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Permit CITY OF TIGARD PLUMBING PERMIT `'p ! COMMUNITY DEVELOPMENT Permit#: PLM2020-00274 Date Issued: 7/17/2020 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S107AA25800 Jurisdiction: Tigard Site address: SW NO ADDRESS Project: Polygon at Roshak Ridge Subdivision: POLYGON AT ROSHAK RIDGE Lot: P Project Description: Irrigation backflow in commons area. Contractor: CASCADIAN LANDSCAPERS, INC. Owner: POLYGON WLH LLC 36700 SW BLOOMING FERN HILL RD 703 BROADWAY ST, SUITE 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: f'( , " 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. Plumbin& Permit Application Er7'\ P7"'" Building Fixtures q qp� FOR OFFICE USE ONLY Cl of Tigard JUL 0 8 2020 Received u 13125 SW Hti all Blvd.,Tigard,OR 9722 DateBy: �/�7�� `(� Permit Nq� ��. ©�/f y I Phone: 503.718.2439 Fax 503.598.1 81 I (..)l: I I'.�.° Plan Review Other Permit No.: Inspection Line: 503 639 4175 rI r J°t ,..""''-' 'n`., DateBy: T I G A R D Date Ready/By: Juris- ® See Page 2 for Internet WIN.tigard-or.gSv Notified/Method'. Supplemental information TYPE OF WORK d rt. FEE*„&HEDULE �a i ® New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF' CONSTRUCTION SFR(1)bath 312.70 ® l-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 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 165t'Ave&SW Sunshine Coast Street 4/0 ,g-,�,p 3 y Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Beaverton,OR 97007 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name:Roshak Ridge Manufactured home utilities 50.03 Cross street/directions to job site:Street Tee Strip on East 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 if: ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: _Q S'//7 7' -4 2 5 J7 7 O Backflow preventer I 31.27 31.27 Backwater valve 12.51 DESCRIPTION OF WORK Irrigation Backflow Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER 0 TENANT Expansion tank 12.51 Name"'orbs-llurusim- Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:703 Broadway St,Suite 510 ✓ Garbage disposal 25.02 City/State/ZIP:Vancouver,WA 98660 ✓ Hose bib 25.02 Phone: (360)695-7700 Fax ( ) Ice maker 12.51 ❑ APPLICANT ❑ 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:Kari6cascadianlandscapers.com Urinal 25.02 CONTRACTOR -1 �_ s- Water closet 25.02 Water heater 37.52 Business name:Cascadian Landscapers,Inc Water Pip I m WV 56.29 Address:36700 SW Blooming Fern Bill Rd Other: 25.02 City/State/ZIP:Cornelius,OR 97113 Subtotal Phone:(503)647-9933 Fax:( ) Minimum permit fee: $72.50 72.50 CCB Lic 4 5 -` 7/ Plumbing Lic.no.: Plan review (25%of permit fee) Authorized signabtl State surcharge(12%of permit fee) 8.70 '� 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:\Building\PermitsWLMU-PermiiApp.doc 10/01/09 440-4616r(10/02/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' r 37.52 Valuation Permit Fee' Storm&Rain Drain-1st 100' 62.54 "" $1.00 to$5,00000 Minimum fee$72.50 Storm&Rain Drain-each additional 100' r 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Ins ections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to A 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 er rm r Replace! Plan review is required for anyof the following. Work Performed: Capped Added Relecate q g' Baptistry/Font Please check all that apply. Bath Tub/Shower ❑ 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 ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ 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 ❑ Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food 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 Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer Clothes Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: F:\Kari\Projects Contracted\Polygon-Roshak Ridge\Street Trees\Plumbid1 Permit-SW 165th&SW Sunshine.doc