Permit (107) CITY OF TIGARD PLUMBING PERMIT
IIII4COMMUNITY DEVELOPMENT Permit#: PLM2018-00477
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/11/2018
TIC.; I=.[� g Parcel: 2S1060001401
Jurisdiction: Tigard
Site address: 13265 SW 169TH AVE
Project: River Terrace East Apartments,Building D Subdivision: RIVER TERRACE EAST Lot: None
Project Description: Building D: 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: 503-992-6664 PHONE: 360-695-7700
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
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.
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Issued By: /�C ♦, / ....I Permittee Signature: ..r2. r- /•-eii 8Z'/ 1.1
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.
RECEIVED
Plumbing Permit Application
Building Fixtures ;E P 2 7 ?.1118 ron orrice USE ONLY
City of Tigard
�v,... Receivz ed
v 13125 SW Hall Blvd. TigTA213 1 IIGARD Datemy:
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Plan ReviewSPhone: 503.718.2439, l2- Date/Br
Inspection Line: 503.63 f � IVIION ,wr j�
TIGARD DateReay/By: leis: H See Page 2for
Internet: www.tigard-or,gov Notified/Method: Supplemental Information
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®New construction 0 Demolition For special information use checklist
Description I Qty. I Ea I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)-
:77,-.'1111-i-.077:4- SFRbath
`r' 312.70
"_.,...®-_._ .. , . nx�-. O�n � _w.a-4sa� (1)
®1-and 2-family dwelling F. • 0 Commercial/industrial{ SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ulft-family Each additional bath/!Itchen 25.02
❑Master builder ❑Other:
_ �..- -�:.;};. _� �_ � _ Fire sprinkler t_sq.ft.) Page 2
4▪ .�▪ `??` z4v 13=M r 1_6:.. ,A TA='�t,Q" 0 R, Site utilities:
Job site address: fl 2.1.0 5 5(A) ,I term; Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no,linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:River Terrace East Manufactured home utilities 50.03
Cross street/directions to job site:r61.2)U-3> Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2 ,
Storm sewer(no.linear ft.:. ) Page 2 1
Water service(no.linear ft.: ) Page 2 1
Subdivision:River Terrace East I Lot no.: Fixture or item: _
Backflow reventer 31.27 I
Taxmap/parcel no.: P
r g-'v e=;��,. mixt_ -.;4:svLw-4,1 ..:?r, "w.-: ,�,-m�a Backwater valve I2,51
. .r :. = I ry *-t 7,.
F Clothes washer 25.02
Dishwasher 25.02
. Drinking fountain 25,02
Ejectors/sump 25.02-
_- ` .Tk;c^-�..+Fw^.-rc. at5u..•.ur+r �:?f _. __4C. -CS.z+:.AVY-a•..W�-.r::=.�tid_�
i k il'NIt' a0 E1(t_ I g ]ifil S1_ ;=MI:.„,_ ba. Expansion tank 12.51
Name:ADVI Land Holdings,LLC T c Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25,02
Address:7600 E Doublerce 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
=a 3>��esN i� �ONT1CFROI� �' Interceptor/grease trap
25.02
,,,ria, _
Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2
Primer 12,51
Contact name:Joleen Smith
Roof drain(commercial) 12.51
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 Far:(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals®polygonhomes.com Urinal 25.02
- ecam"^ ::. -,..triWater closet 25.02
'1 �` � •- Water heater 37.52
Business name: '1r\ `v�Y\g , \YNc. Water piping/DWV 56.29
Address: tlP2�5 SUJ tS t Sire- 1410 Other: 25.02 is
City/State/ZIP:T 0.X r,\ , tyyz. 912-2-4/ Subtotal
Phone:(56) c 2> #4e6.t/ Fax;( ) Minimum permit fee: $72.50 (
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Plan review (25%of permit fee) !
CCB Lie.: C ce fd, / r Plumbing Lie.nei• ` y6 tf/1 State surcharge(12%of permit fee)
Authorized signs •e: ► F TOTAL PERMIT FEE
or
Thispermit a Geatioa
Print name: 7r'4' /- S Date: 12� ii,:, pP expires if a permitis not obtainedp �rithin 80 days
/ [�( T ,after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industy Service Board. .
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