Permit (107) CITY OF TIGARD SEWER CONNECTION PERMIT
IN 2 7
COMMUNITY DEVELOPMENT
Permit#: SWR2016-00360
TtGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/30/2017
Parcel: 2S104AC15100
Jurisdiction: Tigard
Site address: 12863 SW 133RD AVE
Project: Walnut Ridge, Lot 5 Subdivision: WALNUT RIDGE Lot: 5
Project Description: New SF.
Contractor: Owner: RIVERSIDE HOMES LLC
17933 NW EVERGREEN PKWY,#370
BEAVERTON, OR 97006
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee
01/30/2017 $5,300.00
Type of Use: SF Sewer Inspection-Residential 01/30/2017 $35.00
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,335.00
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 ado. ed by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain copy •f t : ru or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.
Issued By:
•. Permittee Signature: ' /// f
Call 503. .4 by 7:00 a.m.for the next available inspection a g�
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.