Permit n CITY OF TIGARD SEWER CONNECTION PERMIT
a COMMUNITY DEVELOPMENT Permit#: SWR2021-00236
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/14/2021
Parcel: 2S 111 BA00802
Jurisdiction:
Site address: 14170 SW 100TH AVE
Project: Wamala Subdivision: Lot:
Project Description: Connect existing dwelling to public sanitary sewer. Charge CWS Residential II Rate 8 bedrooms for property to
be served by a 1"water meter. Must provide certificate of septic system decommission.
Contractor: Owner: WAMALA, RONALD &ELIZABETH
14170 SW 100TH AVE
TIGARD,OR 97224
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/13/2021 $15,212.50
Sewer Inspection-Residential 09/13/2021 $35.00
Type of Use: SF Reimbursement District Fee 09/13/2021 $27,001.91
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 2.5
Total $42,249.41
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth1 in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: `�1r D TDegj 1�ck_ Lr� Permittee Signature: 01
1
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Call 503.639.4175 by 7:00 a.m.for the next available inspection date. �11'r 11 �� ) U�1
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT SEP 07 2021
,4 CITY OF TIGARD
II BUILDING DIVISION
Reimbursement District Payment Worksheet
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
?his Worksheet must be completed by the Finance Department and provided
to the applicant to submit together with a completed plumbrilk,permit
application and payment for sewer connection and reimbursement district fee,
if applicable, by expiration date shown below to the$vildinglivisiort.
FINANCE DEPARTMENT TO COMPLETE:
Site Address: 14170 SW 100th Ave, Tigard, OR 97224
Reimbursement District #:42 Parcel #: 2S111BA00802
Amount Due: $ 27,001 .91 Amount Due Expires On: 2/27/2022
Applicant: Daytime Phone:
Email Address:
El Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee,if applicable)*
By: Date: 9/7/21
Name
Printed: Jared Isaksen
BUILDING DIVISION TO COMPLETE:
*If a sewer loan is processed, wait for journal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ .2 7, OD/.9/ Receipt#: 11/ -t y0 '/
SWR#: •5-!t//L.2002 /— DO 2 3 (, PLM #.- PIS T.7 0 .2/ -p o.2 9' 9
Enter parcel conditions in Accela (check all that apply):
Enter"paid" condition.
Enter"deferral" condition,if applicable.
By: _ ('9'�VVLTe Date:
Printed: n� J
r
Attach this worksheet to issued sewer permit for records scanning:
1:1Building\Riembursement Districts\ReimDistPaymentWorksheet NoDeferredAccounts_041918.docx