Permit (25) CITY OF TIGARD SEWER CONNECTION PERMIT
N . • COMMUNITY DEVELOPMENT Permit#: SWR2018-00092
DateIssued: 04/03/2018
T i[ AP i7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S104AC12800
Tigard
Jurisdiction: Ti 9
Site address: 12660 SW 135TH AVE
Project: JTC Partners Subdivision: HANDY ACRES Lot: 32
Project Description: Sewer connection for existing residence. No sewer reimbursement per Al Dickman.
Contractor: Owner: JTC PARTNERS, LLC
4505 SW FAIRVIEW BLVD
PORTLAND, OR 972223
PHONE:
PHONE: 503-799-2546
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 04/03/2018 $5,500.00
Sewer Inspection-Residential 04/03/2018 $35.00
Type of Use: SF
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,535.00
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 - copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332. 44.
Issued By: /f-t( j Permittee Signature: it A a;
ICall 503.639.4175 by 7:00 a.m.for the next available inspectio .
This permit card shall be kept in a conspicuous place on the job site until co tion of the project.
Approved plans are required on the job site at the time of each inspection.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
111 Reimbursement District Payment Worksheet
,(,A I.l) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov
This completed worksheet is to be submitted along with payment for sewer
connection and plumbingpermit application by expiration date below.
ENGINEERING TO COMPLETE:
Site Address: J4 /3'54 ,•6
Reimbursement District#: ,1f� Parcel #: _g1 6/18.a .
Amount Due: $ Amount Due Expires On:
Applicant: B�/ Daytime Phone:
� . r
❑ Sewer Loan Processed (journal entry to follow for payment)
Deferred Accounts (if applicable):
Owner: Daytime Phone:
Legal Description:
Amount To Be Paid: $
Amount To Be Deferred: $
❑ Deferral Agreement (signed prior to completion of worksheet)
By: AZ, 1//l; :reiret J Date: L/-'3"-,�8
BUILDING TO COMPLETE:
Reimbursement Amount Paid: $ Receipt #:
SWR #: PLM #:
Enter parcel conditions in Accela (check all that apply):
❑ Enter "paid" condition.
❑ Enter "deferral" condition, if applicable.
By: Date:
Attach this worksheet to sewer permit for records scanning.
I:\Building\Riembursement Districts\ReimDistPaymentWorksheet 021014.docx