Permit Support Document Plumbing Permit Applica ipn EIVED
Building Fixtures 202Z I•t►R OH i( I: I til 0\1 1
Received ^ '^^
City of Tigard ( LG Permit No: MST2021-00406
T ,., IGARD Date/By:
13125 SW Hall Blvd.,Tigard,OR'9 Plan Review
= Phone: 503.718.2439 Fax: 503.598.196 off j)/r9P �4667 Other Permit No.:
1 t�'�+r� Date/By:
Inspection Line: 503.639.4175 _''WILDING DIVISION Date Read/B i- mns: H See 2
1 It. I.il Internet: www.ti and-or. ov y y' Page l nr
g g Notified/Meth � InformationSupplemental
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iii T P O ,,°', FEE* 4t* £ lr
ew construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
, '� (iii ioi I0,14 SFR(1)bath 312.70
ID 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ' 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: 1228
r x Fire sprinkler( sq.ft.) Page 2
, € !�A')f TIOi y y k Site utilities:
Job site address: 16722 SW Darwin Loop Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
ty Tigard,OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Polygon at Roshak Ridge 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: I Lot no.:1187(ADU) Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
�
Backwater valve 12.51
t.. � �MULTIPUR MULTIPURPOSE FIRE SPRINKLER KLER SYSTEM Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump
tank
25 02
a
Expansion 12.51
Name: Taylor Morrison Fixture/sewer cap 25.02
Address: 703 Broadway St.Suite 710 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Vancouver,WA 98660
Hose bib 25.02
Phone:( 360) 816 7f305 Fax:( ) Ice maker 12.51
Pros Interceptor/grease trap 25.02
Business name: Alliance Plumbing,LLC Medical gas(value:$ ) Page 2
Contact name: Gavin Thomes Primer 12.51
Roof drain(commercial) 12.51
Address: 146 W Historic Columbia River Hwy
Sink/basin/lavatory 25.02
City/State/ZIP: Troutdale,OR 97060 Solar units(potable water) 62.54
Phone:(503 )492-3490 Fax::(503 )912-6438 Tub/shower/shower pan 12.51
E-mail: gavin@allianceplumbing.net Urinal 25.02
� ��r ? � Water closet 25.02
P Ewa n�, 4 °" Water heater 37.52
Business name: Alliance Plumbing, LLC
Water piping/DWV 56.29
Address: 146 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP: Troutdale,OR 97060 Subtotal
Phone:(503 )492-3490 Fax:( 503)912-6438 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 184601 Plumbing Lic.no.: PB732
State surcharge(12%of permit fee)
Authorized signature:annah Thomas °'M=ZZL, ,, ._�, TOTAL PERMIT FEE
., i 1/27/2022 This permit application expires if a permit is not obtained within 180 days
Print name: Hannah Thomas 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)