Permit (31) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit ft: PLM2016-00231
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/26/2016
f I c"�k�� 9 Parcel: 2S1060001500
Jurisdiction: TIGARD
Site address: 13416 SW SABRINA AVE
Project: River Terrace Northwest,Lot 23 Subdivision: RIVER TERRACE NORTHWEST Lot: 18
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: CASCADIAN LANDSCAPERS, INC. Owner: POLYGON WLH, LLC
21510 NW FARM PARK DR 109 E 13TH STREET
HILLSBORO, OR 97124 VANCOUVER,WA 98660
PHONE: 360-695-7700
503-647-9933
FAX: 503-647-9922
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/26/2016 $31.27
Specifics: 1 12%State Surcharge- 04/26/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/26/2016 $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• _- -• to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue. By: / of 1 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 TIF �� E�
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City of Tigard Received C.I.
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g Date/By: 'I o�6 /('p 1 Permit No.:PI,r./�((,_Ona3/
RI 13125 SW Hall Blvd.,Tigard,OR 97223 pp p Z 6 9 016 Plan Review \\\ `
• Phone: 503.718.2439 Fax: 503.598.1960 i , y Other Permit No.:�M j- jj
Date/B
Inspection Line: 503.639.4175 c, w 9 Date Read /B loris: ® See Page 2 for
TI GA R1) �1 9 & Y Y:
Internet: www.tigard-or.gov ?;l d d�.3:g •`Notified Method
Supplemental Information
7 , t :x , TYPE OF WORItI ti -DWIS1 N i :FEE* SCHED1JLE
®New construction 0 Demolition For special information use checklist
• Description Qty. I Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
s','-..:'..Y",',',:' C , 'EGORX Q1`CONSTRUCTION ,-,, ,i,--: SFR 1( )
bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
'JOB SFFE INIORMATION3 ANDLOCATION.: ` Site utilities:
-
Job site address:13415 SW Sabrina Street Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
•
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:River Terrace Manufactured home utilities 50.03
Cross street/directions to job site:Roy Rodgers and Scholls Ferry Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: 1 Lot no.:23 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF;WORK Backwater valve 12.51
Clothes washer 25.02
Backflow Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Polygon Northwest Company Fixture/sewer cap 25.02
Address:109 E.13th Street Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Cascadian Landscapers,Inc. Medical gas(value:$ ) Page 2
Contact name:Art Meisner Primer 12.51
Roof drain(commercial) 12.51
Address:21510 NW Farm Park Drive Sink/basin/lavatory 25.02
City/State/ZIP:Hillsboro,OR 97124 Solar units(potable water) 62.54
Phone:(503)647-9933 Fax::(503)647-9922 Tub/shower/shower pan 12.51
E-mail:art@cascadianlandscapers.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Cascadian Landscapers,Inc. Water piping/DWV 56.29
Address:21510 NW Farm Park Drive Other: 25.02
City/State/ZIP:Hillsboro,OR 97124 Subtotal
Phone:(503)647-9933 Fax:(503)647-9922 Minimum permit fee: $72.50 72.50
CCB Lic.:521143- 1-e• 5186' Plumbing Lic.no.:LCB#5185 Plan review (25%of permit fee)
„....---7 State surcharge(12%of permit fee) 8.70
Authorized signature:
'� '"` TOTAL PERMIT FEE 81.20
Print name:Bryan Rose Date:4/25/2016 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.\Buildtng\Penults\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13416 SW SABRINAAVE, SHERWOOD, February 9, 2018 at
OR, 97140 9:56:09 AM
Record Type: Record ID:
Residential - Plumbing PLM2016-00231
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
3/4" Wilkins backflow device model 350 ser#A547031 approved with test report
Violation Summary:
Inspector Contractor