Permit (13) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00112
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/10/2016
TIGARD g 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: Plumbing for temporary sales office:30'of sanitary sewer service,90'of water service,install(1)lay and(1)water
closet.
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
30 If Sanitary Sewer 03/10/2016 $62.54
Specifics: 90 If Water Service 03/10/2016 $62.54
1 ea Lavatories 03/10/2016 $25.02
Type of Use: COM 1 ea Water Closet 03/10/2016 $25.02
Class of Work: NEW 1 12%State Surcharge- 03/10/2016 $21.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $196.13
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: Ce.„0.42_44.1..._4„tiPermittee 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.
Plumbing Permit Application )A-61k-32_,L �
�" `""`'- •ci..bi 'O � 1
Site Utilities FOR OF> 1c__ I;;E 0 Nl.1
11111 City of Tigard RECEIVED Reed _./{ t{ /le I Permit No.: eage/6-�ce1.1.
__ 13125 SW Hall Blvd.,Tigard,OR 97223 OL 1,J
Phone: 503,7182439 Fax: 503,5i0A0 plea Review
l ` ;l inspection Lino: 503.639.4175
WI,'-'• 2 2016 Daffy: Other Permit No.:�w for .000
Internet www.tigard-or.gov Date Ready/By: inns; ® See Page 2l for
�, rti r Notified/m(410d.
ion
4- • C•�,,ra z a 7i'"=7".,1:,77-74'--.„7":"r;as • f Sao kmeetal A-1`.- as.
17 . 7 ,:l+'W ..QI ?I'A »� , -T` 1.r r�F'' z+,..62-1 - --.,M.cs''r i �s V-f • h w-.
:ii New construction • Demolition. ^ Forspecial in onnetion use checklist
LIAddition/alteratton/replacement ❑Other: Description J Qty. J Ea. Total
��� New 1-2-family dwellings
`�+ rY l e, 3 , t e ms"' SFR(1)bath (includes 100 ft.for each utility connection)
- ,. . „p.. t r .- c '-om-- ?-421 312.70
r ;_: , 2 .,e re Commercial/industrial _SFR(2)bath 437.78
Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02 O
❑Master builder El Other;Ri
- Fire sprinkler( sq.It) Page 2
I' r.a. .,1as rr .._c'a �kr t r r a x7 c t_ Site utilities:
Job site address: MEMO Catch basin or arca drain 18.76
City/State/ZIP: �( Cir.' Q 12rywell,leach line.or trench drain 18.76 -�
Footing drain(no.linear ft: ) Page 2
Suite/bldg./apt.no.: Project nam
li r.0 EP: 1r r Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
`� Rain drain connector 18.76
Sanitary sewer(no.linear f2 ) Page 2 2,S
Storm sewer(no.linear ft.: ) Page 2
Subdivision: ��' " e l�� Lot no.: 9 _Water service(no.linear ft.:?O f) Page 2 (, ,5-t/
Fixture or item:
Tax map/parcel no.; Backflow preventer
ter 31.27
q ":'' - :Ei'i " .H:"t c4 =1�if t.- ' °,,,,E?, ,* Backwater valve 12.51
...v: ., ';'1 .,s,Wit� - � l Clothes washer 25.02
�� ��r r '1 fryiHT, I ���r,. �,• Dishwasher 25.02
71 a t�� Drinking fountain 25.02
:Mr V'.: Ejectors/sump 25,02
i. s r 5,`13 , ,�' fir: tr 17 s-.1% _. Wye E ion tank
„,. ,-gvr -f,. xpans t2-51
Name: -- Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
( ) Hosecbib 25.02
Phone:
„,1 „�_, �, Ice maker 12.SI
:•
V f r. =� If i+ S'S' + ,,. m r A•p�w n Ht 4:,y•' i.
