Permit (8) CITY OF TIGARD PLUMBING PERMIT
to COMMUNITY DEVELOPMENT Permit#: PLM2016 00360
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/07/2016
Parcel: 2S106DB23700
Jurisdiction: Tigard
Site address: 17390 SW SABRINA AVE
Project: River Terrace NW Subdivision: RIVER TERRACE NORTHWEST Lot: X
Project Description: Backflow preventer for irrigation of common area(Tract X)
Contractor: CASCADIAN LANDSCAPERS, INC. Owner: RIVER TERRACE NORTHWEST HOA
21510 NW FARM PARK DR 109 E 13TH ST, STE 200
HILLSBORO, OR 97124 VANCOUVER,WA 98660
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 questio. • OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: , 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.
07-05-16; 17:00 ; ; # 4/ 6
Plumbing Permit Application .
Site Utilities I-•tn Ilii It I•: 1 44: o I.i
Cityof Tigard Received
Dste/B. 7/1//0 , remit No.: °L1�2,/Cpm 5�a0
lig '. M13125 SW Hall Blvd.,Tigard,OR. 97223 Plan Review
• Phone: 503,718,2439 Fax;, 503,598,1960Data/Sy Other Permit No.:
1 I C i a„1 o Inspection Line: 503.639.4175 Data Ready/By: Anis: ' 0 See Page 2 for
Internet: www.tigard-or.0ov''' Notified/Method: Supplemental Information
• T
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special Information use checklist
Description I Qty. I Ea. I Total
0
Addition/alteration/replacement 0 Other: New 1-2-fami!y dwellings
I - rtfis(includes 10011.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
0 Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( ,sq,ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address' /7 g 90 c� g� N)/4 At) Catch basin or arca drain 18.76
Drywell,leach line,or trench drain I8.76
City/State/ZIP:Tigrad,OR Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt,no.: I Project name:River Terrace
Manufactured hams utilities 50.03
Cross street/directions to job site:SW Roy Rogers Road Manholes 18.76
Tract)(--SW Pumpkin Valley Terrace--Common Arca Rain drain connector 18.76
1 .C7--x Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no,linear ft,:,_) Page 2
Water service(no.linear ft.:_) J Page 2
Subdivision:River Terrace Lot no.: Fixture or item;
Tax map/parcel no.:Tract 11,)( ,z4S1b(p 7)g A37e O Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12,51
Clothes washer 25.02
Baekllow -
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Polygon Northwest Company Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:109 East 13th Ave -
- Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Here bib 25.02
Phone:( ) Fax:( ) Ice maker _ 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Cescadian 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 Sink/basin/lavatory 25.02
City/Statc/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:patty)cascadlanlandscapers.eom Urinal 25.02
Water closet 25,02
CONTRACTOR
Water heater 37.51
Business name:Cascadinn Landscapers,Inc. Water piping/DWV 56.29 m
Address:21510 NW Farm Park Drive Other: 25.02
City/State/ZIP:Hillsboro,OR 9712 Subtotal 31.27
Phone:(503)647-9933 Fax:(503)647-9922 Minimum permit fee: $72.50 72.50
Plan review (25%efpermit fee)
CCB Lie,:51443 Plumbing Lie,no.:LCBN5185
' State surcharge(12%of permit fee) 8.70
Authorized sigrlatur . TOTAL PERMIT FEE $1.20
Pant name:Arthur Meisner ---------- -t-e.:71-43-22016 This permit application expires If a permit is not obtained within 180 days
after it has been accepted as complete.
'fee methodology set by Tri-County Building Industry Service Board.
t:l Building\ParniMPLMU-POmiNpp.doc 10/01109 440.4616T(IW02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17390 SW SABRINA AVE, BEAVERTON, OR, May 1 , 2017 at 11 :29:52 AM
97007
Record Type: Record ID:
Commercial - Plumbing PLM2016-00360
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " 1/2 backflow device Febco model 850 ser#h34961 located on pumpkin valley far
corner of pool between sidewalk and street approved with test report.
Violation Summary:
Inspector Contractor