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Permit (150) CITY OF TIGARD SEWER CONNECTION PERMIT Iiki al . COMMUNITY DEVELOPMENT Permit*: SWR2017-00054 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/23/2017 Parcel: 2S106DB19100 Site address: 13380 SW BEACH PLUM TER Jurisdiction: Tigard Project: River Terrace Northwest,Lot 191 Subdivision: RIVER TERRACE NORTHWEST Project Description: Sewer connection for new SFA. Building/unit 9.2 Lot: 191 Contractor: Owner: ADLV LAND HOLDINGS LLC BY FORSUM, MICHAEL 7600 E DOUBLETREE RANCH RD STE 1 SCOTTSDALE,AZ 85258 PHONE: PHONE: 602-694-4031 FAX: Description Date Specifics: Amount Sewer Connection Fee 02/23/2017 Type of Use: SFA Sewer Inspection-Residential $5,300.00 02/23/2017 $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 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 calling 503.232.1987 or 1.800.332.2344. Issued By: / )4 A Kms-' ,i- Permittee Signature: / e C-x (p GtIt y7 Call 503.639.4175 by 7:00 a.m.for the next available inspection 2:: 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.