Permit (117) CITY OF TIGARD SEWER CONNECTION PERMIT
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COMMUNITY DEVELOPMENT Permit#: SWR2017-00354
Tt Gix.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/14/2017
Parcel: 2S 108 D 803800
Jurisdiction: Tigard
Site address: 15159 SW THAMES CT
Project: Polygon at Bull Mountain, Lot 36 Subdivision: POLYGON AT BULL MOUNTAIN
Project Description: Sewer connection for new SF. Lot: 36
Contractor:
Owner: POLYGON WLH LLC
109 E 13TH ST, STE 200
VANCOUVER, WA 98660
PHONE: PHONE: 360-695-7700
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee
11/14/2017 $5,500.00
Type of Use: SF Sewer Inspection-Residential 11/14/2017 $35.00
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,535.00
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: cg�� ��
j, 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.
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
IN Transmittal a smittal Letter
i !c,i iii 1 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: biA DA �` 1:
DEPT: BUILDING DIVISION
NOV • 2017
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FROM: —,
ROM: iper<rry //1,iT ('.1 0(y rtGARD
COMPANY: �k c e - AA l)C
PHONE: 97/ - `?3O 7/ 9 41 BY' `
RE: 7O1 Sk) H� g
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(Site Address) (remit it Number
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( rolect name or subdivision name and lot num.:- ►
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ATTACHED ARE THE FOLLOWING IT D i )
Copies: Description: Copies: Description:
Additional set(s) of plans. 2 Revisions:
Cross section(s) an. det.' . Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: ADDe0 Vi r/A.) l 77?-711 LtiX Alpe. '— DAye,e__,
FOR OFFICE USE ONLY
Routed to P; it Technician: te: l l Initials:aro
Fees Due. • Yes o Fee Description: Amount iv e:
$
$
$
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes 0 No ❑ Done
Applicant Notified: tr., Date: /i/Al/;°7 Initials: '5 -
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc