Permit (105) CITY OF TIGARD PLUMBING PERMIT
ItCOMMUNITY DEVELOPMENT Permit#: PLM2018-00438
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/11/2018
TIC A I=.L� g Parcel: 2S1060001400
Jurisdiction: Tigard
Site address: 17077 SW APPLEDALE RD
Project: River Terrace East Apartments,Building B Subdivision: RIVER TERRACE EAST Lot: None
Project Description: Building B: Plumbing for new 22 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
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
41 ea Minimum Fee Adjustment- 10/11/2018 $41.23
Type of Use: MF 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.
Issued By: i---- Permittee Signature:
/44
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.
I J : �4 7 -
Plumbing Permit Application
Building Fixtures F P :1 ' "2.018 FOR OFFICE USE ONLY
Cl of Tigard Received
III w 13125 SW Hall Blvd.,Tigard,OR 97223.7 i`v/ (s r, i p i-<k Y• 77/u /// f 'emit /'-"Actio': i /2r
Plan Review ! 1/ ✓
Phone: 503.718.2439 Fax: 503598 °
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TIGARD Inspection Line: 503.639.4175 � !)l it! d '' l" ateReady/By: Suds: See Pag2for
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www tigard orgov Notified/Method: Supplemental if d/Mcthod
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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)
4' .` oft 6ret a 3 � i SFR(1)bath 312.70
®1-and 2-family dwellin SFR(2)bath 437.78
g ❑Commercial/industrial
ir
❑Accessory building 0 Multi-familySFR(3)bath 50032
Each additional bath/Idtchen 25.02
❑Master builder 0 Other:
Fire sprinklersq.ft.) Page2
$.6 .:w,_ t t ! 4Tto . •.'.fG,�l1tXdN '� Site utilities
Job site address: n p'•,-, 5� � � R�r Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:River Terrace East Manufactured home utilities 50.03
Cross street/directions to job site:�l2)G""o I Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2 f
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:River Terrace East I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 1.2-1
0 `bl? r,' i'', , . i- Backwater valve 12.51
m.-F - A k. x _ - _ ,, ,-..tis ,z.,k�- z Clothes washer
25.02 i
Dishwasher 25.02
i
Drinking fountain 25.02 i
_
Ejectors/sump 25.02
* `¢ iii '-FiR' ?0: 1t `t, -rye Q•I'''' '''''' '''''''-''''":11a.:4"aTINAD11' *€'flExpansion tank - 12.51
aw...�..- ,....,,.x+.w....,-c.. ^?".='. °v4"',"*�..', r_�., .c.-_z.l,-f ., ..s_� ..
Name:ADVL Land Holdings,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:7600 E Doublerce Ranch Road
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694-4031 Fax:( ) Ice maker 12.51
1AF'iNT rip }TPyItSQrIy Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$�) 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 Fax::(360)693-4442 Tub/shower/shower pan 12.51 a
E-mail:permitsubmittals®polygonhomes.com Urinal25.02
El.., ---:,... ..., - --,� -- _' : -`,�,ymak.,a.- Water closet 25.02
�" •_. .__-' Water heater 37.52 t.
Business name: ohoA Jirerseji.‘ \do. \pc' WaterF�P•P 1 in WV 56.29
Address:dr ss. ,(4 2 SA/0 $54AN k,y c t 5 1-110 Other: 25.02 a
i
City/State/ZIP: oor,9\ , CIS 91 Zvi Subtotal St.21 b
(5 3) q'et ( )
Phone: D �(0(� Fax: Minimum permit fee: $72.50
:
t Plan review (25%of permit fee)
CCB Lie.: `1 Plumbin_Lie.ne i+
LcAr U f r State surcharge(12%of permit fee)
Authorized signa e: 41� '/,e�n, r - n
TOTAL PERMIT FEE i
Print name: (1v Date: q r� �S This permit apptitation eipires ita permit is not obtained within 180 dayky
t / after it Les been accepted as complete
"Fee methodology set by Tri-County Building Industry Service Board. r
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