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Permit v CITY OF TIGARD SEWER CONNECTION PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: SWR2013 -00024 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/05/2013 Parcel: 2S102CD02603 Jurisdiction: Tigard Site address: 9605 SW HILLVIEW CT Project: Modlin Subdivision: TWALITY HILL Lot: 3 Project Description: Connect existing house to sewer service. Contractor: Owner: MODLIN, PATRICIA M • 1600 MARSHALL CIRCLE DUPONT, WA 98327 PHONE: PHONE: 253- 964 -6147 FAX: FEES Description Date Amount Specifics: Deferred Reimbursement District Fee 02/05/2013 $14,734.60 Deferred Sewer Connection Fee 02/05/2013 $4,665.00 Type of Use: SF Deferred Sewer Inspection Fee 02/05/2013 $35.00 Class of Work: NEW Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $19,434.60 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 sus ended_ or more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. ose rules if- set foi • in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You ma • - copy of the rules or direct questions to OUN by calling 503.232. • n or 1. :Os 332.2344. Iss d By: , , �• r / Permittee Sign ' tu =• . /.rj / �/ 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 of the project. Approved plans are required on the job site at the time of each inspection. General Ledger Journal Entry Proof List User: amyl i`'i; o : a Printed: 12/13/2012 - 5:16 PM Batch: 10010.12.2012 `'TIGARD Account Number Account Description Debit Amount Credit Amount Line Description Project Management Journal Entry: 193 -06 -2013 Journal Entry Dale: 12/13/2012 230 -0000 -12103 Accts Receivable - Reimb. Dist 35.00 0.00 Book Inspection Fee - Modlin 230 - 0000 -23300 Deferred Revenue 0.00 35.00 Book Inspection Fec - Modlin 500- 0000 -12102 Accounts Receivable - CWS 4,665.00 0.00 Book Connection Fee - Modlin 500- 0000 -12103 Accts Receivable - Reimb. Dist 14,734.60 0.00 Book Reimbursement Fee - Modlin 500- 0000 -23300 Deferred Revenue 0.00 19,399.60 I3ook Sewer Loan Fees - Modlin Journal Entry Totals 19,434.60 19.434.60 Journal Entry Balance 0.00 Report Totals: 19,434.60 19.434.60 0.00 GL- Journal Entry Proof List (12/13/2012 - 5:16 PM) Page I '. CITY OF TIGARD RECEIPT n IN {� . _ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 190114 - 02/05/2013 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2013 -00024 Deferred Reimbursement District Fee 500 - 0000 -23300 $14,734.60 SWR2013 -00024 Deferred Sewer Connection Fee 500 - 0000 -23300 $4,665.00 SWR2013 -00024 Deferred Sewer Inspection Fee 230 - 0000 -23300 $35.00 Total: $19,434.60 PAYMENT METHOD CHECK # CC.AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Journal Entry 193 -06 -2013 DADAMSKI 02/05/2013 $19,434.60 • Payor: City of Tigard Total Payments: $19,434.60 Balance Due: $0.00 Page 1 of 1