.
Issued = (' C Permittee Signature: A
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.