Permit Support Document Plumbing Permit Application
Building Fixtures RE EI ■
■ FOR Ofll( F l SE U\I,)
Received
Cityof Tigard OCTDate/By: Permit No.: /4 O f3 tt
ll 131 SW Hall Blvd.,Tigard,OR 97223 OCT 1 1 202' Plan eview I O I. 3 a. > - G J
' Phone: 503.718.2439 Fax: 503.598.1960 t i n' 4(4 Other Permit No.:
Inspection Line: 503.639.4175 e I/ c
I I t,+,It I) p CITY OF TIGA %ate Ready/By: 'Utz/?.Z OK luris: 8J See Page 2 for
Internet: www.tigard-or.gov BUILDING DIV'S. •,ed/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
Et New construction 0 Demolition For special information use checklist
Description 1 Qty. I Ea. I Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
[1 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(11291.ft.) 1 Page 2 121.9C
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16677 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 25 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 I Lot no.:25-#3 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes
Permit - MST2022-00184 Dishwashera e 25.02
her
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
Address:
703 Broadway St unit 510 Floor drain/floor sink/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
ER 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 Solarunits(potablewater) 62.54
Phone:(503)-667-1781 ext. 3081 Fax: :( 503-667-9891 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: cliffb@wolcott.pro
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 121.90
Minimum permit fee: $72.50
Phone:(503}667-1781 ext.3081 Fax:(503).667-9891 Plan review (25%of permit fee) 30.48
CCB Lie.: 112220 Plumbing Lic.no.: 26-824PB
/n State surcharge(12%of permit fee) 14.63
Authorized signature:��11 ,,.. e9B4.4,41LCZ/fi TOTAL PERMIT FEE 167.01
Cliff Bow a 10/10/22 This permit application expires if a permit is not obtained within 150 days
Print name: Date: after it has been accepted as complete.
*Fee methodology set by Tri-Cotmty Building Industry Service Board.
I:lnuildingTermm PLMU-PerauApp.doc 10/01/09 440-4616T(10/02/COM/WEB)