Permit (150) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENTIN , „et Permit#: PLM2017-00052
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 • ' Date Issued: 03/02/2017
T f to g115r Parcel: 2S1060001000
Jurisdiction: Tigard
Site address: no address
Project: River Terrace East Park Subdivision: None Lot: None
Project Description: Site utilities for a park located at the corner of River Terrace Blvd.and Snowdale Street: (7)catch basins, 1,110 If
footing drain,and 671 If storm sewer.
Contractor: NORTHWEST EARTHMOVERS INC Owner: POLYGON WLH LLC
PO BOX 1609 109 E 13TH ST#200
SHERWOOD, OR 97140 VANCOUVER,WA 98660
PHONE: 503-625-3100 PHONE:
FAX: 503-625-3108
FEES
Quantity Description Date Amount
7 ea Catch Basin or Area Drain 03/02/2017 $131.32
Specifics: 1110 If Footing Drain 03/02/2017 $462.75
671 If Storm Sewer 03/02/2017 $287.66
Type of Use: COM 1 Plan Review 03/02/2017 $220.43
Class of Work: ALT 1 12%State Surcharge- 03/02/2017 $105.81
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $1,207.97
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: / .. _„.9) 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.
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00052
Date Issued: 03/02/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 03/ 0/2001000
Jurisdiction: Tigard
Site address: no address
Project: River Terrace East Park Subdivision: None Lot: None
Project Description: Site utilities for a park located at the corner of River Terrace Blvd.and Snowdale Street:(7)catch basins,1,110 If
footing drain,and 671 If storm sewer.
Contractor: NORTHWEST EARTHMOVERS INC Owner: ADVL LAND HOLDINGS, LLC
PO BOX 1609 7600 E DOUBLETREE RANCH RD
SHERWOOD, OR 97140 SCOTTSDALE,AZ 85258
PHONE:
PHONE: 503-625-3100
FAX: 503-625-3108
FEES
Quantity Description Date Amount
7 ea Catch Basin or Area Drain 03/02/2017 $131.32
Specifics: 1110 If Footing Drain 03/02/2017 $462.75
671 If Storm Sewer 03/02/2017 $287.66
Type of Use: COM 1 Plan Review 03/02/2017 $220.43
Class of Work: ALT 1 12%State Surcharge- 03/02/2017 $105.81
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $1,207.97
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: Permittee Signature: "A! ,Q/pepG/Cs -77,0 a /
VCall 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 Foi oi,Flc'E l SE ONE)
F.
City of Tigard Received
Permit No.:
Iii ■ 13125 SW Hall Blvd.,Tigard,OR 9� Date/By: r )4 i 7 pi/ �C/I C,/'7 )5'x
■ Phone: 503.718.2439 Fax: 503.5 , 4+ Plan Date/By:
Review�,a 8 1 1 D 0 Other Permit No.:
D 8'
Inspection Line: 503,639.4175
T I G A R Di�'� j Date Ready/By: inns: 0 See Page 2 for
Internet: www.tigard-or.gov ,N t t,, Notified/Method: / '�, Supplemental Information
TYPE OF WORK 'S FEE* SCHEDULE
9 t`" IIk�
®New construction 0 Di�nr1pctoti►l'';- i X51'^. �` For special information use checklist
as t,r 5 Description Qty. Ea. 1 Total
0 Addition/alteration/replacement 0 Ott. New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRICTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ®Other:Parff.
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 5� Catch basin or area drain 7 18.76 7.31, .
r ��` d �.. . Drywell,leach line,or trenc rarh� 18.76
City/State/ZIP:Tigard,OR 97224 Sw
1 it0 -.0. I ' 4 •LL1. " -,sting drain(no.linear ft.: i(la, ll Page 2 1. 41175
Suite/bldg./apt.no.: Project name: River Terrace East IT* Manufactured home utilities .r'15 50.03
Cross street/directions to job site: Manholes
\-... I i tti 18a6
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no,linear illiasc ille 71 Page 21-<'1,St:
Water service(no.linear ft.: ) Page 2
Subdivision:River Terrrace East I Lot no.: Fixture or item:
Tax map/parcel no.: ? 1 il Backflow preventer 31.27
S` - " �� ` ` �l�Gr Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Park plumbing Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
4� PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:ADVL Land Holdings,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:7600 E Doubletree 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
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:William Lyon Homes,Inc Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Angela Grajewski
Roof drain(commercial) 12.51
Address:109 East 13th Street 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
E-mail:Angela.Grajewski@polygonhomes.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Northwest Earthmovers,Inc WaterPip r m DWV 56.29
Address:13600 SE Galbreath DR Other: 25.02
City/State/ZIP:Sherwood,OR 97140 Subtotal 8s.I-' 3
Phone:(503)849-8540 Fax:( ) Minimum permit fee: $72.50
CCB Lie.:62761 Plumbing Lic.no.: ?,�-4 64 -pb
Plan review (25%ofpermitfee) ` C. a}3
State surcharge(12%of permit fee) i[ ;1
Authorized signature- TOTAL PERMIT FEE l �&(7 9ti
r0 ' This permit application expires if a permit is not obtained within 180 days
Print name: , er ,/f Date: 2/ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
_ z1c aQ7 7 7'v f'e2ti/7 rte �•Z A� ,r�j'r /0,04 y� ZW 7 Ce014A/i
/9-46' 2-1
10/01/09 440-46t6T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1'100' j 50.03 0 to 2,000
50,03 $121.90
Footing drain-each additional 100' i{ 37.52 442,11
2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
�'SQ $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 6 37.52 a ,5,1 Z $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including$10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
(minimum charge 1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr ' and including$25,000.00.
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge 2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal: 75(.1.Wi
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath: -Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3„ Isometric or Riser Diagram
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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