Permit (9) CITY OF TIGARD PLUMBING PERMIT
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` COMMUNITY DEVELOPMENT Permit#: PLM2016-00361
TIGARD D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/07/2016
Parcel: 2S 106D 823200
Jurisdiction: Tigard
Site address: SW NO ADDRESS
Project: River Terrace NW Subdivision: None Lot: None
Project Description: Backflow preventer for irrigation of common area(Tract R)near SW Holly Ridge Ln.
Contractor: CASCADIAN LANDSCAPERS, INC. Owner: RIVER TERRACE NORTHWEST HOA
21510 NW FARM PARK DR 109 E 13TH ST, STE 200
HILLSBORO, OR 97124 VANCOUVER,WA 98660
PHONE: 503-647-9933 PHONE:
FAX: 503-647-9922
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/06/2016 $31.27
Specifics: 1 12%State Surcharge- 07/06/2016 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 07/06/2016 $41.23
Class of Work: OTR Plumbing
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: 0, .. 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.
07-05-16; 17:00 ; . # 1/ 6
Plumbing Permit A�ppli� �Og `� '
Site Utilities tall uhr'ic l'; l si, (►N1.1
Wil City of Tigard J�l 1. ;, Received -'Q//0 Penult NO.: tea-OK&-D0 3(e f
r 13125 SW Mull Blvd.,Tigard,OR 97223 Date/Dy
' y Phone: 503.718.2439 Fax:'503,598.1960 PDnwllly ow Other Permit No,:
t 1 i \P.1� Inspection Line: 503,639.17,5,. - Dote Ready/Dr Mc El See Page 2 for
Internet: www,tigard-or,gdv' Notifled/Method, Supplemental information
TYPE OF WORK FEE* SCHEDULE
g New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other; NOV 1-2-family dwellings(includes 100 IL for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building ElMulti-familySFR(3)bath 50032
0 Master builder Each additional baht/kitchen 25.02
- Other: Fire sprinkler( sq.It.) Page 2
JOH SITE INFORMATION AND LOCATION Site utilities:
Job site address; Catch basin or arca drain 18.76
City/State/ZIP:Tifirad,OR Drywc11,leach line,or trench drain 18.76
Footing drain(no.linear R.:_) Page 2
Suite/bldg./apt,no.: I Project name:River Terrace Manufactured home utilities 50,03
Cross street/directions to job site:SW Ray Rogers Road Manholes18.76
R3.°o - .� __
Pared#2S106DB43590 —Near SW Holly Ridge Rain drain connector 18.76
�� - Sanitary sewer(no.linear R.: Page 2
G M� Storm sewer(no,linear R: ) Page 2
Water service(no.linear ft.:_,_,) Page 2
Subdivision:River Terrace Lot no.: Fixture or item: 111
Tax map/parcel no.:2S106DB23300 Backflow preventer 1 31.27 3I.27
DESCRIPTION OF WORK Backwater valve 12,51
Clothes washer 25.02
Backflow
- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12,51
Name:Polygon Northwest Company Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25,02
Address:109 East 13th Ave
-_ - Garbage disposal 25.02
City/State/:LIP:Vancouver,WA 98660 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12,51
0 APPLICANT 0 CONTACT PERSON Interceptor/prase trap 25,02
Business name:Cascadian Landscapers,Inc. Medical gas(value:$ ) Page 2
Contact name:Arthur Meisner Primer 12,51
Roof drain(commercial) 12.5I
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:patty(cilacadianlandscapers,corn Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37,52
Business name:Caseadian Landscapers,Inc. Water piping/DWV 56.29
Address:21510 NW Farm Park Drive Other: 25,02
Cityress; /ZIP:Hillsboro,OR 97 Subtotal_ 31.27
Phone:(503)647-9933 Fax:(503)647-9922 Minimum permit fee: 572,50 72.50
Plan review (25%of permit fee)
CCB Lie.;51443 Plumbing Lie.no,;LCB#5185
State surcharge(12%of permit fee) 8.70
Authorized signature: `--- _ TOTAL PERMIT FEE 81.20
Print name:Arthur Meisner DatC 916 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 Ouilding industry Service Board,
I:\auildlni\Pcrroin tmy-PonnitApp.doc 10/01/09 440.4616T(I0,02X0M/WCB)