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Permit Support Document 1 Plumbing Permit ApplielaFtir EwED R-t-20 Building Fixtures SEP 2020 FOR OFFICE USE ONLY Received G/Z'/ Permit Nc(�']�T�.n 7.0• © f- City of Tigard ei ! <O ✓t l,.'W ��y 1 ,1111 ■ 13125 SW Hall Blvd.,Tigard,OIE,91732IF TIGARD Plan Review Phone: 503.718.2439 Fax: RilVE.ANKR DIVISION Date/By: et/igho Aet* Other Permit No.: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: '� lens: g Internet: Line: al., / S See Pa e 2 for g Notified/MethoK. a"7/� t- �� Supplemental Information TYPE OF WORK 471.01 e N(7'-4' FEE* SCHEDULE New construction ❑Demolition For special information use checklist. Description I Qty. I Ea. 1 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 [ "l-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 CIAccessory building El Multi-family SFR(3)bath 500.32 ---- Each additional bath hen 25.02 ❑Master builder ❑Other: Fire sprinkler(/l Lp .ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: I/.4:30 1 S� o0Lb ^ ASI 'ICE Catch basin or area drain 18.76 DJob site address: `-�' l-�C�t7 �r In Q^ 2 Footing drain line,ore trench drain 18.76 2 City/State/ZIP: 1::7/T J iL `'� � Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: 10 3 Project name: Q.c s-\jL. Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 t9_ A t , ,,, ,y 1 O2 Rain drain connector 18.76 1CJ I JV11 LL* 1 l7 Sanitary sewer(no.linear ft.: Page 2 Storm sewer(no.linear ft.: ) 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 ((�� '^ Dishwasher 25.02 sp Q,�nk.1e.4 s 4/�an tS F'-to Drinking fountain 25.02 \\ Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: \rty L p�-1 rc Fixture/sewer cap 25.02 Ul 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 ❑ 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 ' I ^ IlW I `,\ Water heater 37.52 nd Business name: �V e W 2 �' N P4(� WUvAcm Water piping/DWV 56.29 Address: 11;y4S Lo 1-tIST 1 uvip. Ewa 4.tu i Other: 25.02 City/State/ZIP: 1-19_01,4,:200-C-..., (1-10(00 Subtotal Phone:(fsps c:,(4,", 1 T 2 Fax:(S113) („:,bq- q IA( Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: 1‘_ 2 Plumbing Lic.no.: d( . �.�� (/�� 0 State surcharge(12%of permit fee) Authorized signature \ TOTAL PERMIT FEE I j'f ,,S3 Print name: Date: q1 I (.0 This permit application expires if a permit is not obtained within 180 days prQ F `�F3�M� s �a�4� after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 19Bundieg\Permits\PLMU-PvotilApp.doc 10/01/09 440-4616T(10/02ICOM/WEB)