Permit Support Document Plumbing Permit Application
Building ixtures RECEIVE n ^7 \�` 1 �r� M u(�
City
g Received kz �L 0 A . �STZbWr�.7�� FV
of Tigard DateBy: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 DEC 1 5 2020 Plan Review /-
■ Phone: 503.718.2439 Fax: 503.598.19601//3/a an /�C 67 Other Permit No.:
Date/By:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: �!1 L�J See Page 2for
Internet: www.tigard-or.gov Notifiul/Method:6-/'��L� V supplemental information
TYPE OF WORUILDING DIVISION FEE* SCHEDULE
'New construction ❑Demolition For special informadon use checklist
r `P Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
I�` 11 CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
'P'-1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
-- - SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler q.ft.)WO Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: }, t 1 Catch basin or area drain 18.76
I � }L- �� "C ��'-'1`+�^�, '1 1�' Drywell,leach line,or trench drain 18.76
City/State/ZIP: <V ��'� }�..
r7�, `/ """"" t` Footing drain(no.linear ft.:_) Page 2
Suite Bldg./apt.no.:(t / Project name: J\1L- Manufactured home utilities 50.03
Cross street/directionsl tto-]ob site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Q.DSICOL_ ) tilt S-i- Q�p_ [ I Lot no.: Cf c 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
Th', �/\�,� C�V tQ . 0 1f k(() Drinking fountain 25.02
1 Ejectors/sump 25-02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 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
❑ 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
� Water heater 37.52
Business name: �I((�� '9 A ) 9 Water i in W V 56.29
U41{' �lJl7 �U ,1� V ll�, U�� 1 �� PP
Address: ',()-}'S 1( MI( C Jj Iak14, 146S . (A I Other: 25.02 ,
City/State/ZIP: < I ���tj4 S Q (�_ Subtotal
Phone:(5. ob-1- v si Fax:(j qc 9 ( Minimum permit fee: $72.50
CCB Lic.: pppJ��mmmbin Lic.no.: Plan review (25%of permit fee)
) ��� �� , State surcharge(12%of permit fee)
Authorized signsd^1re: n TOTAL PERMIT FEE
Print name: n �'`/� ,, e M Date: 1✓I I4 I `- cip This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
°Fee methodology set by Tri-County Building Industry Service Board.
I:lBuildingtPermits\PLMU-Pemut.App.doe 10/01/09 440-4616r(10/02/COMIWEB)