Permit (7) Il
CITY OF TIGARD PLUMBING PERMIT
`E'! 2 °' COMMUNITY DEVELOPMENT Permit#: PLM2016 00358
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/07/2016
Parcel: 2S106DB23600
Jurisdiction: Tigard
Site address: SW NO ADDRESS
Project: River Terrace NW Subdivision: None Lot: None
Project Description: Backflow preventer for irrigation of common area(Tract W)near Sabrina Ave.
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 07/06/2016 $31.27
Specifics: 1 12%State Surcharge- 07/06/2016 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 07/06/2016 $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 q sir-6-ns to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: k----tTht-pg—471/`4
""\ Permittee Signatur .
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.
07-05-16; 17:00 ; # 2/ 6
Plumbing Permit Applicata
Site Utilities # Wit t:li•IIt'i, 1 ,4I irSI,I
City of Tigard 1; D e/B Received 7 t!P ft/ ,% Permit No,: paid,l le—6z)35
IIIII ... + 13125 SW Ha1181vd.Tigard OR 97223 Plan Review
2 Phone: 503,718.2439 Fax:•,$03.598.1960 �4ya Other Permit No.:
Inspection Line: 503.639.4173 Y
1'i�.,111 I� P Date ItendYlBy, _-...� Jude Stl See Pagel for
Internet www.tigard-or.gov=-- Notified'Mached: Supplemental information
TYPE OF WORK`" FEE* SCHEDULE
New construction ❑Demolition For special Information use clieek1156
-. Description r Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ~ ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 50032
CI Accessory building v 0 Multi-family -
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Piro sprinkler{_sq.ft.) _ Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 6/„0 113, ADb2--S Catch basin or arca drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigrnd,OR
Footing drain(no.linear ft.:____) Page 2
Suite/bldg./apt.no.: Project name:River Terrace Manufactured home utilities 50,03
Cross street/directions to job site:SW Roy Rogers Road Manholes 18.76
Tract W --SW Sabrina Avenue--Common Arca Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
storm sewer(no.linear ft:_1 Page 2
Water service(no.linear it.: ) Page 2
Subdivision:River Terrace I Lot no.: Fixture or item:
Tax map/parcel no,:Tract W oZ.S/t��3a Backflow preventer 1 31.27 31 27
DESCRIPTION Or' WORK
Clothes
12,51
Clothes washer 25.02
Backflow Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump _ 25.02
tgi PROPERTY OWNER I Cl TENANT Expansion tank 1231
Nae:Polygon Northwest Company Fixture/sewer cap 25.02
Name:
Floor drain/Boor sink/hub 25.02
Address:109 East 13th Ave
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25,02
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON interceptor/grease trap 25,02
Business name:Cascadian Landscapers,Inc. Medical gas(value:$ ) Page 2
Primer 12,51
Contact name:Arthur Meisner
Roof drain(commercial) 12.51
Address:21510 NW Farm Park Drive Sinit/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/showerpan 12.51
E-mail:patty a cascadlanlandscapers.com Urinal 25.02
- Water closet 25.02
CONTRACTOR
— Water heater 37,52
Business name:Cascadinn Landscapers,Inc, Water piping/DWV 56.29
Address:21510 NW Farm Park DriveOther: 25.02
City/State/ZIP:Hillsboro % ' 97124 I - Subtotal 31.27
Phone:(503)647-9933 Fax:(503)647-9922 Minimum permit fee: $72.50 72,50
CCB Lie.:51443 , ' Plumbing Lie.no.:LCB#5185 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8.70
Authorized signature: lipir '----% TOTAL PERMIT FEE 81.20
Print name:Arthur Meisner Date:7-05-2016 'th Is permit application expires If a permit is not obtained wltldn 1110 days
after It has been accepted as complete.
*Pee methodology set by Tri.County Building Industry Service Board.
1,10uildiny\Pnmits\FLMU-PennitApp.doe 10/01/09 440.616T(IO/02/COM/WED)