Permit Support Document Plumbing Permit ApplicaiL9 fI " E"
Building Fixtures FEB 2 2022 FOR 01 11( I. 1 'NI O\I 1
City of Tigard ReceivedDate/By: '�ZZ TE
PermitNo.:2 ' MST2021-00405
w-y OF TIGARD
111 • 13125 SW Hall Blvd.,Tigard,OR ��++ Plan Review
II Phone: 503.718.2439 Fax: 50 )�Nr DIVISION 0?/ / Other Permit No.:
Date/Be
Inspection Line 503 639 4175
l i( i J i Date Ready/By lures H See Page 2 for
Internet ww.v tigard or gov Nuttfied/Method '� Supplemental Information
New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
1= ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
it'
„•' E.��,�,•' ems.. 0 '�"� � IQItkT �§`'� '•' SFR
bath
it312 70
-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building • ❑Multi-family
r - Each additional bath/kitchen 25.02
El Master builder El Other Fire sprinkler(2BZ3sq.ft.) ✓ Page 2
j iiii 1 LO ik1 a Site utilities:
Job site address: 16724 SW Darwin Loop Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
h Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 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
Stonn sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.:187(SFU) Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
4 RIPTIO�'OF f :; Backwater valve 12.51
' '` °°'`'e'�,5• ' ' ' - Clothes washer 25.02
MULTIPURPOSE FIRE SPRINKLER SYSTEM Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
r ,_ + `' 4 L L L 1,gi kst 0 Expansion tank 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) 816-7805 I Fax:( ) Ice maker 12.51
Interceptor/grease trap 25.02
Business name: Alliance Plumbing,LLC Medical gas(value:$ ) Page 2
Contact name: Gavin Thomas Primer 12.51
Roof drain(commercial) 12.51
Address: 146 W Historic Columbia River Hwy Sink/basin/lavatory 25.02
II 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@allia-nceplumbing.net - Urinal 25.02
Water closet 25.02
fx
g ,. 4 . I< .,:. - . _ it4. . .. .. Water heater 37.52
Business name: Alliance Plumbing,LLC Water piping/DWV 56.29
II 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 Lie.: . 184601 Plumbing Lic.no.: PB732
State surcharge(12%of permit fee)
Authorized signature:Hannah Thomas o ouo,4.o m ..8'88 TOTAL PERMIT FEE
Print name: Hannah Thomas Date: 1/27/2022 This permit application expires if a permit is not obtained within 180 days
I after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/0I/09 440-4616T(10/02/COM/WEB)
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