Permit CITY OF TIGARD SEWER CONNECTION PERMIT
- _ Permit #: SWR2012 -00197
COMMUNITY DEVELOPMENT Date Issued: 09/20/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S102CD01900
Jurisdiction: Tigard
Site address: 9855 SW GARRETT ST
Project: Jensen Subdivision: FREWING'S ORCHARD TRACTS Lot: 16
Project Description: Connect existing house to sewer service. See PFI2012 -00030 for public portion.
Contractor: Owner: JENSEN, WILLIAM G & YOLANDA T
9855 SW GARRETT ST
TIGARD, OR 97223
PHONE:
HONE:
FAX:
FEES
Description Date Amount
Specifics: Deferred Sewer Connection Fee 09/20/2012 $4,665.00
Deferred Sewer Inspection Fee 09/20/2012 $35.00
Type of Use: SF
Class of Work: OTR
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $4,700.00
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: '� " Permittee Signature: ay / ff / p/o/ – /( T
,(.... 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: 188466 - 09/20/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SWR2012 -00197 Deferred Sewer Inspection Fee 230- 0000 -23300 $35.00
SWR2012 -00197 Deferred Sewer Connection Fee 500 - 0000 -23300 $4,665.00
Total: $4,700.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Journal Entry 286 -03 -2013 DHOWSE 09/20/2012 $4,700.00
Payor: City of Tigard for Jensen Loan
Total Payments: $4,700.00
Balance Due: $0.00
Page 1 of 1
General Ledger
Journal Entry Proof List U
User: amyl
Printed: 9/20/2012 - 2:49 PM
Batch: 10028.09.2012
TIGARD
Account Number Account Description Debit Amount Credit Amount Line Description Project Management
Journal Entry: 286-03 -2013 Journal Entry Date: 09/20/2012
230 - 0000 -12103 Accts Receivable - Reimb. Dist 35.00 0.00 Book Inspection Fee - Jensen
230-0000 -23300 Deferred Revenue 0.00 35.00 Book Inspection Fee - Jensen
500 -0000 -12102 Accounts Receivable - CWS 4,665.00 0.00 Book Connection Fee - Jensen
500-0000 -23300 Deferred Revenue 0.00 4,665.00 Book Sewer Loan Fees - Jensen
Journal Entry Totals 4,700.00 4,700.00
Journal Entry Balance 0.00
Report Totals: 4,700.00 4,700.00
0.00
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GL- Journal Entry Proof List (9/20/2012 - 2:49 PM) Page 1