Permit (172) CITY OF TIGARD PLUMBING PERMIT
111 COMMUNITY DEVELOPMENT Permit#: PLM2019-00106
TIC,AR 1-7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/29/2019
Parcel: 2S107AA26300
Jurisdiction: Tigard
Site address: 14450 SW RIVER TERRACE BLVD
Project: Polygon at Roshak Ridge Swim Center Subdivision: ROSHAK RIDGE Lot: U
Project Description: Plumbing site utilities for Roshak Ridge Swim Center.
Contractor: NORTHWEST EARTHMOVERS INC Owner: POLYGON WLH LLC
PO BOX 1609 703 BROADWAY ST STE 510
SHERWOOD,OR 97140 VANCOUVER,WA 98660
PHONE: 360-695-7700
503-625-3100
FAX: 503-625-3108
FEES
Quantity Description Date Amount
1 ea Drywell,Leach Line or Trench 04/29/2019 $18.76
Specifics: Drain
250 If Footing Drain 04/29/2019 $125.07
Type of Use: COM 100 If Sanitary Sewer 04/29/2019 $62.54
Class of Work: ALT 146 If Storm Sewer 04/29/2019 $100.06
Type of Const: 87 If Water Service 04/29/2019 $62.54
Occupancy Grp: 6 ea Roof Drain(Commercial) 04/29/2019 $75.06
Stories: 1 Plan Review 04/29/2019 $111.01
1 12%State Surcharge- 04/29/2019 $53.28
Plumbing
Total $608.32
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. A.
Issued By: � Permittee Signature:
1/(4
Call 503.639.4175 by 7:00 a.m.for the next available inspection°7
date. 6
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 ,_ a
Site Utilities FOR OFFICE USE ONLY
City of Tigard fir'n.R 14 Z019 V9 Dateived
IN 13125 SW Hall Blvd.,Tigard,OR 97223i. Plan Review
II Phone: 503.718.2439 Fax: 503.598.19610 l DateBy: Other Permit No.:
I I c;ARD Inspection Line: 503.639.4175 Date Ready/By: , Juris: Pi See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 1, i' WISP
.v Supplemental Information
,. r 55y" ^F,a*f1.A :h� - i ,' r .,'4 '' 'G * fir, ' i'7:; Ai, ».,< q,,,, v.. ,,too,:: ,,,,==y,,,,-.0.--,"� .s a' l 5 .1 „,, ,sr y ,,,,,..,,4--,,,,,,,,,,,,--
,
For special information use checklist
®New construction ❑Demolition
Description I 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 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:14450 SW River Terrace Blvd Catch basin or area drain 18.76
Drywell,leach line,or trench drain 1 _ 18.76 Lk', -IC:,
City/State/ZIP:Tigard,OR 972245 •O�7
Footing drain(no.linear ft.:4S'r ) Page 2
Suite/bldg./apt.no.:N/A Project name:Roshak Ridge Manufactured home utilities 50.03
Cross street/directions to job site:North of Bull Mountain Road Manholes 18.76
Rain drain connector 18.76
- Sanitary sewer(no.linear ft.: /L1) ! Page 2 Gats,..,---4
Storm sewer(no.linear ft.: AO _ Page 2
Water service(no.linear ft.:r7) 1 _ Page 2 g_1 .y
Subdivision:Polygon at Roshak Ridge I Lot no.:U Fixture or item: Ge`
Tax map/parcel no.:2S107AA26300 Backflow preventer 31.27
DSCRIPTION OF WORD Backwater valve 12.51
Clothes washer 25.02
Roshak Ridge Swim Center site utilities Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
R4 PROPERTY OWNER Q TENANT Expansion tank 12.51
Name:Polygon WLH LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway ST Suite 510 Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:(360)693-4442 Ice maker 12.51
Cl APPLICANT 13CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:same as owner
Primer 12.51
Contact name: ,,,,7Roof drain(commercial) _ (ts 12.51 ' ,.:5--.Lk.
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan _ 12.51
Urinal 25.02
E-mail: -
Water closet 25.02
COI? RACT4 _ _
Water heater 37.52
Business name:Northwest Earthmovers,Inc. Water piping/DWV 56.29
Address:13600 SW Galbreath Dr.PO Box 1609 Other: 25.02
City/State/ZIP:Sherwood,OR 97140 Subtotal /14 y
Phone:(503)858-9231 Fax:( ) 7 L f/2-U Minimum permit fee: $72.50
3 ��� Plan review (25%of permit fee) ii j 61 i
CCB Lic.:62761 Plumbing Lic.no.: �G 73 .
