Permit Support Document (2) I
Plumbing Permit Application RECEIVED
Building Fixtures OCT 1 L 202
�CitY of Tigard Received
Datesy: I n13 a a (� Permit No.:
/l/I y7-?va..s1 -DC hSC
a 13125 SW hall Blvd.,Tigard,OR 97223 CITY OF TIGARD Plan Review ether Permit No.:
i s Phone: 503.718.2439 Fax: 503.598.196bUILDING DIVISIOR�Pte'By t1/iy/4a2 '` '
T I G A R D Inspection Line: 503.639.4175 ate Ready/By:III /2* le, Jura. HI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
a New construction 0 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)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
CR 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinklerq.ft.) 1 Page 2 169.6C
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16709 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
Water service(no.linear ft.:_) Page 2
Subdivision: South River Terrace 1 Lot no.:26-#1 Fixture or item:
Tax maplparcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clotheswasher
Permit - MST2022-00186 hw hr25.02
Dishwasher 25.02
Multi-Purpose Fire Sprinklers Drinking fountain 25.02
Ejectors/sump 25.02
[ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Taylor Morrison Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 703 Broadway St unit 510 Garbage disposal 25.02
City/State/ZIP: Vancouver, WA 98660 Hose bib 25.02
Phone:(360) 695-7700 Fax:( ) Ice maker 12.51
15t APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Wolcott Plumbing Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Cliff Bowman
Roof 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: :(5031-667-9891 Tub/shower/shower pan 12.51
E-mail: cliffb@wolcott.pro Urinal 25.02
Water closet 25.02
CONTRACTOR 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 169.69
Minimum permit fee: $72.50
Phone:(503)-667-1781 ext.3081 Fax:(503)667-9891 Plan review (25ern of permit fee) 42.43
CCB Lie.: 112220 Plumbing Lic.no.: 26-824PB State surcharge(12%of permit fee) 20.37
Authorized signature:CCTTdf I 9B64,4,gadt, TOTAL PERMIT FEE 232.49
Date: 10/10/22 This permit application expires if a permit is not obtained within 180 days
Print name:Cliff BOW after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:1Building\Parmits\PLMU-PermitApp.doc 10/01/09 440.46161110/021COM/WEB)