Permit (54) a CITY OF TIGARD
11111
SEWER CONNECTION PERMIT
2 . . COMMUNITY DEVELOPMENT Permit#: SWR2016 00169
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/02/2016
Parcel: 2S 108DB05000
Jurisdiction: Tigard
Site address: 15153 SW 154TH AVE
Project: Polygon at Bull Mountain,Lot 48 Subdivision: POLYGON AT BULL MOUNTAIN Lot: 48
Project Description: Sewer connection for new SF
Contractor: POLYGON WLH, LLC Owner: POLYGON WLH LLC
109 E 13TH STREET 109 E 13TH ST, STE 200
VANCOUVER,WA 98660 VANCOUVER,WA 98660
PHONE: 360-695-7700 PHONE:
FAX: 360-693-4442
FEES
Description Date Amount
Specifics: Sewer Connection Fee 06/02/2016 $5,100.00
Sewer Inspection-Residential 06/02/2016 $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 $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 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.
Issued By: Permittee Signature: OAlf '/.tom elei77n,j
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.