Permit II ,1 CITY OF TIGARD SEWER CONNECTION PERMIT
' 2 ; °`- COMMUNITY DEVELOPMENT Permit #: SWR2012 -00012
TIGARD! 3125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Date Issued: 02/02/2012
D
W Parcel: 25111 BA01600
Jurisdiction: Tigard
Site address: 14405 SW 97TH AVE
Project: Mitchell Subdivision: CONDO SUPPLEMENTAL PLAT NO.3: Lot: 32
Project Description: Connect existing house to sewer, less than 200'. Septic tank must be pumped and filled or removed.
Contractor: Owner: MITCHELL, MICHAEL
14325 SW 97TH AVE
TIGARD, OR 97224
PHONE: PHONE: 503 - 620 -3203
FAX:
FEES
Description Date Amount
Specifics: Deferred Reimbursement District Fee 02/02/2012 $6,000.00
Deferred Sewer Connection Fee 02/02/2012 $4,500.00
Type of Use: SF Deferred Sewer Inspection Fee 02/02/2012 $35.00
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $10,535.00
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. ose rules -re set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to OUN by calling 503.2 •.19: or 1.80 32.2344. `
Issu d B , I �/ Permittee . l n ature: ��. �/ / `�
Call 503.639.4175 by 7:00 a.m. for the next available inspecion 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.
General Ledger
Journal Entry Proof List 0)!
User: amyl •
Printed: 1/31/2012 - 12:07 PM
Batch: I 00131.01.2012 T I GARD
Account Number Account Description Debit Amount Credit Amount Line Description Project Management
Journal Entry: 436 -07 -2012 Journal Entry Date: 01/31/2012
230- 0000 -12103 Accts Receivable - Reintb. Dist 35.00 0.00 Sewer Connection Loan - Mitchell
230 - 0000 -23300 Deferred Revenue 0.00 35.00 Sewer Connection Loan - Mitchell
500- 0000 -12102 Accounts Receivable - CWS 4,500.00 0.00 Sewer Connection Loan - Mitchell
500 -0000 -12103 Accts Receivable - Reimb. Dist 6,000.00 0.00 Sewer Connection Loan - Mitchell
500- 0000 -23300 Deferred Revenue 0.00 10,500.00 Sewer Connection Loan - Mitchell
Journal Entry Totals 10,535.00 10,535.00
Journal' Entry Balance 0.00
Report Totals: 10,535.00 10,535.00
0.00
GL- Journal Entry Proof List 11/31/2012 - 12:07 PM) - Page 1