Permit CITY OF TIGARD SEWER CONNECTION PERMIT
IL q'''! '' COMMUNITY DEVELOPMENT Permit#: SWR2015-00145
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/09/2015
Parcel: 1 S 136AA00301
Jurisdiction:
Site address: 6873 SW LOCUST ST
Project: Oak Street Estates,Lot 7 Subdivision: OAK STREET ESTATES Lot: 2
Project Description: New SF.
Contractor: Owner: LENNAR NORTHWEST INC
11807 NE 99TH ST, STE 1170
VANCOUVER,WA 98682
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/30/2015 $5,100.00
Sewer Inspection-Residential 11/30/2015 $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 $5,135.00
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 th= a -.. Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a cop • e les • direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: r OIL `Permittee Signature: `—
C5 by 7:00 a.m.for the next available inspec ion date.
This permit card shall be kept in a conspicuous place on the job site until c•mpletion oft e project.
Approved plans are required on the job site at the time of each i -sectio
City of Tigard
TIGARD j Accela Refund Reques t
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Actioz. form (if applicable)must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Lennar Northwest Inc. DATE:
Attn: Juls Call 3/7/2016
11807 NE 99`h St., Suite 1170 REQUESTED BY: Dianna Howse
Vancouver,WA 98682
TRANSACTION INFORMATION:
Receipt#: Various Case#:
Date: Various Various
Pay Method: CreditCard Address/Parcel: Various
Project Name: Oak Street Estates
EXPLANATION: Refund for transportation development and parks system development fees paid prior
to demolition credits for armorystructures and
(1)residential al structur .
e Received
inspection for BUP2015-00091 on 2/10/2016 so credits carr be applied and all SDC
fees paid by developer shall be refunded.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account N®_
efund
Exam..le: $Aou
e: Building Permit Fee Example: 2300000-43104 Rmou
Washington County Transportation Development Tax 405-0000-43320 nt
$237,723.00
Parks SDC -Improvement 425-0000-43300
Parks SDC Reimbursement 20,203.00
425 0000 43301
3,633.00
Sewer Connection
500-0000-25500 '
._.21,898700
TOTAL REFUND: ,$3337449701
APPROVALS: SIGNAT •ES/DATE: -3 R,03-?,try
If under$5,000 Professional Staff ' F /
lPrOkr
If under$12,500 Division Manager j9/`&
If under$25,500 Department Manager f
If under $50,000 City Manager
If over$50,000 Local Contract Review Board _jeE s. 'u
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: MainB : maw