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Permit CITY OF TIGARD SEWER CONNECTION PERMIT • COMMUNITY DEVELOPMENT Permit #: SWR2013 -00158 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/09/2013 Parcel: 1 S136DC00200 Jurisdiction: Tigard Site address: 7135 SW BAYLOR ST Project: Roth Subdivision: HUNTER POLLOCK NO.2 Lot: PTS 16- Project Description: Connect existing house to sewer service. Septic tank is to be pumped, filled and inspected. Reimbursement District #46 fee paid 7/9/13. Contractor: Owner: ROTH, J T JR & THERESA A 12600 SW 72ND AVE, STE 200 TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 07/09/2013 $4,800.00 Sewer Inspection - Residential 07/09/2013 $35.00 Type of Use: Reimbursement District Fee 07/09/2013 $18,223.28 Class of Work: Install Type: Fixture Units: Number of Dwelling Units: Total $23,058.28 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 •y the Oregon Utility Notification Center. Those s—are set h in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a co. of the rules or direct questions to OUNC by (ling 503.232.1 7 or . 0.332.2344. Issued y: 2 Permittee Signature: " 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 •f the project. Approved plans are required on the job site at the time of each inspection. Dianna Howse From: Greg Berry Sent: Tuesday, July 02, 2013 1:18 PM To: 'timr @jtrothinc.com' Cc: Dianna Howse Subject: Sewer Reimbursement Fee for 7135 SW Baylor Attachments: Greg N Berry P E .vcf Sewer Reimbursement Fee for 7135 SW Baylor: $18,223.28 (This amount was arrived at by taking the original fee of $15,423.85 then adding 3 annual increases of 6.05% or $933.14. The annual increase is applied every April 27 finalization of the district.) In addition, payment of a sewer connection fee of $4,835 and a plumbing permit is required. The fees may be paid at the Permit Center of City Hall Monday through Thursday 8am to 6 pm. rrill Greg N. Berry, P.E. City of Tigard Project Engineer , 13125 SW Hall Blvd ,--' : 1 Tigard, OR 97223 ''' " .: i (503) 713 -2468 D;:€ (503) 63911171 (503) 624 -0752 ra greg © tgard - or.gov DISCLAIMER: E -mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E -mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 1 i CITY OF TIGARD RECEIPT 4 g . I 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 192159 - 07/09/2013 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2013 -00158 Sewer Connection Fee 500 - 0000 - 25500 $4,800.00 SWR2013 -00158 Reimbursement District Fee 500 - 0000 -48001 $18,223.28 SWR2013 -00158 Sewer Inspection - Residential 230 - 0000 -43118 $35.00 Total: $23,058.28 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 009624 DADAMSKI 07/09/2013 $23,058.28 Payor: Jacob T Roth Jr - JT Roth Construction Total Payments: $23,058.28 Balance Due: $0.00 Page 1 of 1