Permit (197) CITY OF TIGARD SEWER CONNECTION PERMIT
,71---
2e . COMMUNITY DEVELOPMENT Permit#: SWR2018-00180
G A '
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/28/2018
T f' Parcel: 2S103AB00401
Jurisdiction: Tigard
Site address: 11345 SW WALNUT ST
Project: 11325 Subdivision: None Lot: None
Project Description: Sewer connection to connect existing house to sewer.
Contractor: Owner: BERMAN, JOHN M
MYERS, THOMAS L&DIANE E
7175 SW BEVELAND ST STE 210
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 06/28/2018 $5,500.00
Sewer Inspection-Residential 06/28/2018 $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 • . .t. *AR 952-001-0090. You may obtain a copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800,312 934,
NW
Issued By: �`—� Permittee Signature:
Call 51 .6 `.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 • COMMUNITY DEVELOPMENT DEPARTMENT
r
� Reimbursement District Payment Worksheet
T i 6 ri[z n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
This worksheet must be completed by the Finance Department and provided
to the applicant to submit together with a completed plumbing permit
application and payment for sewer connection and reimbursement district fee,
if applicable, by expiration date shown below to the Building Division.
FINANCE DEPARTMENT TO COMPLETE:
Site Address: `J >,( AL/0 iA T
Reimbursement District #: 44- Parcel #: a S l03 f3C OEC)0
Amount Due: $ S` Amount Due Expires On:
Applicant: 4 T H/{A) ► L C u 4 Tv Daytime Phone: 503-?/,5--7S-6
Email Address:
Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection f d reimbursement district fee, if applicable)*
By: Date: 6. ,� ,/
Name
Printed: �y c;sL
BUILDING DIVISION TO COMPLETE:
*If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ Receipt #: /14
SWR #: 564,1420/T-00 ire) PLM #:
Enter parcel conditions in Accela (check all that apply):
❑ Enter "paid" condition.
Enter "deferral" condition, if applicable.
By:
Date:
Name
Printed:
Attach this worksheet to issued sewer permit for records scanning.
I:\Building\Riembursement Districts\ReimDistPaymentWorksheet_NoDeferredAccounts_041918.docx