Permit iii ,,.
CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2012-00011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2012
Parcel: 2S111BA00803
Jurisdiction: Tigard
Site address: 9960 SW MCDONALD ST
Project: ENGEL Subdivision: TIGARDVILLE HEIGHTS Lot: 24
Project Description: Connecting existing home to sewer with drain reversal.
Contractor: Owner: ENGEL, JOHN B
9960 SW MCDONALD ST
TIGARD, OR 97224
PHONE: PHONE: 503 - 968 -2010
FAX:
FEES
Description Date Amount
Specifics: Deferred Reimbursement District Fee 01/27/2012 $14,232.00
Deferred Sewer Connection Fee 01/27/2012 $4,500.00
Type of Use: SF Deferred Sewer Inspection Fee 01/27/2012 $35.00
Class of Work: OTR
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $18,767.00
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 2! or 1.800.332.2344.
Issued By: / r P ermittee Signature: Aga----112,1r/ o// ,4 009Af .6-ocs
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.
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 185309 - 01/27/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SWR2012 -00011 Deferred Reimbursement District Fee 500 - 0000 -23300 $14,232.00
SWR2012 -00011 Deferred Sewer Connection Fee 500 - 0000 -23300 $4,500.00
SWR2012 -00011 Deferred Sewer Inspection Fee 230 - 0000 -23300 $35.00
Total: $18,767.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Journal Entry JE #371 -07 -2012 DHOWSE 01/27/2012 $18,767.00
Payor: City of Tigard (Engel loan)
Total Payments: $18,767.00
Balance Due: $0.00
Page 1 of 1
General Ledger 5
Journal Entry Proof List,. ', ,H
User: amyl
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Printed: 1/26 /2012 - 4:38 PM
Batch: 00003.012012 ; GARD
Account Number Account Description Debit Amount Credit Amount Line Description System Reference Project Management
Journal Entry: 371 -07 -2012 Journal Entry Date: 01/26/2012
230-0000-12103 Accts Receivable - Reimb. Dist 35.00 0.00 Inspection Fee - Engel Sewer
230- 0000 -23300 Deferred Revenue 0.00 35.00 Engel Sewer Loan
500 -0000 -12102 Accounts Receivable - CWS 4.500.00 0.00 Connection Fcc - Engel Sewei
500 -0000 -12103 Accts Receivable - Reimb. Dist 14,232.00 0.00 Reimbursement Fee - Engel S
500 - 0000 -23300 Deferred Revenue 0.00 18,732.00 Engel Sewer Loan
Journal Entry Totals 18,767.(10 18.767.00
Journal Entry Balance 0.00
Report Totals: 18,767.00 18,767.00
0.00
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GL- Journal Entry Proof List (1/26/2012 - 4:38 PM) Page 1