Permit Ill CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2021-00216
Date Issued: 11/4/2021
T f t;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S107AA22300
Jurisdiction: Tigard
Site address: 16627 SW DARWIN LOOP
Project: Polygon at Roshak Ridge,Lot 223 Subdivision: ROSHAK RIDGE Lot: 223
Project Description: Sewer connection for new detached dwelling
Contractor: Owner: POLYGON WLH LLC
703 BROADWAY ST STE 510
VANCOUVER,WA 98660
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/04/2021 $6,085.00
Sewer Inspection-Residential 11/04/2021 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $6,120.00
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
Issued By: Horny Va.w De Wege Permittee Signature: Qw Aj l.i agic- .
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 'f'
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.