Permit CITY OF TIGARD SEWER CONNECTION PERMIT
s v COMMUNITY DEVELOPMENT Permit#: SWR2021-00179
Date Issued: 9/23/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 107AA15900
Jurisdiction: Tigard
Site address: 16679 SW TOWNSVILLE ST
Project: Polygon at Roshak Ridge Lot 159 Subdivision: ROSHAK RIDGE Lot: 159
Project Description: New sewer connection for detached home
Contractor: Owner: POLYGON WLH LLC
703 BROADWAY ST STE 510
VANCOUVER,WA 98660
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Inspection-Residential 09/23/2021 $35.00
Sewer Connection Fee 09/23/2021 $5,800.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,835A0
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
Issued By: Ho-U,)j Van De,Wege Permittee Signature: ti
O Apr-iica#icm
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.