�„,�,� ,___ - �F� � '•" �.,.;1c' L. Intercoptorlgrcase trap 25.OZ
Business name; i_ J Medical gas(value:$ ) Page 2
Contact name: AMMI : / Primer BEEN
Roof drain(commercial) I2.51
Address: i 'I�
Sink/basi avatory� Ira25.02 ®7
f .G 6 4111=3/ ILIII Solar units(potable water) 111111 6254
Phone: j) AffiaMill Fax;;( ) Tub/shower/shower pan 12.51
E-mail:-31) 72rMirellir A VA Urinal r 25,02
r+ _i74�c--_ ,^7744:4 k' > . : Water closet a
7-lrr �a tri 9 r 7,n 1 ^ ''�a e 07' 1 25.02 ^ 7
�`''' '�° Water heater 37.52
sr Water piping/OWV 5629
Address; 11'� _Other:
25.02
tif A72 W rr FrAP 0 Subtotal 16-,I
Phone: ..d 351 r- O 3 Fax:( ) - Minimum permit fee: $72.50 -
CCB Lie.: ` y �n Plumbing Lic-t14•: i 158 Plan review (25%of permit fee) -
.41 State surcharge(12%ofpermit fee) Cy
Authoriaed,signature: i - 7 i7
TOTAL PERMIT FEE KIM
{II 1`C(, M -dL' `y 77 Date:APrilial This permitappfcatioa expire*Ka permit ili not obtained within 180 0."
after it has been accepted as complete.
`Fro mcthodoiocv set by Tri-County Building Industry Service Board.
l;u;oilding\PermitarLMtl,PermitApp.doc 10101105 .40-4e1GTii DMZ/COM/WEB)
rillra
CITY OF TIGARD FEE AND PAYMENT HISTORY
. 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
SWR2016-00054 - 15111 SW DANUBE DR, TIGARD, OR 97224
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Sewer Connection Fee 500-0000-25500 $2,550.00 $2,550.00 $2,550.00
Sewer Inspection-Commercial 230-0000-43118 $45.00 $45.00 $45.00
Totals for Fees $2,595.00 $2,595.00 $0.00 $2,595.00
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
Total Payments: $0.00
Balance Due: $2,595.00
•
I
Accumulative Sewer Tally
i II 41
Tenant NamIIIIIc Polygon Sales Office for Polygon at Bull Mountain SWR# 2016-00054
Site Address: 15111 SW Danube I)r PLN1# 2016-00112
TIGARI)
Parcel#: 2S1080001500
I:ix ture Value Previous previous Credits Capped Fixture l'ixture New New
# value count capped#5 value count_ added# added value total#s total values
Baptistry/Font 4 0 0 0 - 0 0
Bath: - lob/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
Drinking Fountain 1 0 0 0 _ 0 0
lye Wash 1 0 0 0 0 0
Floor brain/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 I IP) 16 0 0 0 0 0
-Commercial(to 5 1 IP) 32 0 0 0 0 0
-Industrial(over 5 1 IP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
()il 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:
-l.av/Bar-Non-Food Related 2 0 0 1 2 1 2
-Bradley 5 0 0 0 0 0
-Cum/Sery/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
Water Extractor 6 0 0 0 0 0
Water(inset-Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous [DU Count 0 0
Capped 1:DU Credit 0
T(a. 0 0 0 0 2 8 2 8
Current Fixture Value 8 divided by 16= 0.500 Current I?Dll 1 EDU = $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous I?Dll
Change 8 divided by 16= 0.500 over (under) S 2,550.00
Enter EDU Change Here 0.500
`Round IDUs to the nearest]/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: Debbie,\damski Date: 3/7/2016
Building Division
Note: The property owner shall retain the ORIGIN Al,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.
l:A Building\Sewer Tally\Scwcr'faI]yShcct_5100_070115.xlsx
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 27, 2018 at
9:01 :28 AM
Record Type: Record ID:
Commercial - Plumbing PLM2016-00112
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
This inspection is to close out permit for temporary sales office removed. Water and
sewer lines are capped. Investigative fee applied for occupancy prior to approved final
inspection.
OSSC 108, 111 .3
Violation Summary:
Inspector Contractor