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Permit (58) IN - 14 CITY OF TIGARD SEWER CONNECTION PERMIT COMMUNITY DEVELOPMENT Permit#: SWR2018-00008 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/05/2018 Parcel: 2S 106AD06500 Jurisdiction: Tigard Site address: 12924 SW RIVER TERRACE BLVD Project: River Terrace East,Lot 172 Subdivision: RIVER TERRACE EAST Lot: 172 Project Description: Sewer connection for new SF. 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: FEES Description Date Amount Specifics: Sewer Connection Fee 02/05/2018 $5,500.00 Type of Use: SF Sewer Inspection-Residential 02/05/2018 $35.00 Class of Work: NEW Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $5,535.00 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: 2' !7 t% ✓ /1-r �i — Permittee Signature: e9A,/ --� /e�r'_/7l>ft,� 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.