Permit (16) $11CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00081
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/10/2016
TIGARD 9 Parcel: 2S1060001600
Jurisdiction: TIGARD
Site address: 17255 SW HOLLY RIDGE LN
Project: River Terrace Northwest,Lot 21 Subdivision: 2002-032 PARTITION PLAT Lot: 3
Project Description: 300'of water service, 100'of sanitary service to temporary septic tank and 100'of storm sewer for sales trailer.
Contractor: KRUCKMAN PLUMBING LLC Owner: ADVL LAND HOLDINGS LLC
PO BOX 1375 BY FORSUM, MICHAEL
GRESHAM, OR 97030 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 971-806-5183 PHONE:
FAX:
FEES
Quantity Description Date Amount
300 If Water Service 03/10/2016 $137.58
Specifics: 1 12%State Surcharge- 03/10/2016 $16.51
Plumbing
Type of Use: COM 100 If Sanitary Sewer 03/10/2016 $62.54
Class of Work: NEW 100 If Storm Sewer 03/10/2016 $62.54
Type of Const: 0 12%State Surcharge- 03/10/2016 $15.01
Plumbing
Occupancy Grp:
Stories:
Total $294.18
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..- ions to .- C by calling 503.232.1987 or 1.800.332.2344.
Is ed 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.
Feb/17/2016 1:02:01 PM AIG 1-503-323-2569 1/1
1Lu[ltbt !eriuit A,_„e IVED
Site Utilities int,: 1,11 it 1 1 -,1 EI'.1 1
FEB 17 2016
cit,/of Tigard 1eaelvadArj / •11:25,1t.N,v t-67C*9/
9123 tial Hs 131vd,1 i run tto ew Ot4et F�mlt►io.l Cil t�q'�d l 1p"p�'
O Phony: 503.718.2434® �IGARD tw,sty
rnepeedon 1,18c: sus. t?DING DIVISION Polo aayRly. > ® tlaaPego2fR
t' lateatet; www,ttgerd-orgov Notlfied/Mbgwdy
v �.. r.r7 { yr n.1''17, f��t�L • 4
allon
�� t vll fXI 1left77�IV , 1 ! p& ,.i jJ U -,
�. pI r r ,�������� '•u';' ���74Sftid:+'YUCN13r..rF�',.J0utm/,:.�,��VIU- Yvw�.'iti.
t: $Ip�fl�t3ti�l:tiilli�ld,.s�,
❑NOW Constniotiott 0 pentolidon For yprvfal_, r, sv„
,i J" nptt i ti',J:=1., Tat_j9,.._
(a Add,(tiott'altceatitm/rnp1eonmont ❑Other: Neer j.141likagr dwalWya(includes I00_1t.for?loll utiUt)'aarwoct on)
'jam ��y.r.n,{eal�?aptt'' Ir:'q.Pi,ilqiM4 [7t1,..,14#1s(1) 1.70
� ' �. adkeln4�lu/•,g' 161...ii;:.i9,w0.1+i� h SFR f2)�� v 31
437.78 _
0 1-and 2-011114 dviaing ❑CottuueroieVindustrial SFR(3)beth 500,32
❑Aocessoay building D Matti-lbtni1y gest a tddw iimat batb/kitahao 25.02
El Mantas Wilder ID Other Wee trek -Firo eprEokiAr(,r-, _sq.ft) Pep 2
t. 7unrrf r*1-,��s�i9(„1„r''ru wr'r(41 r.'14�+;l,•:-wry � ' ...-,
�l4.1/d,'. ...., i�a�Mti?1i!; ,(;:1--blit Ml9lf It'�c(�V701R11� ]tl.76
_Catch basin or ora drain
Sob cite edArnsa:J er+nae-. "t 2.55- 1•�0 LL'f 4172e,,,„ 'Thy 411.leaob�or inmost drain, 18.76
City/State/Z1P:Tigard OR l+outing drain(no.liaar ft.:.....) Page 2
Suitc/bldg,/apt.no � Prgjeclnnma:� -Manulttoturbdhttitnetuilidea - 50.03
Croat streaddireetiott9 to job site:Trailer sits on2 lot 20&21 Manholes t8,'76
----
Rain�Sn connector, .� 18.76
Sanitary raver(no,linear R.1 � F.s e 2 .S
�
ntl s
8toewer(na,Gnaar f1:tQQ) Sa 2
Water service(nal linear ft,;30 Pogo
Subdivision: trot no,: Fxtike aRtZem: ..
Backflow preventer 31.27
Tex Inv/parcel no.: -
.,Q T 7'.y r army"."..! M;Yl'CA1 erg. )•3sol tYtttet valve 12.51
t ± 'r';. c+.vur washer 25.02
CloUwt
•"1. �� .tr.� ,i r. a:hlz't�:1,�111i�14^•,y, .in% ,. ...
LAD. ' . ,„.,....., t _ - (7iehenole r 25.02
1/ t . . to-'T -�
2s, ,-\b IV/,k_ i'h(nkmg(uunllut 25.02
'"' "' 25.02
r' L'jaotbrs/eUrfip µ
',' • ayy„ M " s :rjr� j r 4 1 r,r, , ,i. _ximmiai tank 12,51
'',I.
