Permit (19) CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2019 00239
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/30/2019
Parcel: 25111 BD00501
Jurisdiction: Tigard
Site address: 14860 SW 98TH AVE
Project: BENJAMIN Subdivision: DARMEL Lot: 3
Project Description: Sewer connection for existing house. Septic tank to be pumped and filled.
Contractor: Owner: BENJAMIN,WARD A/KIMBERLY A
14860 SW 98TH AVE
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/30/2019 $5,800.00
Type of Use: SF Sewer Inspection-Residential 07/30/2019 $35.00
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,835.00
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 a copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: —�� Permittee Signature: /:/// y'� ✓ •
Call 503.6 r 75 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
.111
Reimbursement District Payment Worksheet
['GARP 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: Tax Lot ID: 2S111BD00501 (14860 SW 98th Avenue)
Reimbursement District #: 27 Parcel #:
Amount Due: $0 Amount Due Expires On: 6/22/2019
Applicant: Ward Benjamin Daytime Phone:
Email Address:
Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee, if applicable)*
By IniZO Date: 7/30/19
Name
Printed: Mai Quach
BUILDING DIVISION TO COMPLETE:
*If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ CJ ' Receipt #: !//
SWR #: (5-ea 0201 `� f� PLM #: /" iroc;20iY_00.7105-
-
00 05_ ntteer parcel conditions in Accela (check all that apply):
Q >�:nter "paid" condition.-- , r: ,��+41' rv� dye! tenrci +- ,.sekki.
0 P
Enter "deferral" condition, if applicable.
By.
Date: —7/3.)//1
Name
Printed: 0.-- e,) /Cy9
Attach this worksheet to issued sewer permit for records scanning.
I:\Building\Riembursement Districts\ReimDistPaymentWorksheet_NoDeferredAccounts 041918.docx