Permit Support Document (2) Plumbing Permit Applicatio'P
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Building Fixtures J2999 FOR OFFICE USE ONE I
FH3 Received 001
City of Tigard PermitNo.:MSIr
Date/By:
11 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read/B Sufis: ® See Page 2 for
TIGARD Y Y g
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
®New construction ❑Demolition For special information use checklist
Description Qty. Ea. Total
O 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
❑x 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13097 SW Foran Hills Ct. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97224
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Foran Hills Manufactured home utilities 50.03
Cross street/directions to job 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: Foran Hills I Lot no.: 3 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
New, single family residence Dishwasher 1 25.02
Change contractor on existing permit Drinking fountain 25.02
Permit#: MST2021-00178 Ejectors/sump 25.02
El PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Stone Bridge Homes NW, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 4230 Galewood St. Suite#100 Garbage disposal 1 25.02
City/State/ZIP: Lake Oswego, OR 97035 Hose bib 2 25.02
Phone:(503)387-7577 Fax:( ) Ice maker 12.51
Eia APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Stone Bridge Homes NW, LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Permit Tech
Roof drain(commercial) 12.51
Address: 4230 Galewood St. Suite#100 Sink/basin/lavatory 6 25.02
City/State/ZIP: Lake Oswego, OR 97035 Solar units(potable water) 62.54
Phone:(503)387-7577 Fax::( ) Tub/shower/shower pan 2 12.51
E-mail: portlandpermits@stonebridgehomesnw.com Urinal 25.02
Water closet 3 25.02
CONTRACTOR
Water heater 1 37.52
Business name: Jardine Plumbing Water piping/DWV 56.29
Address: PO Box 186 Other: 25.02
City/State/ZIP: Estacada, OR 97023 Subtotal
Phone:( ) Fax:( ) 3..32_of5 Minimum permit fee: $72.50
CCB Lie.: 108747 Plumbing Lic.no. 93-1 1863�47 Plan review (25%of permit fee)
.
State surcharge(12%of permit fee)
Authorized signature:jay ALMA/Vie TOTAL PERMIT FEE
Print name: JayJardine6-9-2021 This permit application expires if a permit is not obtained within 180 days
Date: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)