. , ,..),;,,, 'ysterxliao.,.. • .. . .�..
rewaruuy 25,01
_
Mune:Polygon NW Roes -_ Hoot drain/floor sinMut)hub 25.02
Addrese: (lerbage oh pusel 25.02
City/5tate(ZlP: Hoe bib 111111111131
Flume!( )•, ±�j j� ,� Fax:( ) , ice ranker 12.51
Illi !!QtZUilr9�.�Trlrr .77,'�`4111M :.i'rI`•'igreZC�1" •,"I'"��I"r"r r,' It1Wmarlgdgraaeetri 25.02
{ �+F,7,�{::'•t':'lSA] 1• cal gee Volute:S_) P e8°2
8ueiltees tWnC Kruelm tan iPlombIng LLC - Primer 11,51
Contact name:Mark ICAlttlanio .,_,,,-„r. Root-drain(commercial) 12.51
Ad4rese:110 Dox 1375Sknk/beairtliavatrey 25.02
�--�
City/Stete/TIP:Gresham OR 97074 - ..� Solarunits(potable water) 62.54 J
nom(971)00(dtt$3 Fax::( ) '1'ub/ahnwer/shower pan 12.51
ittiUrinalIIIII 25.02
)?»ttlail;k7^llClt7t7dA1eiMtM7<Ctifap�gR1 .t:Om
Water clean
° . 25.02
Hd � "i .p .<�rll)n+{h *i+nXH).t '� g� % -...eatOf� i .
Dueness nate:Krutktnen Plumbing 1.1.0 W_ Witer pi,'n/r)WV 56.29
Addre»:TO Bus.2375other25,02
City/t'sgtttl/LiP:t^wttieltatn OR 97030 __ _ snbtot4 ..i• '.
Phone:(911)00003 Fax:Fax:( ) M1Nmtstnptxnilt fee: $72.3()
Plan review (254 of permit tire) ,--- "
CCR Lit,:206424 PitvnbinB>~k,no.:2'l1602 ._..,.-- (state etuoharge(12%of permit(be) Pliv
Authorircd signature: _ TOTAL,PERMXT PFR
A
Date:x111/16 � ,_ 71eb Dodi ar kaftan mire*If a par r e...r+*• r,.. dove
' printnttmt:Mal* ruekman paw kba5been mesa mg nimphtv.
.....,--- +k+aa tnstbodvk'v sot byTri-(oenty Rwtdtre fadusay 8w(t�
1
t:WuudheskAltArt.MU.Ferafspp•doa 1141M9 4�MI5Trtoirixowna) C2 /Ql .
Debbie Adamski
From: Debbie Adamski
Sent: Wednesday, February 17, 2016 3:56 PM
To: 'Sherri Kruckman'
Subject: RE: River Terrace Northwest Sales Trailer
Hi Sherri,
Is this trailer going to be "self-contained" and not be connected to sewer service or storm service? If it is being
connected to sewer service, then I need know what fixtures are in the structure so I can calculate the sewer connection
fee. If it is just water service for potable water supply to the trailer I will finish creating the permit and add the fees so
you can pay them online. Let me know or give me a call if you have any questions.
Debbie Adamski
Senior Building Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
From: Sherri Kruckman [mailto:sherri.kruckmancontracting@@gmail.com]
Sent: Wednesday, February 17, 2016 1:04 PM
To: Debbie Adamski
Subject: Re: River Terrace Northwest Sales Trailer
Debbie.
I am faxing this back now. Mark signed it yesterday and added the water line and footage. Let me know if there
is anything else you need.
Sherri Kruckman
Kruckman Plumbing LLC
503-593-8040
On Thursday, February 11, 2016, Mark Kruckman <kruckmancontracting a,gmail.com> wrote:
Forwarded message
From: Debbie Adamski <DEBBIE@u,tigard-or.gov>
Date: Thursday, February 11, 2016
Subject: River Terrace Northwest Sales Trailer
To: "kruckmancontractingAgmail.com" <kruckmancontracting(&,,gmail.com>
Cc: #Building Permit Technicians <TigardBuildingPermits(a�tigard-or.gov>
Mark,
Please see the attached application form that you submitted. I am returning it as we need additional information
on the application before we can process the permit.
1. Please sign the application
2. Indicate on the right side of the application form what fixtures you want on the permit
1
3. Are you doing the utility line work? If so indicate the linear footage.
Please resubmit the application once this information is complete. Thanks.
Debbie Adamski
Senior Building Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd., Tigard, OR 97223
503-718-2450
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If
requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public
Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules
"City General Records Retention Schedule."
Sent from Gmail Mobile
2
Debbie Adamski
From: Chris Walther<Chris.Walther@polygonhomes.com>
Sent: Thursday, March 10, 2016 4:04 PM
To: Debbie Adamski
Cc: Maggie Gordon;kruckmancontracting@gmail.com
Subject: FW: Plumbing Permit#PLM2016-00081
Debbie,
See below,thanks.
( vria larIniroa
e4Tia.araftier.0060ark ea.arm
cele 503-312-6213
www.ftei ogiteme-4.aux
L Y'
From: Mark Kruckman [mailto:kruckmancontracting@gmail.com]
Sent:Thursday, March 10, 2016 4:01 PM
To:Chris Walther<Chris.Walther@polygonhomes.com>
Subject: Re: Plumbing Permit# PLM2016-00081
Chris
Yes, we can add the sewer to our plumbing permit.
Thank you
Mark Kruckman
Kruckman Plumbing
971-806-8183
On Mar 10, 2016 3:59 PM, "Chris Walther" <Chris.Walther@polygonhomes.com>wrote:
Good afternoon Mark,
Can we please get your approval to add the sewer connection to the current plumbing permit for the sales
office at NW River Terrace?
1