Permit (110) CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMENT Permit#: PLM2018-00481
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/11/2018
T t t;;ti I Dg Parcel: 2S1060001400
Jurisdiction: Tigard
Site address: 13187 SW 169TH AVE
Project: River Terrace East Apartments,Building H Subdivision: RIVER TERRACE EAST Lot: None
Project Description: Building H: New 12 unit apartment building. Backflow preventer for landscape irrigation.
Contractor: ANDERSEN HEATING, INC. Owner: POLYGON WLH, LLC
16285 SW 85TH AVE STE 410 703 BROADWAY ST, SUITE 510
TIGARD, OR 97224 VANCOUVER,WA 98660
PHONE: 360-695-7700
PHONE: 503-992-6664
FAX: 503-536-6615
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/11/2018 $31.27
Specifics: 1 12%State Surcharge- 10/11/2018 $8.70
Plumbing
Type of Use: MF 41 ea Minimum Fee Adjustment- 10/11/2018 $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 to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �: .-rmittee Signature: "rijr.C•/75;-
(.
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 EISti FOR orrIcc use ONLY
City of Tigard Received // /1// % V /
13125 SW Hall Blvd.,Tigard,OR 97223_, DateB : //')
•
1 Phone: 503.718.2439 Fax 503.598.199��l,;1 DaWB��ipi
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Inspection Line: 503:639.4175 6rG/�
TIGARD DateReadyBy: iris: 0 eePage 2for
Internet:'www.tigard-or.gov Nottiied/Metho
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®New construction d _ y For s eclal information use checklisL�s `
Description �� Qty. ( Ea- I Total
•0 Addition/alteration/replacement 0 Other. New 1-2-family dwellings(includes 100 ft.for each utility connection)
� = ::= --t A _ �OCOU ( * SFR(1)bath 312.70
-_, •••.- --'-g_ ;:}4-•;;,-.._- :y--._ '_:'_.
®1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
gr
0 Accessory building lig Multi-fesY SFR(3)bath 500.32
El Master builderEach additional bath/kitchen 25.02
0 Other: _ Fire sprinkler( s4.ft) Page 2
:_ 2-'rte-=._ ._`---- Vin,_:-- ..r-- - --- --• _2,ti_'=t=,•�E_:-:;_:'�
_ tjBir1-i 't Ift&Prj-Q(4. i2�0`iI .rm ry Site utilities:
Job site address: 1313-1 51/0 110`'-6-+ NU& Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP;
Footing drain(no.linear R.: ) • Page 2
Suite/bldg./apt.no.: I Project name:River Terrace East Manufactured home utilities 50.03
Cross street/directions to job site:(-61.2)G‘....V Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: Page 2 ,
Storm sewer(no.linear it: ) Page 2
Water service(no.linear ft.:. ) Page 2
Subdivision:River Terrace East I Lot no.: Fixture or item:
Tax map/parcel no.: Baekilowpreventer _ 31.27
r .t -,r a ---N 0 U - • _tate=---g _-=7_ La Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
. Drinking fountain 25.02
Ejectors/sump
1 cam..
25.02
��$aF�� T� �: - -- L ' Lt 1Wt wi- Expansion 12.51- _ Z - -
Name:ADVL Land Holdings,LLC Fixture/sewer cap 25.02
Address:7600 E Doubleree Ranch Road
Floor drain/floor sink/hub 25.02 I
Garbage disposal 25.02
City/Stater/1P:Scottsdale,AZ 85258 Hose bib 25.02 r
Phone:(602)694-4031 Fax( ) lee maker 12.51
_ - I4 _ :. .' "Gr=FR--)� aIntercePtor/ ease trap
25.02:. - - - =.r• �;v'�: :-_tm.,. ��:..ice.«.�,. w
Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2
• Primer 12.51
Contact name:Joleen Smith
Roof drain(commercial) 12.51 ! s
Address:703 Broadway St,Ste.510 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54 -
Phone:(360)695-7700 Fax:(360)693-4442 Tub/shower/shower pan 12.51 C
E-mail:permitsubmittals@polygonbomes.com Urinal 25.02
_ Fp CLbk _ , rM? � Water closet 25.02 k.
Waterlleater 37.52
Business name: )!rnde%cz,e r.., geo..\,;\v l \YAC,
Water piping/DWV 56,29
Address: at'7.-ISS S1.0 1S4-kn. f-e 1 5`}2 z--11 O Other. 25.02
City/State/ZIP:�1 G
1 t�0.-YD\ , �7YZ q'r Z7� Subtotal _
Phone:(5jl3) 2 (�(0(,#e/ Fax ( ) Mmimumpemlitfce: $72.50 t
CCB Lie.: /t (r,1 I Plumbing Lie.ne-ypA/y�� Plan review (25%of permit fee)
l V f ` State surcharge(12%of permit fee)
Authorized sign e: , TOTAL PERMIT FEE T.2•f/
Print name: 7yt,y y�� ,t{l�/i Thttpermita ]icefion
/ f�'(( fYi/C/�J!`� Date: pp expires if a permit is not obtained within 180 days LLf
E.
•after ithas been accepted as complete: 4.
*Fee methodology set by Tri-County Building Industry Service Board. i
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