Permit CITY OF TIGARD SEWER CONNECTION PERMIT
1111 3 ' COMMUNITY DEVELOPMENT Permit#: SWR2015-00063
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/22/2015
Parcel: 2S110BA12500
Jurisdiction: TIGARD
Site address: 14121 SW 118TH CT
Project: Medallion Meadows,Lot 18 Subdivision: MEDALLION MEADOWS Lot: 18
Project Description: New SF.
Contractor: Owner: JT ROTH CONSTRUCTION INC
FOUR D CONSTRUCTION CO
12600 SW 72ND AVE#200
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/22/2015 $4,900.00
Sewer Inspection-Residential 07/22/2015 $35.00
Type of Use: SF
Class of Work: ALT
Install Type:
Fixture Units:
Number of Dwelling Units: 1
Total $4,935.00
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. Tho . e 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 b calling 503.23 . •8 :'0.332.2344.
Issue By: Permittee Signature: 4110P
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-6(the project.
Approved plans are required on the job site at the time of each inspection.