Permit n CITY OF TIGARD SEWER CONNECTION PERMIT
tli COMMUNITY DEVELOPMENT Permit#: SWR2015-00023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/16/2015
Parcel: 2S103DA05900
Jurisdiction: Tigard
Site address: 10590 SW COOK LN
Project: FOSTER Subdivision: FANTASY HILL Lot: 13
Project Description: Connecting to sewer. 100 ft.of sanitary sewer. Reimbursement district 29.
Contractor: Owner: FOSTER, SCOTT A&LORRI K
10590 SW COOK LN
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 03/10/2015 $4,900.00
Sewer Inspection-Residential 03/10/2015 $35.00
Type of Use: SF Reimbursement District Fee 03/10/2015 $23,703.40
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $28,638.40
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 ' the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344. iI _
Issued By: Permittee Signature:
..�1.
C• 5 •. .=.-175 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.
I
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
III ■
■ Reimbursement District Payment Worksheet
1 1(,A it I) 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 plumbing permit application by expiration date below.
ENGINEERING TO COMPLETE: Z., ),(1 -
Site Address: /159t C/ )04_
Reimbursement District #: Q� Parcel #: o75/0.31-)A 05900
Amount Due: $ al 3 '7Q,j ! Amount Due Expires On: °.,94.//e
Applicant: ..1g_eT� f2)7.-bW.-- Daytime Phone: ge' - e/,'t7 — g, .,
❑ 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 A Bement(signed prior to completion of worksheet)
By: Date: 3 /e j
BUILDING TO COMPLETE:
Reimbursement Amount Paid: $ )31 -7 G 3.`z°— Receipt #: /7 4/0 f6
SWR #: 0261 S_ Q,23 PLM #: 0201 5'— oeo67
Enter parcel conditions in Accela (check all that apply):
❑ Enter "paid" condition.
Enter "deferral" condition,if applicable., e.,, ,.,__<-----4.
By Date: 3/c /i -
Attach this worksheet to sewer permit for records scanning.
I:1Building\Riembursement Districts\ReimDistPaymentWorksheet_021014.docx