Permit 7,4CITY OF TIGARD SEWER CONNECTION PERMIT
2 '' COMMUNITY DEVELOPMENT
Permit#: SWR2016-00377
TtC;A&t D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/03/2017
Parcel: 1 S135AD03400
Jurisdiction: Tigard
Site address: 8775 SW SPRUCE ST
Project: Hall Pointe Townhomes Subdivision: 1990-053 PARTITION PLAT Lot: 2
Project Description: Building A-Sewer connection for new SFA
Contractor: Owner: DAVIS, EUGENE REVOCABLE LIVING T
10875 SW 89TH AVE
TIGARD, OR 97223
PHONE: PHONE: 503-246-5862
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 08/03/2017
$5,300.00
Type Inspection-Residential 08/03/2017 $35.00
of Use: SFA
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,335.00
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 503.232.1 87 or 1.800.332.2344.
Issued By: 671/./.4e1141-1:4
./.4 114 1- 4 Permittee Signature:
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.
II
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action 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: DR Horton, Inc. DATE: 2/2/2017
Attn: Emerald Weeks
4380 SW Macadam Ave, Ste 100 REQUESTED BY: Dianna Howse
Portland, OR 97239
TRANSACTION INFORMATION:
Receipt#: 407694 Case#: SWR2016-00377
Date: 11/29/2016 Address/Parcel: 8775 SW Spruce St
Pay Method: CreditCard Project Name: Hall Pointe Townhomes
EXPLANATION: Per applicant's request as permit fees were paid on the wrong permit number for
another development. Refund 100%of permit fees.
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Fee� t. - h:. zt,&',
t empt ial l %nnit F a i Sg "t , s s x,le: i x ,�' �i
Sewer Connection Fee 500-0000-25500 $5,300.00
Sewer Inspection-Residential 230-0000-43118 35.00
TOTAL REFUND: $5,335.00
APPROVALS: SIG . U i= S 11 ATE:
If under$5,000 Professional Stafft'��
If under$12,500 Division Manager k ILO
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
.;£:"''. a €,,,,..a y"; 2 v ^ x^"1.41{ 1..STWIO 7 WO -t ..TM'v: sts ,y
1 pa �5�. , ,A.
Case Refund Processed: Date: c2/,Zy//7 By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010