Permit (93) CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT11
Permit#: PLM2016-00242
��
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 W Date Issued: 05/04/2016
T t ca f► 9 Parcel: 2S106DB23700
Jurisdiction: Tigard
Site address: 17390 SW SABRINA AVE
Project: River Terrace Northwest-Neighborhood Park Subdivision: RIVER TERRACE NORTHWEST Lot: X
Project Description: Plumbing site utilities for neighborhood park on Tract W: (9)catch basins,476'storm sewer, 182'water service,
and(1)drinking fountain.5/24/16,REPRINTED to correct parcel from 2S1060001800 to 2S106DB23700
Contractor: NORTHWEST EARTHMOVERS INC Owner: ADLV LAND HOLDINGS LLC
PO BOX 1609 BY FORSUM, MICHAEL
SHERWOOD, OR 97140 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 503-625-3100 PHONE:
FAX: 503-625-3108
FEES
Quantity Description Date Amount
g ea Catch Basin or Area Drain 05/04/2016 $168.84
Specifics: 476 If Storm Sewer 05/04/2016 $212.62
182 If Water Service 05/04/2016 $100.06
Type of Use: COM 1 ea Drinking Fountain 05/04/2016 $25.02
Class of Work: OTR 1 12%State Surcharge- 05/04/2016 $60.78
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $567.32
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 questi.. to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B : Permittee Signat
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.
CITY OF TIGARD PLUMBING PERMIT
N . . . COMMUNITY DEVELOPMENT Permit#: PLM2016-00242
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/04/2016
T[t,,1 ti i i 9 Parcel: 251060001800
Jurisdiction: TIGARD
Site address: 17390 SW SABRINA AVE
Project: River Terrace Northwest-Neighborhood Park Subdivision: RIVER TERRACE NORTHWEST Lot: 1
Project Description: Plumbing site utilities for neighborhood park on Tract W: (9)catch basins,476'storm sewer, 182'water service,
and(1)drinking fountain.
Contractor: NORTHWEST EARTHMOVERS INC Owner: ADLV LAND HOLDINGS LLC
PO BOX 1609 BY FORSUM, MICHAEL
SHERWOOD,OR 97140 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 503-625-3100 PHONE:
FAX: 503-625-3108
FEES
Quantity Description Date Amount
g ea Catch Basin or Area Drain 05/04/2016 $168.84
Specifics: 476 If Storm Sewer 05/04/2016 $212.62
182 If Water Service 05/04/2016 $100.06
Type of Use: COM 1 ea Drinking Fountain 05/04/2016 $25.02
Class of Work: OTR 1 12%State Surcharge- 05/04/2016
$60.78
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $567.32
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.
Plumbing Permit Application EC IVED
Site Utilities I(112 ()I I I( I I I. ()NI 1
City of Tigard MAY 0 4 2016 Received 4/y/i� }Xi. PermitNo.����/` ...-e)0,2142,
II13125 SW Hall Blvd.,Tigard,OR 97223 ,_, .. Date/By: t0
1 Phone: 503.718.2439 Fax: 503.598.1QT Y OF I°a.�l i\R[) Plan Review Other Permit n
Inspection Line: 503.639.4175 }' t(` -)'V S i y: N �/� �-ss(o
I i t, \h I Internet: Www.ti and or. ov �� ,4v► e Date ReadyBy: June: ® See Page 2 for
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description J Qty. j 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
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ®Other:City Park Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 9 18.76 168.84
City/State/ZIP:Tigard,OR Drywell,leach line,or trench drain 18.76
n' g kli/E2 7 6/Z41"CE/o it4_c�
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Neighborhood Park Manufactured home utilities 50.03
Cross street/directions to job site:West of the SW Aubergine Terrace& Manholes 18.76
SW Sabrina Avenue intersection Rain drain connector 18.76
Sanitary sewer(no.linear R: ) Page 2
Storm sewer(no.linear ft.:476) 5 Page 2 212.62
Water service(no.linear ft.:1D 2 Page 2 100.06
Subdivision:River Terrace Northwest I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Park construction and installation of storm drain system and water supply for Dishwasher 25.02
drinking fountain. Drinking fountain 1 25.02 25.02
Ejectors/sump 25.02
_4 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Polygon Northwest Company Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 109 E l3'a Street
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(503)312-6213 Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Northwest Earthmovers Inc. Water piping/DWV 56.29
Address: 13600 SW Galbreath Dr. Other: 25.02
City/State/ZIP:Sherwood,OR 97140 Subtotal 506.54
Phone:(503)625-3100 Fax:(503)625-3108 Minimum permit fee: $72.50
�j Plan review (25%of permit fee) ..
CCB Lic.:62761 I Plumbing Lic.no.: 3y-4/6/ /9 14, State surcharge(12%of permit fee) fk- .
Authorized signature: G TOTAL PERMIT FEE -.08'16-
Print name: Date: rte This permit application expires If a permit B not obtained w 160 da
�-.LS T , after it has been accepted as complete. in .302_•Fee methodology set by Tri-County Building industry Servilk Boarr t
I:\Building\Permits\PLMU-PermiApp.doc 10/01/09 440.4616T(10/02/COM/WEB)