State surcharge(12%of permit fee) �,, �
Authorized signature: /// n �4,, TOTAL PERMIT FEE ( 1` jf),
�} 1.
{� This permit application expires if a permit is not obtained within 180 days
Print name: ,A. ('Aie,�)sU n` r�.� l Date: �I 1 � after it has been accepted as complete.
I *Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/OI/09 440-4616T(10/02/COM/WEB) 1,
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sup ression Systems
/ I ii �
Footing drain-151 100' 1 50.03 {c 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 1 62.54 6).
) it 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 1 62.54 61,.91 Medical Gas S stems:
Water Service-each additional 100' 37.52 ,itPr
jett.ePE. r.1"n--4117"f•V , 1
Storm&Rain Drain-1st 100' 1 62.54 V1.S� $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' / 37.52 1 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
1 each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $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:
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*.
r a � w
� _ � Plan review is required for anyof the following.
t `€` pd 3 Added Refit Please check all that apply.
Baptistry/Font
❑ Any new commercial building with water service 2"and
Bath -Tub/Shower
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-4,, marrr ,' € : `;. ., A,
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
N:\proj\395-010\05 Reports\Planned Development\Permitting\395010.PLIIU_PermitApp.20l9-03-12.doc
III a Site Utilities — Plumbing Permit Application
■
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ® map&tax lot# ® project name I site address ® suite number
® zoning ® applicant name ® phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS -Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping,manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Permits\PLMF-PermitApp.doc 12/30/05
A
Plumbing Permit Application
Site Utilities FOR OFFICE GSE O\Ll
City of Tigard Received PL M 26
g Date/By: � J��/E� Permit No.: 1 i-wh�
III13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review p n
_ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: -1 V I L ./a Other Permit No.:
T I G A R l) Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
'i'YPE VO RK
a ,..,w. ma
`
F For special information use checklist
!-1 New construction 0 Demolition
Description I Qty. Ea. 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
I=11-and 2-family dwelling jtrCommercial/industrial
SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
1 � ��w` �i Uew �e rYU Q l�� Drywell,leach line,or trench drain j 18.76 /8. 74
City/State/ZIP: -T-;6a,4 j 0 K. Cl I D.14Footing drain(no.linear ft.:2 O) 3 Page 2 /a 5,O7
Suite/bldg./apt.no.: Project name: R�Lk R i„- Manufactured home utilities 50.03
Cross street/directions to job site: ! '+\. ( Q tot:- ir Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:agi,) / Page 2 („'!.S¢
Storm sewer(no.linear ft.:/M6) Z, Page 2 /00.O 6
Water service(no.linear ft.:j.) / Page 2 62.5q.
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
, f SCRIPTIOIi F WiRIc ri „e;
Clothes washer 25.02
S;A Q (A.ti(t{ i es . r SC.r✓4 in. L-fi.1,.`k-eV- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
z d PROPERTY VNER I '4, ;.❑ TEN.'Aill,7'i Expansion tank 12.51
` Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
- APP.ICAN''. ❑ CONTACT PERSON r Interceptor/grease trap 25.02
.. , t , f..' ' Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name: Roof drain(commercial) 6 12.51 95,
c,‘
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 414-.03
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) ///.Q
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee) s3,28
Authorized signature: TOTAL PERMIT FEE 09.32
Date: This permit application expires if a permit is not obtained within 180 days
Print name: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440.4616T(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' / 50.03 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 2 37.52 75.04 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' ` 62.54 6,1.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 02.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:"
Storm&Rain Drain-1st 100' j 62.54 61.Sof $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' ( 37.52 39,5.2 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections br Fees {Qty, Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $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: 354.2 I
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*.
_ Quantity by Fixture Type
Fixture Type for eplacel".Y Review for Plumbing InStaatiOlC1S
Work Performed;. Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower
0 Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain ISOltlie> 'iC of Kiger Diagram
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU_PermitApp.doc 2
•
III "I Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map&tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS-Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping,manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Permits\PLMF-PermitApp.doc 12/30/05