Permit (18) CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2016-00054
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/10/2016
T f t'���`C' 9 Parcel: 251080001500
Jurisdiction: TIGARD
Site address: 15111 SW DANUBE DR
Project: Polygon at Bull Mountain,Lot 9 Subdivision: 1998-005 PARTITION PLAT Lot: 2
Project Description: .5 EDU's for temporary sales office. Tying into sewer line of house.
Contractor: Owner: POLYGON WLH LLC
109 E 13TH ST, STE 200
VANCOUVER,WA 98660
PHONE: PHONE:
FAX:
FEES
•
Description Date Amount
Specifics: Sewer Connection Fee 03/10/2016 $2,550.00
Sewer Inspection-Commercial 03/10/2016 $45.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .5
Total $2,595.00
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 call'•• z .232.1987 or 1.800.332.2344.
Issued By: - +41; / • 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.
Accumulative Sewer Tally
Tenant Name: Polygon Sales Office for Polygon at Bull Mountain SWR# 2016-00054
Site.Address: 15111 SW Danube Dr P1,NI # 2016-00112
IIGARI)
Parcel#: 2S1080001500
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptistry/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
I)rinking Fountain 1 0 0 0 0 0
I?yc\\'ash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 11P) 16 0 0 0 0 0
-Commercial (to 5 I IP) 32 0 0 0 0 0
-Industrial (over 5 I IP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
I iving Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-I:ood Related 2 0 0 1 2 1 2
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
\WaterIixtractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous I?llU Count 0 0
Capped [DU Credit 0
'l'()T.\I,S 0 0 0 0 2 8 2 8
Current Fixture Value 8 divided by 16= 0.500 Current I?DU 1 EDU = $5,100.00
Previous I:ixture Value 0 divided by 16= 0.000 Previous I?DU
Change 8 divided by 16= 0.500 over (under) S 2,550.00
Enter EDU Change Here 0.500
"Round IDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or Tess shall be rounded down to.01.
Notes:
Authorized Name/Signature: Debbie Adamski Date: 3/7/2016
Building Division
Note: 'l.'he property owner shall retain the ORIGINAL,sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\BuildingsASewer Tally ASewer'I'allyShcet_5I 00_070115.xlsx