Permit 1114 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00485
T1G RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/05/2019
Parcel: 2S107AA24300
Jurisdiction: Tigard
Site address: NO ADDRESS
Project: Polygon at Roshak Ridge-Tract A Subdivision: POLYGON AT ROSHAK RIDGE Lot: A
Project Description: Irrigation backflow in common space of Tract A between lots 8 and 9, 14291 and 14309 SW 168th Ave.
Contractor: CASCADIAN LANDSCAPERS, INC. Owner: POLYGON WLH, LLC
16700 SW BLOOMING FERN HILL RD 703 BROADWAY ST, SUITE 510
CORNELIUS, OR 97113 VANCOUVER,WA 98660
PHONE: 503-647-9933 PHONE:
FAX: 503-647-9922
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/05/2019 $31.27
Specifics: 1 12%State Surcharge- 12/05/2019 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 12/05/2019 $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 ail 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: ec:_t' Permittee Signature:
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 y` - FOR OFFICE DISE ONLY
City of Tigard Received G �ge J�J L
13125 SW Hall Blvd.,Tigard,OR 97223r, Date/By:/ /S // '�� �/Y rmit No��� �� �/y0�-
C Plan Review
Phone: 503.718.2439 Fax: 503.598.19'60 2019 Date/By: Other Permit No.:
T I G A R D Inspection Line:.503.639.4175 Date Ready/By. Juris: 63 See Page 2 for
Internet: www.tgard-or.gov Notified/Method: Supplemental Information
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®New construction ❑Demolition For special information use checklist.
Description Qty. Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
" _}°" t w STRU t a .: SFR(1)bath 312.70
1 ® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
\I 0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Firesprinkler(-sQ ft.) Page 2
t t E i "TIO ' ° t Site utilities:
to Catch basin or area drain 18.76
Job site address:SW 168 Ave(T7:aec.7!,).tyween Lots 8&9
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Beaverton,OR
Footing drain(no.linear ft.:__) Page 2
' Suite/bldg./apt.no.: I Project name:Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site:Common Space along SW 168th Ave Manholes 18.76
iand between lots 8&9 Rain drain connector 18.76
6) %A p/ r- „ /6 6en Sanitary sewer(no.linear ft.:_) Page 2
r /�/307 9 -ju/ Storm sewer(no.linear ft.:_) Page 2
,Jl C( [r r/
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
11
Tax map/parcel no.: S' A= , Backflow preventer 1 31.27 31.27
l 9° d '
7.
Backwater valve 12.51
Clothes washer 25.02
ti Irrigation Backflow
Dishwasher 25.02
Drinking fountain 25.02
,�•�tl1J Ejectors/sump 25.02
6YT ..• -q •- pkv
t tr '� ' ^ 0 TENANT Expansion tank 12.51
it
I Name:Polygon Northwest Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St,Suite 510
Garbage disposal 25.02
L' City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
�a e N Interceptor/grease trap 25.02
Business name:Cascadian Landscapers,Inc Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Art Meisner
Roof drain(commercial) 12.51
Address:36700 Sw Blooming Fern Hill Rd Sink/basin/lavatory 25.02
City/State/ZIP:Cornelius,OR 97113 Solar units(potable water) 62.54
Phone:(503)647-9933 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:Kari@cascadianlandscapers.com Urinal 25.02
CONTRACTOR I.4 Water closet 25.02
Water heater 37.52
Business name:Cascadian Landscapers,Inc Waterg�1 m WV 56.29
pip
Address:36700 SW Blooming Fern Hi d Other: 25.02
City/State/ZIP:Cornelius,OR 97113 Subtotal
Phone:(503)647-9933 Fax:( ) Minimum permit fee: $72.50 72.50
Plan review (25%of permit fee)
CCB Lic.:51443 ___._ - Plumbing Lic.no.:
State surcharge(12%of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20
i
11/18/19 This permit application expires if a permit is not obtained within 180 days
Print name:Art Meisner after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
440-4616T(10/02/COM/WEB)
l:\Building\Permits\PLMU-PermitApp.doc 10/01/09