Permit (169) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00395
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/21/2018
T I c Ii Dg Parcel: 2S1080001500
Jurisdiction: TIGARD
Site address: 15111 SW DANUBE DR
Project: Polygon at Bull Mountain,Lot 9 Subdivision: 1998-005 PARTITION PLAT Lot: 2
Project Description: Adding(1)backflow preventer for landscape irrigation.
Contractor: BDL PLUMBING LLC Owner: POLYGON WLH LLC
PO BOX 85 109 E 13TH ST, STE 200
CORBETT, OR 97019 VANCOUVER,WA 98660
PHONE: 503-351-3903 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/21/2018 $31.27
Specifics: 1 12%State Surcharge- 08/21/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/21/2018 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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: Z �� Permittee Signature:
,--' ct-i'''' /
77.
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.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLI
Received 'S-^
Ci}�,of Tigard ( { _ s-..
' `J g 1 1 r r ', Date/By: i ! // Permit �r ( L`
13125 SW Hall Blvd.,Tigard,OR 97223 A a Plan Review ,��%%
0 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other
PeL� t �,/J�
,Inspection Line: 503.639.4175 T1GARD Date Ready/By: Juris0 See Page
for
Internet: www tigard-or.govNotified/Method: Supplemental Information
� ,R �' --�
®New construction El Demolition For special information use checklist
Description Qty. Ea. Total
El Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
C F # # #- 74--% _ SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
ElAccessory building ElMulti-familySFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder ❑Other:
_ Fire sprinkler sq.ft.) Page 21 � 3 ;'i :',',-,',',. Ri� Site utilities:# + i
Job site address: t 6-11 t 5(v D Absiu0E De Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name, F.,(iLL 1lOU/J I A,) Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision. 15 LILA-/10001V1/111 il) Lot no.: 1 Fixture or item:
Tax map/parcel no,: Backflow preventer 1 31.27
T
tki Backwater valve 12.51KCRIPO OF Q� � '. .,' , ' �.'N, ; '',. v Clothes washer25.02/KRi64r1Ult) Mex.
Flow Dishwasher 25.02
use neva-pet 613pr rD it FEE-5 LDrinking fountain 25.02
i Ejectors/sump 25.02
PROPERTY TIER -� TE)�T ,1 Expansion tank 12.51
Name:ADVL Land Holdings LLC Fixture/sewer ca 25.02
Floor drain/floor sink/hub 25.02
Address:7600 E Doubletree Ranch Rd
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 28660 Hose bib 25.02
Phone:(602)694-4031 Fax:( ) Ice maker 12.51
t,® APP CMT ywiT'AL"f p p Interceptor/grease trap 25.02
Business name:Polygon WLH LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Tom Dicianno
Roof drain(commercial) 12.51
Address:109 E 13th St Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(503)577-4160 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:tom.dicianno@polygonhomes.com Urinal 25.02
Water closet 25.02
Water heater 37.52
Business name: 6 Pct/� piping/DWV►olvg Water i m DWV 56.29
1
_
Address: D 6 pl. gs Other: 25.02
City/State/ZIP: Gs.tl3 T DK "1?Oil Subtotal
Phone:(51)3 ) 351 3103 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 1/,( 0 /5 0 Plan review (25%of permit fee)
l lJ Plumbing Lic.no.: 1
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
( fl*
Print name: Mt"OA✓ oER Date: t/ j//J g This permit application expires if a permit is not obtained within 180 days
", I after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I.\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-46161(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15111 SW DANUBE DR, TIGARD, OR, 97224 August 24, 2018 at
7:45:36 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00395
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
3/4" irrigation backflow device Febco model 850 ser #HD34793 located left of front porch
approved with test report.
Violation Summary:
Inspector Contractor