Permit (16) CITY OF TIGARD PLUMBING PERMIT
`F�! COMMUNITY DEVELOPMENT Permit#: PLM2016 00384
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/20/2016
Parcel: 2S106DC14900
Jurisdiction: Tigard
Site address: SW NO ADDRESS
Project: Polygon at West River Terrace Subdivision: None Lot: None
Project Description: Installation of(2)commercial backflow preventers for irrigation. Located in the south east corner of Tract L
(2S16DC14900).
Contractor: CASCADIAN LANDSCAPERS, INC. Owner: TIGARD, CITY OF
21510 NW FARM PARK DR 13125 SW HALL BLVD
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503-647-9933 PHONE:
FAX: 503-647-9922
FEES
Quantity Description Date Amount
2 ea Backflow Preventer 07/19/2016 $62.54
Specifics: 2 12%State Surcharge- 07/19/2016 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 07/19/2016 $9.96
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:(.1---')Ci 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 ApplieaiatI ,,
Building Fixtures
CT O Tigard AT(� Received Permit
1,1 . 13125 SW Hall Blvd.,Tigard OR. 4'722 1•i; Date/By �g �V L��t'�D..603.6.,..„-/
Plan Review
I Phone: 503.718.2439 Fax 503.598.1960, Date/By, Other Permit No.:
_
T I G A R U Inspection Line: 503.639.4175 Date Ready/By: funs: H See Page 2 for
Internet: www.tigard-or.gov, Notified/Method: Supplemental Information
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... . - > _ ".°".;w,i;,et , TYPE O WOR ,,,m- r/,n.u, g o,,: TRAr,, .,,,�_ ,,, �`t 4,;, '.r .s., �FEET* SCHEDULEa ,:,,,,F` ,I. mm '_g
®New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 11.for each utility connection)
�� *t` ,,CATEGORY OF CONSTRUCTION'50,4, � r ` Baia t SFR(1)bath 312.70
0 1-and 2-family dwelling EICommercial/industrial SFR(2)bath 437.78
E..]Accessory buildingH
SFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
f f' JOIi ST)�FrfIINFORMATION*ANDS LOCATION g� "A; , Site utilities:
Job site address:
Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR \ Drywell,leach line,or trench drain 18.76
paLV'I" 4 1.dts5r Footing drain(no.linear ft: ) Page 2
Suite/bldg./apt.no.: Project name:River Terrace Manufactured home utilities 50.03
Cross street/directions to job site:SW Roy Rogers Road Manholes 18.76
Parcel#2S16DC14900 and Tract L Rain drain connector 18.76
SW Sabrina Ave Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:River Terrace I Lot no.: Fixture or Item:
Tax map/parcel no.:Parcel# DC'T390� 626/C40-DC l 4/9QO Backflow preventer 2 31.27 62.54
1 r E / Backwater valve 12.51
,; Rw A DSCRIPTION,OF WOKH yii II _
r
Clothes washer 25.02
2-Backflows
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
'",, ® PROPERTY O'V1YERR f F I,�.;n t 0 TENT ~NA ' ,` Expansion tank 12.51
Name:Polygon rthwest ompany a cry G "fi�f+2b Fixture/sewer cap 25.02
Floor drain/floor snit/hub 25.02
Address:109 East 1 venue (3) c7-S H-141,1 LL PJ1.4/4/) Garbage disposal 25.02
City/State/Z1P:V couv WA 98660 ---170 t/L b 402. 97 p..2--b Hose bib 25.02
Phone:( ) Fax ( ) Ice maker 12.51
>rx t 'moi® APPLICANT ❑
' , CONTACT PERSON Interceptor/grease trap 25.02
Business name:Cascadian Landscapers,Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Arthur Meisner
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:patty@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 ' Subtotal 62.54
Phone:(503)647-9933 Fax:(503)647-9922 Minimum permit fee: $72.50 72.50
CCB Lic.:51443 i Plumbing Lie.no.:LCB#5185 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8.70
Authorized signature: - :- �-=�---1 TOTAL PERMIT FEE 81.20
Print name:Arthur Meisner Date:7-13-2016 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:\Building\Pennits\PLMU-PermitApp.doc 10/01/09 440.4616T(10/02/COM/WEB)