Permit 3
CITY OF TIGARD PLUMBING PERMIT
''> COMMUNITY DEVELOPMENTIN Permit#: PLM2016 00385
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/20/2016
Parcel: 2S106DC16000
Jurisdiction: Tigard
Site address: SW NO ADDRESS
Project: Polygon at West River Terrace Subdivision: None Lot: None
Project Description: Installation of(1)commercial backflow preventer for irrigation. Located in south east corner of parcel at south east
end of SW Silent Fox Terrace.
Contractor: CASCADIAN LANDSCAPERS, INC. Owner: POLYGON AT WEST RIVER TERRACE
21510 NW FARM PARK DR HOMEOWNERS ASSOCIATION
HILLSBORO, OR 97124 00000
PHONE: 503-647-9933 PHONE:
FAX: 503-647-9922
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/19/2016 $31.27
Specifics: 1 12%State Surcharge- 07/19/2016 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 07/19/2016 $41.23
Type of Use: COM 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 OUNCCbby calling 503.232.1987 or 1.800.332.2344.
Issued B C Permittee Signature: c ca
0-� .
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 :
Building Fixtures FOR OFFICE USE ONLY
I
Received _ ✓
City of Tigard Date/By: f I g' 1(r I Permit No.: ,C-0(0/4-003 gs
.4 13125 SW Hall Blvd.,Tigard,OR 97223 14
ii Phone: 503.718.2439 'Fah: 503.598.1960 Date/By:Plan Review Other PermitNo.:
Inspection Line: 503.¢39,4175 Date Read/B Jude: HI See Page 2 for
TIGAKU Internet: www.tigard.cT,gdl . - ' Notified/Method: Supplemental Information
R 3W„ "4 $‘-..7 µf5's'y�k it h. a' d tv 9 fz 1'xf ^#p r t Y r',�' .; P s �. 9A .tx+ •[' a4 in ,,,r hit Ag k' 4' 'K.Fs g '
- '�' �£'d t ate .
mz:� a�' 'r' '�'arr'�" ``z�vx� �m`"TYPE OF,WOR1� -�.�; . ...'� _ a � '���,a"� .t !-rm�w.�'>.._,.g.- FE'E SCHEDULE .r� 5�� r;k., � •i
®New construction ❑Demolition For special information use checklist
Description I Qty. I Ba. 1 Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
a 9. r41 CATEGORY OI+ CONSTRUCTION'` ,t ', 4;64 u �' � SFR(1)bath 312.70
❑ I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
nt4= OB SITE NOMSite utilities:" VJTNNDtAT �
Catch basin or area drain 18.76
Job site address:
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR
¢yr Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: ?Alt Project name:River Terrace Manufactured home utilities 50.03
Cross street/directions to job site:SW Roy Rogers Road Manholes 18.76
Parcel#2S106DCI6000 Rain drain connector 18.76
Near Lot 19 Sanitary sewer(no.linear ft.:_) Page 2
Stonn sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:River Terrace Lot no.: Fixture or item: 31.?-7
Tax map/parcel no.:Parcel#:2S106DC16000 Backflow preventer I 31.27 6.3,34-
fii, e•W - .-DESCRIPTIONOF WORK , 4 Backwater valve 12.51
Clothes washer 25.02
1-Backflows Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ry ®,PROPERTV'OWNER- : y 1•. ,L4 TENANT . vi Expansion tank 12.51
Name:Polygon Northwest Company Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:109 East 13th Avenue
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
4174: ® APPLICANT r' 0 CONTACTPERSON nterceporgrease trap 25.02
y, v W , l,Sy
Medical gas(value:$ ) Page 2
Business name:Cascadian Landscapers,Inc.
Primer 12.51
Contact name:Arthur Meisner
Roof dram(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
Water closet 25.02
fiCONTRACTOR i r
`
6. - E x„ ....-. : „ ..y ,, d 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 63754' 31.3?
Phone:(503)647-9933 Fax:(503)647-9922 Minimum permit fee: $72.50 72.50
CCB Lie.:51443 OP Plumbing Lic.no.:LCB#5185 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8.70
•
Authorized sign_ .:,..+�% 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.
I:\Building\Penuits\PLMU-PemhitApp.doc 10/01/09 440-4616T110!02/COMRVEB)