Permit CITY OF TIGARD PLUMBING PERMIT
,,,14f' Permit#: PLM2021-00215
COMMUNITY DEVELOPMENT DateIssued: 5/20/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106DC13700
Jurisdiction: Tigard
Site address: 17004 SW JEAN LOUISE RD
Project: Polygon at West River Terrace Subdivision:POLYGON AT WEST RIVER TERRACE Lot: 137
Project Description: Backflow preventer for irrigation. Location is in the right of way close to the NE corner of this property.
Contractor: CASCADIAN LANDSCAPERS, INC. Owner: MEYER, LINDA KAY
36700 SW BLOOMING FERN HILL RD 17004 SW JEAN LOUISE RD
CORNELIUS, OR 97113 SHERWOOD, OR 97140
PHONE:
PHONE: 503-647-9933
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
41 ea Minimum Fee Adjustment- 05/20/2021 $41.23
Type of Use: COM 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: 41 % Permittee Signature: t
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 s -r-In
Site Utilities RECEIVED FOR OFFICE USE ONLY
City of Tigard 1,�/ 0 2021
Received
�idil 3 Date/By: �`/}b/j-t Lr Permit No.: �,f1
■ 13125 SW Hall Blvd.,Tigard,OR 97223 �- pLe 1 1_004.1 S'^
g• Phone: 503.718.2439 Fax: 503.598.1 Plan Review tPrY OF TIGARD DateBy: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 Date Ready/By:
dY y: Aviv ® See Page 2 for
Internet: www.tigardor.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
I'lliNew 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
❑ 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
['Accessory building El Multi-familySFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
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7 001 JOB SITE INFORMATION AND LOCATION Site utilities:
ry Jo site address:Jea-�n 5e, a k er`1 Catch basin or area drain 18.76
City/State/ZIP: - j S(L 0 y Grit r �J Drywell,leach line,or trench drain 18.76
� Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:l��[' 1261J IVYIpYC;VPI91PI1$Manufactured home utilities 50.03
Cross street/directions to job site: (( Manholes 18.76
CaSi- J c 121)\ �€xd ^s a iti 6n Lw I� Rain drain connector 18.76
Wake f i �, c (L Nb' Corn
rdeal v Sanitary sewer(no.linear ft.:_) Page 2
l/ 2 �(� � r t t Storm sewer(no.linear ft.: ) Page 2
AJVC(:7 . �3J Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer i3127I 21
DESCRIPTION OF WORK Backwater valve 12.51
r }/ Clothes washer 25.02
SV ri S m1 1 ()41-1Ol- 1 Dishwasher 25.02
7�
- rtr 1 '
rf r4 " /741 07The-NF- Drinking fountain 25.02
Ole /?Ca y R.-1 jG LL9el:J-C- F,4, Ejectors/sump 25.02
)] PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Id)n Salt f� /t0 � Fixture/sewer cap
Name: 1 Y 1 1 l l 25.02
fy
Address:
155 N, VS t Ayr,
Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: I-h I iSbbru Dr q q- 1 Z-. Hose bib 25.02
Phone:(NCO ) (a, .�� Fax:( ) Ice maker 12.51
,IX/APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: l kde ad t(AV) 1 JAY ILf1 I �p yi5t I to/' Medical gas(value:$_) Page 2
Contact name: I40.,v1 �'"�'` KJ Primer 12.51
Q'� ( Roof drain(commercial) 12.51
Address:ai � �
� INOOYM n few l Sink/basin/lavatory 25.02
City/State/ZIP: W r f ld t US 0`/ 13 Solar units(potable water) 62.54
Phone: )��{} 331 Fax::( ) Tub/shower/shower pan 12.51
�7
E-mail: K-09 C cot4 � //y
� lavid5 p rs f�i1 Urinal 25.02
"" ` f Water closet 25.02
CONTRACTOR
] � 1 p� Water heater 37.52
Business name:�.1+4:�1-Ii dj I.fil ' l i`mi l I YI C. Water r m W V
Address:�{ G,' Nonni:, , 4/t p p FfD 56.29
Chu 0!/ c_I u e.r pi/ 1 124 Other: 25.02
City/State/ZIP: •I'y (I U5 » _ �-II 2, Subtotal SI.Z.,�
Phone:( 7�)(a,e� ��C1 dr 3 Fax:( ) Minimum permit fee: $72.50 2.60
CCB Lie
" - r ' Plumbing Lic.no.: Plan review (25%of permit fee) Y
WV',___ State surcharge(12%of permit fee) ,
Authorized signature: TOTAL PERMIT FEE (?)l,240
Print name:A1,4 Me ish�x Date: 4. ) I .� 1 This permit application expires if a permit is not obtained within 180 daysda_
b /� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
t:lBuilding/PemdtaLMUA-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
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FLAOYOUT OF THE IRRIGATION SYSTEM AS SHOWN ON DRAWINGS IS
FURNISH&INSTALL DIAGRAMMATIC.IRRIGATION LINES SHOWN WITHIN PAVED AREAS ARE FOR CYii ;€R
r- IR MAINLINE POWER FOR IRRIGATION GRAPHIC CLARITY ONLY.IRRIGATION HEADS AND PIPES ARE TO BE PLACED C e. ae
_;� - -WITHIN LANDSCAPED AREAS WITH THEIR LOCATIONS MODIFIED AS REQUIRED TO •C C N
CONTROLLER,COORD. ----
WITH ELECTRICAL DWGS. AVOID PLANT MATERIALS.UTILITIES AND OTHER OBSTRUCTIONS. O 'o m
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.- BEHIND SIDEWALK,SEE DETAIL 8/L30. 'e i m m z
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O IRRIGATION PLAN 100255
SCALE FEET 281 9.1171 42T
m 0 ao 80 NORTH WM IDLE
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