Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00238
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/28/2016
1 r i ;r I<.n g Parcel: 2S108DB08800
Jurisdiction: Tigard
Site address: SW NO ADDRESS
Project: Polygon at Bull Mountain Subdivision: None Lot: None
Project Description: Site utilities for new park-(7)catch basins/area drains,473'of storm sewer service,250'of water service&(1)
drinking fountain.
Contractor: NORTHWEST EARTHMOVERS INC Owner: POLYGON NORTHWEST COMPANY
PO BOX 1609 109 E 13TH STREET
SHERWOOD, OR 97140 VANCOUVER,WA 98660
PHONE: 503-312-6213
503-625-3100
FAX: 503-625-3108
FEES
Quantity Description Date Amount
7 ea Catch Basin or Area Drain 04/28/2016 $131.32
Specifics: 473 If Storm Sewer 04/28/2016 $212.62
250 If Water Service 04/28/2016 $137.58
Type of Use: COM 1 ea Drinking Fountain 04/28/2016 $25.02
Class of Work: ALT 1 12%State Surcharge- 04/28/2016 $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 B o\�.Cizir ALA/ 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
Site Utilities OPSI` 1 `9Ni471il it
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(I t V.9;! 'l ,l 4,;ly,1m
Received �/ / /� ,J,
City of Tigard DateBy: 4-D / ' Cad), Permit No.: �G&p'O 3-
41 13125 SW Hall Blvd.,Tigard,( 5§2
Phone: 503.718.2439 Fax: yy'`b�3 8. 9 Plan Review Other Permit No.:
Date/By:kilt-
I 1 t, \1:1 Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tlgard-Or.gTIA. cii Notified/Method: Supplemental Information
TYP FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist
Description Qty. Ea. 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 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑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: /2A-el-- Catch basin or area drain 7 18.76 131.32
D Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Bull Mountain Park Manufactured home utilities 50.03
Cross street/directions to job site:NW of intersection of SW Hawk Ridge and Manholes 18.76
SW Missouri Ave Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:473) Page 2 c2 1 ,&C 7-
Water service(no.linear ft.:250) Page 2 /37.$T '
Subdivision:Polygon at Bull Mountain 1 Lot no.: Fixture or item:
Tax map/parcel no.: A410(6-06o $ o Q 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
C PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Polygon Northwest Compant Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:109 E 13th 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
Medical gas(value:$ ) Page 2
Business name:
-- 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
CONTRACTOR Water closet 25.02
• Water heater 37.52 t
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
Phone:(503)625-3100 Fax:(503)625-3108
Minimum permit fee: $72.50
CCB Lic.:62761 Plumbing Lic.no.: Plan review (25%of permit fee)
....mi.
� State surcharge(12%of permit fee)
Authorized signatur-• _IN#PP- i TOTAL PERMIT FEE 667, 3>
Print name: ,rt�`i'�� Date G,' - 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.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)