Permit (95) CITY OF TIGARD PLUMBING PERMIT
" COMMUNITY DEVELOPMENT Permit#: PLM2018-00231
T t G A D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/15/2018
Parcel: 2S108DB09100
Jurisdiction: Tigard
Site address:
Project: Polygon at Bull Mountain Subdivision: POLYGON AT BULL MOUNTAIN Lot: G
Project Description: Irrigation backflow in commons area south of lot 37,15191 SW Thames.
Contractor: CASCADIAN LANDSCAPERS, INC. Owner: POLYGON NORTHWEST COMPANY
21510 NW FARM PARK DR 703 NW BROADWAY, SUITE 510
HILLSBORO, OR 97124 VANCOUVER,WA 98660
PHONE: 503-647-9933 PHONE:
FAX: 503-647-9922
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/15/2018 $31.27
Specifics: 1 12%State Surcharge- 05/15/2018 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/15/2018 $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
toOUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,<:(:2" //7/7"0.7.4......_ Permittee Signature: (:/v 0/0z,/may. 7-7C2
"/
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
City of Tigard c / F, . `-�
IIII . . 13125 SW Hall Blvd.,Tigard,OR 97223 V y J//s ��" Permit 17 1,/N��yA?-_6K,23 l
Phone: 503.718.2439 Fax: 503.598.196 Review/
Inspection Line: 503.639.4175 Date/By: other Permit No.:
F I L A R U P Date Ready/By Juris:
_Internet:,www tigard or gov A r� p € S See Page 2 for
4 0 Notified/Method:
�} R +„Supplementallnformation
®New construction o Demti li1n� OF IGA For special information use checklist.
Addition/alteration/replacementOI11 Description 1 Qty. I Ea. I Total
❑
New 1-2-family dwellings(includes 100 ft.for each utility connection)
I I
c y V 01 cOM* ) k m , r SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building ®Multi-family SFR(3)bath 500.32
o Each additional bath/kitchen 25.02
Master builder 0 Other:
1.50 x :r t ti ,.r..� Fire sprinkler( sq.ft.) Page 2
+• : }=�� .._ ,, �'�� + Site utilities:
Job site address: NO eh� �i. Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: I Project came:Bull Mountain Dickson Footing drain(no.linear ft.:_) Page 2
Manufactured home utilities 50.03
Cross street/directions to job site:
Manholes 18.76
In the common space in front of Lot 37 on the northside of Thames Lane Rain drain connector 18.76
&SW Seine Dr 65/?/ -5.4) 7% 77 ) Sanitary sewer(no.linear ft.: ) Page 2
L/ r
Storm sewer(no.linear ft.:
) Paget°CC ( Tj-ctCc. "1-7070,0-79-7A/
Subdivision: Water service(no.linear ft.: ) Page 2
I Lot no.: Fixture or item:
Tax map/parcel no.: 42.S/0 tPZ) 3 ei 9/OO Backflow preventer I 1 I 31.27 I 31.27
to I .k OR Backwater valve 12.51
Landscape Irrigation Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
I 94 o rtER Expansion tank I 12.51 I
Name:Polygon Northwest Company Fixture/sewer cap 25.02
Address:703 NW Broadway,Suite 510 Floor drain/floor sink/hub 25.02
City/State/ZIP:Vancouver,WA 98660 Garbage disposal 25.02
Hose bib 25.02
Phone:( ) Fax ( )
Ice maker 12.51
.,•:_ ,• 1:' 1S�I'` C, + Interceptor/grease trap 25.02
Business name:Cascadian Landscapers,Inc Medical gas(value:$ ) Page 2
Contact name:Art Meisner Primer 12.51
Address:21510 NW Farm Park Dr Roof drain(commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:Hillsboro,OR 97124
Solar units(potable water) 62.54
Phone:(503)647-9933 I Fax::( ) Tub/shower/shower pan 12.51
E-mail:art@cascadianlandscapers.com Urinal 25.02
+ Water closet 25.02
Business name:Cascadian Landscapers,Inc Water heater 37.52
Water piping/DW V 56.29
Address:21510 NW Farm Park Dr
Other: 25.02
City/State/ZIP:Hillsboro,OR 97124
Subtotal 31.27
Phone:(503)647-9933 Fax:(503)647-9922 Minimum permit fee: $72.50 72.50
CCB Lic.:51443 Plumbing Lic.no.: Plan review (25%of permit fee)
Authorized signat /` State surcharge(12%of permit fee) 8.70
�•j --"'^ TOTAL PERMIT FEE 81.20
Print name: A°tz„T ! This permit application expires if a permit is not obtained within 180 days
,rtrt�/S��/ /L. 'Date: ZI/3���/Is,� I
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\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:
Record Type: Record ID:
Residential - Plumbing PLM2018-00231
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 1/2" Febco irrigation backflow device ser#H34921 in common area located by meter
for 15191 sw Thames lane lot 37 approved with test report.
Violation Summary:
Inspector Contractor