Permit v CITY OF TIGARD SEWER CONNECTION PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: SWR2013 -00024
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/05/2013
Parcel: 2S102CD02603
Jurisdiction: Tigard
Site address: 9605 SW HILLVIEW CT
Project: Modlin Subdivision: TWALITY HILL Lot: 3
Project Description: Connect existing house to sewer service.
Contractor: Owner: MODLIN, PATRICIA M
•
1600 MARSHALL CIRCLE
DUPONT, WA 98327
PHONE: PHONE: 253- 964 -6147
FAX:
FEES
Description Date Amount
Specifics: Deferred Reimbursement District Fee 02/05/2013 $14,734.60
Deferred Sewer Connection Fee 02/05/2013 $4,665.00
Type of Use: SF Deferred Sewer Inspection Fee 02/05/2013 $35.00
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $19,434.60
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 sus ended_ or more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. ose rules if- set foi • in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You ma • - copy of the rules or direct questions
to OUN by calling 503.232. • n or 1. :Os 332.2344.
Iss d By: , , �• r / Permittee Sign
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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.
General Ledger
Journal Entry Proof List
User: amyl i`'i; o : a
Printed: 12/13/2012 - 5:16 PM
Batch: 10010.12.2012
`'TIGARD
Account Number Account Description Debit Amount Credit Amount Line Description Project Management
Journal Entry: 193 -06 -2013 Journal Entry Dale: 12/13/2012
230 -0000 -12103 Accts Receivable - Reimb. Dist 35.00 0.00 Book Inspection Fee - Modlin
230 - 0000 -23300 Deferred Revenue 0.00 35.00 Book Inspection Fec - Modlin
500- 0000 -12102 Accounts Receivable - CWS 4,665.00 0.00 Book Connection Fee - Modlin
500- 0000 -12103 Accts Receivable - Reimb. Dist 14,734.60 0.00 Book Reimbursement Fee - Modlin
500- 0000 -23300 Deferred Revenue 0.00 19,399.60 I3ook Sewer Loan Fees - Modlin
Journal Entry Totals 19,434.60 19.434.60
Journal Entry Balance 0.00
Report Totals: 19,434.60 19.434.60
0.00
GL- Journal Entry Proof List (12/13/2012 - 5:16 PM) Page I
'. CITY OF TIGARD RECEIPT
n
IN {� . _ 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 190114 - 02/05/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SWR2013 -00024 Deferred Reimbursement District Fee 500 - 0000 -23300 $14,734.60
SWR2013 -00024 Deferred Sewer Connection Fee 500 - 0000 -23300 $4,665.00
SWR2013 -00024 Deferred Sewer Inspection Fee 230 - 0000 -23300 $35.00
Total: $19,434.60
PAYMENT METHOD CHECK # CC.AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Journal Entry 193 -06 -2013 DADAMSKI 02/05/2013 $19,434.60
• Payor: City of Tigard
Total Payments: $19,434.60
Balance Due: $0.00
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