Permit (32) CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit#: PLM2016-00229
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/26/2016
T r�;A I<.i) 9 Parcel: 2S1060001500
Jurisdiction: TIGARD
Site address: 13515 SW CALABASH TER
Project: River Terrace Northwest,Lot 1 Subdivision: RIVER TERRACE NORTHWEST Lot: 19
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: CASCADIAN LANDSCAPERS, INC. Owner: ADLV LAND HOLDINGS LLC
21510 NW FARM PARK DR BY FORSUM, MICHAEL
HILLSBORO, OR 97124 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 503-647-9933 PHONE:
FAX: 503-647-9922
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/26/2016 $31.27
Specifics: 1 12%State Surcharge- 04/26/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/26/2016 $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.
Issue By: Ii/ Permittee Signature-
41111W,
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
Plumbing Permit Applica ' `,
Site Utilities
City of Tigard APR Z Q'S Received /6 r Permit No.: AUy�/4,'6d a-2.9
sr 13125 SW Hall Blvd.,Tigard,OR 97223
:511 111 a Plan Review H. .,-,.ryLC
Phone: 503.718.2439 Fax: 503,555a960 Date/By Other Permit No.: Cly 7
Inspection Line: 503.639.4175 Date Read /B 7uris: ® See Page 2 for
IIGART) l,zr Y Y g
Internet: www.tigard-or.gov z �h`: Notified/Method: Supplemental Information
... a - .� �,, TYPE OF,WORK'' z41 444 f ",' l'FEE* SCHEDULE i iI.' . l
®New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
4: ' `CATEGORY OE CONSTRUCTIOI '144 SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
0 Accessory 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
.., '' JOB,SITE INFORMATION ANDxLOCATION 4: Site utilities:
Job site address:13510 SW Calabash Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Riverside Terrace Manufactured home utilities 50.03
Cross street/directions to job site:Roy Rodgers and Scholls Ferry Manholes 18.76
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: I Lot no.:1 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
Backwater valve 12.51
DESCRIPTION OF WORK,
Clothes washer 25.02
Backflow Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
®_PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Polygon Northwest Company Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:109 E.13th Street
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
0 APPLICANT , 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Cascadian Landscapers,Inc. Medical gas(value:$ ) Page 2
Contact name:Art Meisner Primer 12.51
Roof drain(commercial) 12.51
Address:21510 NW Farm Park Drive Sink/basin/lavatory 25.02
City/State/ZIP:Hillsboro,OR 97124 Solar units(potable water) 62.54
Phone:(503)647-9933 Fax::(503)647-9922 Tub/shower/shower pan 12.51
E-mail:art@cascadianlandscapers.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Cascadian Landscapers,Inc. Water piping/DWV 56.29
Address:21510 NW Farm Park Drive Other: 25.02
City/State/ZIP:Hillsboro,OR 97124 Subtotal
Phone:(503)647-9933 Fax:(503)647-9922 Minimum permit fee: $72.50 72.50
CCB Lic.:S1= Le-6 51 t S Plumbing Lic.no.:L�B#51t5 Plan review (25%of permit fee)
. State surcharge(12%of permit fee) 8.70
Authorized signature: o. TOTAL PERMIT FEE 81.20
This permit application expires if a permit is not obtained within 180 days
Print name:Bryan Rose Date:4/25/2016 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pennits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13515 SW CALABASH TER, SHERWOOD, November 22, 2017 at
OR, 97140 11 :53:24 AM
Record Type: Record ID:
Residential - Plumbing PLM2016-00229
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
3/4" Wilkins model 350 ser#A546457 Backflow device located right of front door
approved with test report
Violation Summary:
Inspector Contractor