The URL can be used to link to this page

Permit CITY OF TIGARD SEWER CONNECTION PERMIT COMMUNITY DEVELOPMENT Permit#: SWR2017-00291 Date Issued: 09/21/2017 TEGA&t.1 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111 BD00600 Jurisdiction: Tigard Site address: 9665 SW DARMEL CT Project: STONE Subdivision: DARMEL NO.2 Lot: 33 Project Description: Connecting existing house to sewer. Reimbursement District#27. Contractor: Owner: STONE, HELEN 9665 SW DARMEL CT TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 09/19/2017 $5,500.00 Sewer Inspection-Residential 09/19/2017 $35.00 Type of Use: SF Reimbursement District Fee 09/19/2017 $12,746.79 Class of Work: ALT Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $18,281.79 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Co s and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not starte in 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules pted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You m Iain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332." 44. 9 Issued By: Permittee Signature:- A,t,(AL. � C 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. il CITY OF TIGARD SEWER CONNECTION PERMIT r � . : ' COMMUNITY DEVELOPMENT Permit#: SWR2017 00291 D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/21/2017 TE t�1R° g Parcel: 2S111BD00600 Jurisdiction: Tigard Site address: 9665 SW DARMEL CT Project: STONE Subdivision: DARMEL NO.2 Lot: 33 Project Description: Connecting existing house to sewer. Reimbursement District#27. Contractor: Owner: STONE, HELEN 9665 SW DARMEL CT TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 09/19/2017 $5,500.00 Sewer Inspection-Residential 09/19/2017 $35.00 Type of Use: SF Reimbursement District Fee 09/19/2017 $12,746.79 Class of Work: ALT Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $18,281.79 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Co s and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not starte in 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules pted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You m Iain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332/..s44. .------% Issued By: � � �G � �� j Permittee Signature: ( 4�LtA GG \� NLI- 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. CITY OF TIGARD SEWER CONNECTION PERMIT 11 ,. .. b E 41 ' COMMUNITY DEVELOPMENT Permit#: SWR2017 00291 13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439 Date Issued: 09/21/2017 f Com ` g Parcel: 2S111 BD00600 Jurisdiction: Tigard Site address: 9665 SW DARMEL CT Project: STONE Subdivision: DARMEL NO.2 Lot: 33 Project Description: Connecting existing house to sewer. Reimbursement District#27. Contractor: Owner: STONE, HELEN 9665 SW DARMEL CT TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 09/19/2017 $5,500.00 Sewer Inspection-Residential 09/19/2017 $35.00 Type of Use: SF Reimbursement District Fee 09/19/2017 $12,746.79 Class of Work: ALT Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $18,281.79 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 503.232.1987 or 1.800.332.2344. [ h Issued By: .639Permittee Signature: Call 50 .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. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Reimbursement District Payment Worksheet r I c; A it n 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 plumbingpermit application by expiration_date below. ENGINEERING TO COMPLETE: Site Address: �-((,(,��' �,� pa r,,,.ve I CA Reimbursement District #: ;Z ] Parcel #: ,2 S/I 1 3 D OO(Q O O Amount Due: $ 12,1-Me. 7C1 Amount Due Expires On: 'jljarcL F 2013 Applicant: Daytime Phone: ❑ 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 Agreement (signed prior to completion of worksheet) BY' Date: 9/I //`7 BUILDING TO COMPLETE: Reimbursement Amount Paid: $ /FI j/ 77 Receipt #: SWR #: � ✓�' l7-00,2g/ PLM #: /t,/)) 117—CXw 3 Enter parcel conditions in Accela (check all that apply): ❑ Enter "paid" condition. ❑ Enter "deferral" condition, if applicable. BY �Lo ., Date: 1//q// j -1//7 Attach this worksheet to sewer per iit for records scanning. Pcv„,,,, 1S r.3 uN i Jii (xf at1 i I:\Building\Riembursement Districts\ReimDistPaymentWorksheet_021014.docx R27ke6;1/ ("eN4 1— thv 9 4,0 7 u► I4 CITY OF TIGARD RECEIPT I1s . 13125 SW Hall Blvd.,Tigard OR 97223 r 14 503.639.4171 TI AR Project Name: STONE Site Address: 9665 SW DARMEL CT Receipt Number: 412854 - 09/19/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2017-00291 Sewer Connection Fee 500-0000-25500 $5,500.00 SWR2017-00291 Sewer Inspection-Residential 230-0000-43118 $35.00 SWR2017-00291 Deferred Reimbursement District Fee 500-0000-23300 $12,746.79 Total: $18,281.79 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 1341 BTAGGART 09/19/2017 $18,281.79 Payor: Robert Blakely Total Payments: $18,281.79 Balance Due: $0.00 Page 1 of 1