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Permit (32) CITY OF TIGARD SEWER CONNECTION PERMIT 1111 . COMMUNITY DEVELOPMENT Permit#: SWR2016-00401 D 13125 SW Hat Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2017 F F fes` ° g Parcel: 2S106DB17400 Jurisdiction: Tigard Site address: 13250 SW AUBERGINE TER Project: River Terrace Northwest,Lot 174 Subdivision: RIVER TERRACE NORTHWEST Lot: 174 Project Description: Sewer connection for new SFA. Building/unit 5.5 Contractor: Owner: ADLV LAND HOLDINGS LLC BY FORSUM, MICHAEL 7600 E DOUBLETREE RANCH RD STE 1 SCOTTSDALE,AZ 85258 PHONE: PHONE: FAX: FEES • Description Date Amount • Specifics: Sewer Connection Fee 12/06/2016 $5,300.00 Sewer Inspection-Residential 12/06/2016 $35.00 Type of Use: SFA 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. y • Issued By: zk. pefjeor1640 . Permittee Signature: /G��l/� 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.