Permit (201) CITY OF TIGARD PLUMBING PERMIT
Ills COMMUNITY DEVELOPMENT Permit#: PLM2018-00428
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/19/2018
T1(;rt R n g Parcel: 2S1060001400
Jurisdiction: Tigard
Site address: 17051 SW APPLEDALE RD
Project: River Terrace East Apartments,Building A-Clubhouse Subdivision: RIVER TERRACE EAST Lot: None
Project Description: Building A: Clubhouse and 7 unit apartment building. Backflow preventer.
Contractor: ALLIANCE PLUMBING LLC Owner: POLYGON WLH, LLC
PO BOX 386 703 BROADWAY ST, SUITE 510
TROUTDALE,OR 97060 VANCOUVER,WA 98660
PHONE: 360-695-7700
PHONE: 503-899-9912
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/19/2018 $31.27
Specifics: 1 12%State Surcharge- 09/19/2018 $8.70
Plumbing
Type of Use: MF 41 ea Minimum Fee Adjustment- 09/19/2018 $41.23
Plumbing
Class of Work: ALT
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: .
'�`/ �- Permittee Signature: C irtfe. 754�
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.
a v`^; a
Plumbing Permit Application;i=p t 3 01
Building Fixtures FOR OFFICE USE ONLY
C1 Of Tigard 5 Received Cs� /L /� Permit No.��U`r UD Y�1
111, 41 13125 SW Hall Blvd.,Tigard, i I'i2, �' a ,,i s i i.li a Plan Revrew ( / ✓
C Phone: 503.718.2439 Fax: 503.598.1966 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Suds: H See Page 1 for
Internet: www.tigard-or.gov Notified/Mothod: Supplemental Information
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®New construction 0 Demolition For special inforalafion use checklist
Description ( Qty. I Ea 1 Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
:-.'_--:"4:-;i'.-17-57 .7-1.-7 7 � A -..V �.� .-.7-0,...-447=w- SFR(1)bath 312.70
®1-and 2-family dwelling 0 Commercialfmdustriai SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
iFire
t-sq.ft.) Page2
` -11:7! *s � 3:- gn, Siteitilities
Job site address:
,'�OCJrt Sur )1,99\0.6..0„.11L. R6...� - Catch basin or area drain 18.76
City/State/TIP: Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:River Terrace East ,-
Manufactured home utilities 50.03 I
Cross street/directions to job site:r.?"1„/ , A Manholes 18.76 1
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:River Terrace East J Lot no.: Fixture or item: I
Tax map/parcel no.: Backflow preventer 1 31.27 ' 1.2. • }
v~ � 11ta4VtJ7[tTq > /, < Backwater valve 12.51
�
Clothes washer 25.02
Dishwasher 25.02 'i-
Drinking
Drinking fountain 25.02
' Ejectors/sump 25.02
} ) r °z "` '� c' Expansion tank 12.51 1
.11
Name:ADVL Land Holdings,LLC Fixture/sewer cap 25"02 I
Floor drain/floor sink/hub 25.02 k
Address:7600E Doubleree Ranch Road
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694-4031 Fax ( ) Ice maker 12.51
,70,..„-'17, � 012r. «4,4t,+rpAtIVWRES4s Interceptor/grease trap 25.02 R
Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Joleen Smith
Roof drain(commercial) 12.51 f
Address:703 Broadway St,Ste.510 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
I
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
� Water closet 25.02 t
` , "' ,` 4"-s.�'- � `"7.""a` y'e, ' chnol,'a.' Water heater 37.52
Business name: Au•1anCi._ (Aim\10
��f Water piping/DWV 56.29 e
Address: k(05 fl I� PJ6 134 Other: 25.02
City/State/ZIP: flAme\R05 t LOA Cr82-i Z, Subtotal 31.2
Phone:(StD J t...kj^,. g0Fax:( ) 7f/� Minimum permit fee: $72.50
L y ! 1 I PK 73 Plan review (25%of permit fee) 4
CCB Lic.: 0 l�0/ I r -Plumbing ic.nat. State surcharge(12%of permit fee) i
Authorized signature:„,4,, TOTAL PERMIT FEE '5.4.,. '
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`� 4 ��„ // /� This ermit a Ilcatlon expires if a emit is not obtained within 180 de 3., t
Print name: i r Date: / / p pp after It has been accepted as complete. yy ,7S
"Fee methodology set by Tri-County Building Industry Service Board. CCC»> li
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Muilding1Permits\PLMU-PermilApp.d°e 10/01/09 440.4616T(10/02/COTUK13a) I
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17051 SW APPLEDALE RD, SHERWOOD, December 7, 2018 at
OR, 97140 7:44:37 AM
Record Type: Record ID:
Commercial - Plumbing PLM2018-00428
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor