Permit 1
CITY OF TIGARD PLUMBING PERMIT
a '' COMMUNITY DEVELOPMENT Permit#: PLM2021 00214
Date Issued: 5/20/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106DB26000
Jurisdiction: Tigard
Site address: 13066 SW AUBERGINE TER
Project: River Terrace Northeast Subdivision: RIVER TERRACE EAST 3 Lot: 3
Project Description: Backflow preventer for irrigation. Location is behind home in right of way near Roy Rogers Rd.
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 05/20/2021 $31.27
Specifics: 1 12%State Surcharge- 05/20/2021 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 05/20/2021 $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: 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.
Pluihbing Permit Application -
tlek
". site Utilities RECEIVED FOR OFFICE USE ONLY
City of Tigard Received /� y L/
: t+ Permit No.: Ail _co�.1 I
13125 SW Hall Blvd.,Tigard,OR 97223 lr,,,Y 0 3 7�J2? Date/By: j i ��-- c
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.
Inspection Line: 503.639.4175Date Re
CITY OFTIGARD Ready/By: ® See Page 2 for
TIGARD I Date Read/B Jens:
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: --r* .e Supplemental Information
TYPE OF WORK FEE* SCHEDULE
Iji New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
ElAccessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder ❑Other: Each additional bath/kitchen 25.02
Fire sprinkler( sq.ft.) Page 2
g
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 1 S Catch basin or area drain 18.76
City/State/ZIP:T
0 9-4-1 rywell,leach line,or trench drain ft.: 18.76
Footing drain(no.linear ) Page 2
Suite/bldg./apt.no.:J 1 Project name: 120 Q PA ( Manufactured home utilities 50.03
Cross street/directions to job site: y -- u K3 Manholes 18.76
�{`AA►L�O I C) 1 si- Si/ e, Tj(1 �(� ✓✓✓Rain drain connector 18.76
' V" '1 t l "Cr I_e f n'n n ® Wvn�` O,v,.✓M _r Sanitary sewer(no.linear ft.: ) Page 2
W�riruind i� �I II33IIXf� ..CVV5GG//II LFA.v 1� 1n 1A`-CI'tm(1 StormWater sewer(no.
(n linear ft.: ) Page 2
��n ttr l IA i Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow7J
preventer 31.27 1,
DESCRIPTION OF WORK Backwater valve 12.51
/r"�,' ly] �%f ' t Clothes washer 25.02
L'VI J 601� ."ct-clo .L Dishwasher 25.02
\J Drinking fountain 25.02
Ejectors/sump 25.02
pi PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:wash;net�p Co U d1 Fixture/sewer cap 25.D2
7� Floor drain/floor sink/hub 25.02
Address: I Sr) r;YSf Ave,Y� (� /1 Garbage disposal 25.02
City/State/ZIP: WI I ISV)OYO 1 0 q' z`T
-1 Hose bib 25.02
Phone:(503) o , I I Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: \.Clia../tcl` av l 1 v d S('O 1 C(yam I i oc Medical gas(value:$_) Page 2
I Primer 12.51
Contact name: kart-
'` Roof drain(commercial) 12.51
Address:34)300 bl� R1 nir/yt FjXvi 111II1�•�
�� Sink/basin/lavatory 25.02
City/State/ZIP:COMA i IASI O 1/ 0I,'-}ul'4f); K Solar units(potable water) 62.54
Phone:(1 jb6).p4- -. 9 3 3 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: 1``tdVi , CRC-adjail (Or UAJCa c , c.d Urinal 25.02
CONTRACTOR 1 " `� ' Water closet 25.02
(ilk
'n Water heater 37.52
Business name: s.add.y Land6CapU, if !L• Water PP Y�1 in WV 56.29
Address:a/00/�A) I M BID f Fen') �1" 2r� Other:F� 25.02
City/State/ZIP:l�l/ (1 AS. � ' II13 Subtotal 31,2-/'
Phone:(9V)Vet.' Fax:( ) Minimum permit fee: $72.50 32 S1!/
CCB Lic.: ��/3 ,pltunbing Lic.no.:
Plan review (25%of permit fee)
r State surcharge(12%of permit fee) Co,{-
Authorized ' TOTAL PERMIT FEE �I
n Print name: Ay-(- MO 5x Date: II" 2' 12,1 This permit application expires if a permit is not obtained within I80 days
"� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pormits\PLMU-PermitApp.doc 10101/09 440-4616T(10/02/COMIWEB)
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LAYOUT OF THE IRRIGATION SYSTEM AS SHOWN ON DRAWINGS IS C Z '¢ -.
DIAGRAMMATIC.IRRIGATION LINES SHOWN WITHIN PAVED AREAS ARE FOR ! 6Q
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