Permit (111) CITY OF TIGARD PLUMBING PERMIT
■'. COMMUNITY DEVELOPMENT Permit#: PLM2018-00483
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/11/2018
T f t .l I<.1) g Parcel: 2S1060001400
Jurisdiction: Tigard
Site address: 17043 SW APPLEDALE RD
Project: River Terrace East Apartments,Building C Subdivision: RIVER TERRACE EAST Lot: None
Project Description: Building C: New 12 unit apartment building. Backflow preventer for landscape irrigation.
Contractor: ANDERSEN HEATING, INC. Owner: POLYGON WLH, LLC
16285 SW 85TH AVE STE 410 703 BROADWAY ST, SUITE 510
TIGARD, OR 97224 VANCOUVER,WA 98660
PHONE: 360-695-7700
PHONE: 503-992-6664
FAX: 503-536-6615
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/11/2018 $31.27
Specifics: 1 12%State Surcharge- 10/11/2018 $8.70
Plumbing
Type of Use: MF 41 ea Minimum Fee Adjustment- 10/11/2018 $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.
Issued By: / Permittee Signature:
/44
ez9/4"Ai
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.
y M
REF
VE
Plumbing Permit Application C -
Building Fixtures y ry fQ FOR OFFICE USE ONLY
1 F P j 7 (-0 i 8 Received
Cityof Tigard 1
v 131SW Hall Blvd.,Tigard,OR 9727�.17.g/ g DateBy UAff / // p /. / MS
n Phone: 503.7182439 Fax 503.591>. bff f ' A r A�t' `�gy,lew - Otirg 1? �3 7
TIGARD Inspection Line: 503.639.4175 BUILDING DIVIc fr ydyeBd: Juris: H Se
ePage2forInternet:-www.tigard•or,gov Supplemental
Information
314 . .u= Oki O,,y r Mme. - l^--•c•*- 1. - at'-`r, -R- �p gT;;..�zc-.7,--'e' _
- -+E. . _--`i-�__ �:r.-mei:`- --. ti�``.tt;f�`aA� .? --• - .: .�•v-- •-- _- .:, •
®New construction ❑Demolition For special information rise checklist
Description I Qty. I Be- 1 Total
❑Addition/alteration/repIacement 0 Other. New I-2-family dwellings(includes 100 ft.for each utility connection)
*� = ,4T191- 71 312.70
�__-- ��.�1��� 0 `4 O T� U- -- - �- -== SFR(I)bath
_ - sem-=Y"F��,-
1-and 2-family dwelling 0 CommerciaVmdustrial SFR(2)bath 437.78
❑Accessory building Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other
,4� -` -LL_,=- ,�,N. _ ,.v._ :__. Fire sprinkler�sq.ft) Page2
i-' � 0 9;T VW44-td3eW,,,L �s _a:,_r Site utilities:
Job site address: ‘1045W , -C\f1�, � � Catch basin or area drain 18.76
City/State/ZIP; Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:__) Page 2
Suite/bldg./apt.no.: I Project name:River Terrace East Manufactured home utilities 50.03 I
Cross street/directions to job site:r--61.2) C.;,, Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2 I
• Storm sewer(no.linear ft.: Page 2 I
Water service(no.linear ft.:_) Page 2 €
Subdivision:River Terrace East I Lot no.: Fixture or item: _
Tax map/parcel no.:
Backflow preventer 31.27
""lr. ?� - ;i= .._.- _. .- ._...... . Backwater valve 1151
- .,...-�--rte ;.
�_.. _..- = Clothes washer 25.02
Dishwasher 25.02 €
Drinking fountain 25.02
Ejectors/sump 25.02
a, L F x _ __ r x u2-__ Expansion tank 1251^�s ;' ER O AV-WieP N `9
Name:ADVL Land Holdings,LLC
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25,02 a
Address:7600 E Doublerce Ranch Road l
Garbage disposal 25.02 t
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694-4031 Fax:( ) Ice maker I2.51
- .:.SFA=S..: .. x-at nY,yt....-"" `.
� - rix ' .17=- Interceptor/grease 25.02
; ,� .' �'[]"�bNT�1CT �l3SQPTa - trap
Business name:Polygon WLH,LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Joleen Smith i
Roof drain(commercial) 12.51
Address:703 Broadway St,Ste.510 Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54 f
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/showerpan 12,51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
= _ _ �_T= e=-- <:. -:_ Water closet 25.02
,� Water heater 37.52
Business name: k X' +i`°e _OANY\,P \l'..
Water piping/DWV 56.29
Address: 1,4 55.5 $U3 'trj e t 54 L-I D Other. 25.02
City/State/ZIP: 1 1�O..YcA , � 91 2.11-/ Subtotal i
Phone:(503) 2 (o(p(,. Fax( ) Minimum permit fee: $72.50 t'
/� Plan review (25%of permit fee)CCB Lie.: /Y !/ Plumbing Lic,na•i• /q/�/���/ State surcharge(12%of permit fee)
Authorized sig ma e: �,l^ , / /' TOTAL PERMIT FEE R'(,z 0 E
Print name: I^�n e !` Date: , 124/718, T permit application expires if a permit is not obtained within 180 days
i/VJ ( ,after ithas been accetedascomlete.
*Fee methodology set by Tri-County Building Industry Service Board.
Ituiidiog\em;itaiPLMCTPeneitApp.dao 1WPoIN9 -44a.46l6T(10/f2/CO14/WEB)
er