The URL can be used to link to this page

Permit Support Document (2) Plumbing Permit Application Building Fixtures J3008 FOR OFFICE USE ONLY City of Tigard F H 1 2 ` - ` Received Permit N • 13125 SW Hall Blvd.,Tigard,OR ' Z R Plan Rev ( Date eview o.. MST20(,1- W ': I Phone: 503.718.2439 Fax: 503.5'' Date/By: Date/By: Other Permit No.: .11 Ct A R D Inspection Line: 503.639.4175 Date Ready/By: turfs: El See Page 2 for Internet: www<tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ®New construction El Demolition For special information use checklist Description Qty. I Ea. Total O Addition/alteration/replacement ElOther: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 © 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ID Accessory buildingSFR(3)bath 1 500.32 ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder El Other: Fires sprinkler p (_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 13080 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.: 12 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 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER ❑ 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 ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$_) Page 2 Business name: Stone Bridge Homes NW, LLC Contact name: Permit Tech Primer 12.51 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:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: 108747 Plumbing Lic.no.: 3-320PB State surcharge(12%of permit fee) Authorized signature:Jey Jc (,V1,P TOTAL PERMIT FEE Print name: JayJardine Date: 5-13-2021 This permit application expires if a permit is not obtained within ISO days 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)