Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00275
Date Issued: 7/17/2020
Tf GI RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA17900
Jurisdiction: Tigard
Site address: 16759 SW DARWIN LOOP
Project: Polygon at Roshak Ridge Subdivision: ROSHAK RIDGE Lot: 179
Project Description: Irrigation backflow for commons area.
Contractor: CASCADIAN LANDSCAPERS, INC. Owner: POLYGON WLH LLC
36700 SW BLOOMING FERN HILL RD 703 BROADWAY ST STE 510
CORNELIUS, OR 97113 VANCOUVER, WA 98660
PHONE: 503-647-9933 PHONE:
FAX: 503-647-9922
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/17/2020 $31.27
Specifics: 1 12%State Surcharge- 07/17/2020 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 07/17/2020 $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: l�L�j �f Permittee Signature:•
fir! ,.
l im 1_�l} �cCA G' i,
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 \7 Kr-
Building Fixtures FOR OFFICE USE ONLI
City of Tigard
'� }x, g _ V � 2fl)il Received PermitN
• 13125 SW Hall Blvd.,Tigard,OR 97223 U LU Date/By: 7// / (; °F't.I°1 Zf120 OGb�7�
U ' Phone: 503.718.2439 Fax: 503.598 1960 Plan Review Date/ByOther Permit No,:
Inspection Line: 503.639.4175
'I('AKIJ Internet'. w'ww.ti and-Or. ov Date d/ o: - Saris. See Page 2l Information
i' g Notified/Method: Supplemental
TYPE OF WORK .d=- .. }i" '` FEE* SCHEDULE
®New construction ['Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
s-r •Y CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ElI-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION ' _ Site utilities:
Job site address: SW 165° f !.5 j SLcii Ave&SW Bull Mountain Rd / Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Beaverton,OR 97007 6'2<<J/A) `P Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:Roshak Ridge Manufactured home utilities 50.03
Cross strcet/directions to job site: Street Tee Strip on west side of 165th 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: Lot no.: Fixture or item:
Tax map/parcel no.: .2_'' it-f',1-4-/7 C"=' Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
-- - - Clothes washer 25.02
Irrigation Backtlow
Dishwasher 25,02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER, :e ) 0 TENANT Expansion tank 12.51
Name -aytor-Morrison �.. ,„ 4/ Fixture/sewer cap 25.02
dame;- L y 4 Floor drain/floor sink/hub 25.02
Address:703 Broadway St,Suite 510 rf
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25,02
Business name:Cascadian Landscapers,Inc Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Art Meisner
Roof drain(commercial) 12.51
Address:36700 Sw Blooming Fern Hill Rd Sink/basin/lavatory 25.02
City/State/ZIP:Cornelius,OR 97113 Solar units(potable water) 62.54
Phone:(503)647-9933 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:Kari@cascadianlandseapers.coro Urinal 25.02
CONTRACTOR Water closet 25.02
-i'''r' ' - Water heater 37.52
Business name: Cascadian Landscapers,Inc Water piping/DWV 56.29
Address:36700 SW Blooming Fern Hill Rd Other: 25.02
City/State/ZIP:Cornelius,OR 97113 Subtotal
Phone:(503)647-9933 Fax:( ) Minimum permit fee: $72.50 72.50
Plan review (25/o of permit fee)
CCB Lic 1 ' .5i 7/31h j Plumbing Lic.no.: n
State surcharge(12%of permit fee) 8.70
Authorized signature: - TOTAL PERMIT FEE 81.20
Print name:Art Meisner Date:6/15/2020 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
I:\B1.alding\Pernits'PLMNl1-PermiiApp.doc 10/01/09 440-46161(io/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: _
Footing drain- 1'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 -,-
Storm&Rain Drain-1st 100' 62.54 V'Nation: Permit Fee
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Q�' Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type :Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required lorof the
Work Performed: - "- Capped Added Relocate 9 anyfollowing.
Baptistry/Font Please check all that apply.
Bath Tub/Shower 0 Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
SwWasher- Pool Filter *Note: If the fixture work under this permit results in an
washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
F:1Kari\Projects Contracted\Polygon-Roshak Ridge Street Trees\Plumbirtg Permit-SW 165th&SW Bull Mm Rd.doc