HomeMy WebLinkAboutPermit Support Document (4) Plumbing Permit Application
Building Fixtures RECEIVED ►t GITUI: ISI: ()Ni.,
Received
Cityof Tigard „ ,. Permit No.:11 57- o -Ora v l
g Date/By: f l 1 %i'
:I; • 13125 SW Hall Blvd.,Tigard,OR 97fj 1 2 2022 Plan Review / Ia A
Phone: 503.718.2439 Fax: 503.59 Date/By: i t[l a Az67 Other Permit No.:
i t n Al:I., Inspection Line: 503.639.4175 Date Ready/By: II iZt3/ZZ 4 E 7mis: ® See Page 2 for
Internet: www.tigard-or.gov p'C'ITTYY OF TIGARD Notified/Method: Supplemental Information
TYPE OF *WOING DIVISION FEE* SCHEDULE
a New construction 0 Demolition For special information use checklist
Description i Qty. I Ea. f Total
❑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
[�j 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 sprinkler 0128aq.ft.) 1 Page 2 169.6.
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16637 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.: Bld 23 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.:234t1 Fixture or item:
Tax map/parcel no.: Backflow preventer 3127
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Permit - MST2022-00209 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
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
5t APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Wolcott Plumbing Medical gas(value:$_) Page 2
Primer 12.5I
Contact name: Cliff Bowman
Roof drain(commercial) 12.51
Address:1075 W Historic Columbia River Hwy Sink/basin/lavatory 25.02
City/StaterZIP:Troutdale, OR 97060 Solar units(potable water) 62.54
Phone:(503)-667-1781ext. 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 (25%of permit fee) 42.43
CCB Lie.: 112220 /� Plumbing Lic.no.: 26-824PB State surcharge(12%of permit fee) 20.37
Authorized signature:�?�
Date:
a go.0 fiL/llfi TOTAL PERMIT FEE 232.49
Cl Iff BOW 11/'d/T1J 10/10/22 This emit application eapires if a permit is not obtained within 180 days
Print name:
after it bas been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:1Building\Permits\PLMU•PermitApp.doc 10/01/09 440-4616T(10/02/COM/WSB)