Permit Support Document (2) Plumbing Permit Application RECEIVE
Building Fixtures RECEIVE OFFICE USE ONLh
Cityof Ti and OCT i 2 2022 DateB a
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.�i • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
111 ' Phone: 503.718.2439 Fax: 503.598.1960 Y j / /�� Other Permit No.:
l i c n It I) Inspection Line: 503.639.4175 CITY OF TIGARO D endy/B ((7"'�^^^"'grrr'LZ (�K lur s: B See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVIS IClotified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
[i New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath _ 312.70
1-and 2-famil dwellingSFR(2)bath 437.78
Y 0 Commercial/industrial
0 Accessory building 0 Multi-family SFR(3)bath 500.32
0 Master builderEach additional bath/kitchen 25.02
0 Fire sprinkler P (.17.291 ft.) 1 Page 2 121.9C
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16721 SW Colorado LN Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR
Footing drain(no.linear ft.:,) Page 2
Suite/bldg./apt.no.: Bid 26 I Project name: South River Terrace 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
Subdivision: Water service(no.linear ft.:_) Page 2
South River Terrace I Lot no.:26-#3 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Permit - MST2022-00188 Clothes washer 25.oz
Dishwasher 25.02
Multi-Purpose Fire Sprinklers Drinking fountain 25.02
Ejectors/sump 25.02
a PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Taylor Morrison Fixture/sewer cap 25.02
703 Broadway St unit 510 Floor drain/floorpsink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Vancouver, WA 98660 Hose bib 25.02
Phone:(360) 695-7700 Fax:( ) Ice maker 12.51
Q APPLICANT to CONTACT PERSON Interceptor/grease trap 25.02
Business name: Wolcott Plumbing Medical gas(value:$_) Page 2
Primer
Contact name: Cliff Bowman Roof
d 12.51
drain(commercial) 12.51
Address:1075 W Historic Columbia River Hwy Sink/basin/lavatory 25.02
City/State/ZIP:Troutdale, OR 97060 Solar units(potable water) 62.54
Phone:(503).667-1781 ext. 3081 Fax: :( 503-667-9891 Tub/shower/shower pan 12.51
E-mail: ciiffb@wolcott.pro Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Wolcott Plumbing Water piping/DWV 56.29
Address: 1075 W Historic Columbia River Hwy Other: 25.02
City/State/ZIP:Troutdale, OR 97060 Subtotal 121.90
Phone:(503).667-1781 ext.3081 Fax:(503)667-9891 Minimum permit fee: $72.50
CCB Lic.: 112220 Plumbing Lieno.: 26-824PB Plan review (25%of permit fee) 30.48
/J /� State surcharge(12%of permit fee) 14.63
Authorized signature:�n1 i1 a abGflhLA.JL, TOTAL PERMIT FEE 167.01
Print name:Cliff BOW TT/a/f1J Date: 10/10/22 This permit application expires if a permit is not obtained within Ian days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building'iPermita1PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)