Permit CITY OF TIGARD SEWER CONNECTION PERMIT
s COMMUNITY DEVELOPMENT Permit #: SWR2013 -00084
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2013
T € t; A R. L� 9 Parcel: 2S 111 BA00805
Jurisdiction: Tigard
Site address: 14130 SW 100TH AVE
Project: Randall Subdivision: TIGARDVILLE HEIGHTS Lot: 25
Project Description: Connect existing house to sewer service, approximately 160'. Septic tank is to be properly decommissioned.
Contractor: Owner: RANDALL, MARIA L
14130 SW 100TH AVE
TIGARD, OR 97224
PHONE: PHONE: 503 - 899 -7363
FAX:
FEES
Description Date Amount
Specifics: Deferred Reimbursement District Fee 04/15/2013 $6,000.00
Deferred Sewer Inspection Fee 04/15/2013 $35.00
Type of Use: SF Deferred Sewer Connection Fee 04/15/2013 $4,665.00
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $10,700.00
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 sus. • . • - • • ore the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. ose rules are forth is OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to 0 C by calling 503.232.198 • • .800.3 344.
sued By: / / Permittee Signatur 4„/../„. /
L_ ' / f
Call 503.639.4175 by 7:00 a.m. for the next available inspection • • e.
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 V
User: AmyL w -
Printed: 4/1/2013 - 6:07 PM -
Batch: 00001.04.2013
T1G.ARD
Account Number Account Description Debit Amount Credit Amount Line Description Project Management
Journal Entry: 017 -10 -2013 Journal Entry Date: 04/01/2013
230 - 0000 -12103 Accts Receivable - Reimb. Dist 35.00 0.00 Book Inspection Fee - Randall
230 - 0000 -23300 Deferred Revenue 0.00 35.00 Book Inspection Fee - Randall
500- 0000 -12102 Accounts Receivable - CWS 4,665.00 0.00 Book Connection Fee - Randall
500 -0000 -12103 Accts Receivable - Reimb. Dist 6,000.00 0.00 Book Reimbursement Fee - Randall
500- 0000 -23300 Deferred Revenue 0.00 10,665.00 Book Sewer Loan Fees - Randall
Journal Entry Totals 10,700.00 10,700.00
Journal Entry Balance 0.00
Report Totals: 10,700.00 10,700.00
0.00
GL- Journal Entry Proof List (4/1/2013 - 6:07 PM) Page 1
CITY OF TIGARD RECEIPT
r C 1 3125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 190970 - 04/15/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SWR2013 -00084 Deferred Reimbursement District Fee 500 - 0000 -23300 $6,000.00
SWR2013 -00084 Deferred Sewer Inspection Fee 230- 0000 -23300 $35.00
SWR2013 -00084 Deferred Sewer Connection Fee 500 - 0000 -23300 $4,665.00
Total: $10,700.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Journal Entry 017 -10 -2013 DADAMSKI 04/15/2013 $10,700.00
Payor: City of Tigard
Total Payments: $10,700.00
Balance Due: $0.00
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