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Permit Plumbing Permit Application F/15-1, -p Building Fixtures r . 1 ( `- ,,,I I yI, rotz owlet ow ()NI City of Tigard Received p Permit N 13125SWHallBlvd.,Tigard,OR 97223 AUG 2 iZ 2020 Data'By O/ � �}( � �����7 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: TICiARII Inspection Line: 503.639.4175 Dore Ready/By: luris: Id See Page 2 for Internet: www,tlgard-or OV Notified`Method: Supplemental Inrm oration TYPE OF WORK. FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist. Description 1 Qty. I Ea. I Total Y_ Addition/alter ation;replaccmetit ❑Other: New I-2-family dwellings(includes 100 ft,for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 (si I-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 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: c Catch[xis in or area drain 18.76 � �'� �� �, Job site address: ' -� -,-C�y'),C.(L{�. '�)�' Cit lState/ZIP: �r _ �-Z Drywell,leach line,or trench drain 18.76 y ( J��` 75 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Z C) Z1(e Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 • -I Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: 1 Page 2 Water service(no.linear ft.: .Ir1Q) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION_OF WORK Backwater valve 12.51 cY-/ l{ d.t. , )a ray' '5 e v' V(C.E- G-6)f Clothes washer 25.02 1 i.�` - Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER Tmm�© TENANT Expansion tank 12.51 Name. GeJE/_�S'% 'r Fixture/sewer cap 25.02 ------ - 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 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: %),1f.¢JUtr 6 ✓h-+r,. 4.1. y '(_- Medical gas(value:$ ) Page 2 f' _ Printer 12.51 ( Contact name: at,el (-e c.)i'k,( Roof drain(commercial) 12.51 Address: p,. U,,,^^^. .arr ? 7, ( C Sink/basin/lavatory 25.02 City/State/ZIP: p/71 /4(c:4_ ei.8. 0,e- ` 7 Z X) Solar units(potable water) 62.54 Phone:( ) ' f Fax::( ) p3- Z-.jfCt/'-` cT� Tub/shower/shower pan 12.51 L 5 7�T 7 /G7S _ E-maiL� c 4, Vt.C' � ail` ��( y7,.ki C'' Urinal 25.02 --�` i•L>[ CONT .,21 sl 1 -c,a . �.C-.q-t-.� 2 Water close[ 25A� CONTRACTOR Water heater 37.52 Business name: 17 ,27- ik.)t t�44f'!+-6v2JJ4>' t,_.z-,, Water piping/DWV 56.29 Address: (.,0(i( i 12/1., ).. r yu.�s'i- .s- 4--- f3/V ., Other: 25.02 City/State/ZIP: y- ��j��,..�j. �%, 9 7 7-2-3 Subtotal Phone: r,. ` c- Fax: :3 2-T -S-' ='7 Minimum permit fee: $72ee) 72 r so { a�jib JfL'C 3 -u CCB Lie.: Plumbing Lic.no.: �[ Plan review (25%of permit fee) 5- 3 7 j" ✓rU 1�'� State surcharge(12%of permit fee) B'r'(7 Authorized signature:. ,(. /,�y�yyy��J .(' f� x TOTAL PERMIT FEE .P7. j' Print name: dd( f. 73 y�t2.yks..(,c _ Date: o- CYj 2 2.c.) This permit application expirbe it a permh is nor obtained within 180 days after It has been accepted as complete. *For methodology act by Tri-County Building Industry Service Board. 1:9u ilaina\Pcrmus'SPIMU-Permit.4pp.doe 1001419 440-46t6T(I0'021C.OM5WEB)