Permit Support Document Plumbing Permit App1EiVED Q l -2a B
Building Fixtures ILIJ FOR OFFICE USE ONLY
SEP 01 2020 Received
- City of Tigard Permit No
11111 ■ 13125 SW Hall Blvd.,Tigard at '7 Plan RevBy: f'li/� T�!�-d���0
Plan Review eAj
Phone: 503.718.2439 F. • 9 6�IGARD Date/By: ry/J H`70 A 4.1.1) Other Permit No.:
TIGARD Inspection Line: 503.639.41 - iING DIVISION Date Ready/By / A Jars. l See Page 2 for
Internet: wwnv.tigard-or.gov Notified/Metho / V 'nCT- Supplemental Information
TYPE OF WORK 477. -f 6.... N--,Ti9- FEE* SCHEDULE
''New construction ❑Demolition For special information use checklist.
--------- Description l Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
X-and 2-family dwelling 0 Cornmercial/industrial SFR(2)bath 437.78
❑Accessory building El Multi-family
SFR(3)bath 500.32
Each additional bath/kiichen 25.02
❑Master builder ❑Other: Fire sprinkler(J'2-tut ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ,(432,Q c' , tbQ-s Catch basin or area drain 18.76
DrCity/State/ZIP: C�A-9 a"Dag Footing
drain
line,noe trench drain 18.76 Page
p n', Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: -1'3 I Project name: �54 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
it)LCn e I 11�f -4 Rain drain connector 18.76
l.]- '�-e_(..~J J Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear R.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
r ` Dishwasher 25.02
R(� SQQ.ltn L e(- V F--" [�J, Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: 1- C , A�cL �( / _n O'�r Fixture/seweroo cap 25.02
'"_'� 1`��C1�-�- 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
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Deue�PmQnk baA) ctbA (,��jllau Water heater 56.29
Business name: {�' a Water piping/DWV 56.29
Address: lO�.%- W' f�R,�`( - CO M 13IA�tL1 ,QL Other: 25.02
City/State/ZIP: l ro(AAcQAtiL ``R-OC,O Subtotal
Phone:(�3 (�(p-� `'� (s\ t Fax:(tg.SI, G(o-R- q$ii Minimum permit fee: $72.50
CCB Lic.: `k, 0.,D.4:::) Plumbing Lic.no.: `96 P
( . 1 Plan review (25%of permit fee)
e 1 State surcharge(12%of permit fee)
Authorized signature: _ TOTAL PERMIT FEE /36,,r3
(� r� This permit application expires if a permit is not obtained within 180 days
Print name: ( i 2 l� Date: Q � 'aV till after it has been accepted as complete.
"` *Fee methodology set by Tri-County Building Industry Service Board.
I:'BuildineermitstPLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)