Permit Support Document I
Plumbing PermitAuplica> a>N-nEfVED
Building Fixtures �'[Ll�
City of Tigard MAR 6 2020 • xeeavea �/p Penflicrrof'/s ap
r� 13125 SW Nail Blvd.,Tigard,OR 9plieFilv TIGARD nc �t � / /p OD/
Phone 503.718.2439 Fax 51)3.5988. Other Pmnit No,:
Inspection Line 503.639.4175 BUILDING DIVISION pat�ar
n<s,au r Dare ed/MeeY lees: See Page 1 kr
Internet: aww4i -or, v Notified/Method: Supplemental information
1 TYPE OF WORK FEE+;SCHEDULE
®New construction ' ' 0 Demolition For special information use checklist.
__ Description T.Ot1L I Ea.. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-fatally dwellings(includes 100 ft.for each uhlitycotinection)
CATEGORY OF CONSTRUCTION SFR(1)bath 31i.70
Nr I-;and 2-family dwelling I El Commercial/nduatrial SFR(2)bath 437.78
❑.Accessorybuilding Multi•famrly
SFR(3)bath 501332
❑Master builder Each additional hathhitchea 25.02
Other
1 Fire sprinkler( ,.sq.fl:) Paget
JOB STIF INFORMATION AND LOCATION .Site utilities:
lob site site address: .13V4' IGS-r-r1 t , Catch basin or area drain .19.76
. - Drywall,leech line,or trench dram 18.76
Crry/Stafe/ZTP:Tigard,OR 97224 Forting drain(no.linear ft.; ) .. Page 2
SuiteibidgJapt.no. , I Project name r"[,4,.rmzr R Z.
Mannfacturcd home utilities 50.03
Cross street/directions to job site: Manhole 1836
Rain drain connector 18.76
' Sanitary sewer(no.linear tl.:_„-) Page 2
. Storm sewer(no.linear it: ) Page2
Water service(no linear R.:: -) Page 2
Subdivision:'--att3 r— •'fierfat:G 5k.. n 2.• Lot no.: 2 2 8 ?Fixture or Item:
Tax map/parcel no.: j ' Backflow preeventer ,, 3127
Backwater valve —
DESCRIPTION OF WORK 1251
... Clothes washer -
MSTzO14- 160(110 25.0z-
Diskwasher 25 02
Chi 4—rrl Co/177-7 ri Thinking fountain 25.02
I F7ectors)sumP 25.02
® PROPERTY OWNER l 0 TFNANT Expansion tank 1251.
Naps Polygon WLN,L LC Flxturdsewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510 'Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 5..
Rase bib 25.02
Phone:(360)695-7700 FaX ( ) Ice maker 12.51
APPLICANT laierc tor/ Crap
ID PERSON eP Brame 25.02
Business namq:Polygon Will,LLC Medical;gas(value:S ) Page 2
Primer
Contact name:Toaja Morris Roof drain(commerciai) 12.5I
Address:703 Broadway St.,Ste 510 Su k bas nlavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 I Fax::(360)6934442 Tub/shdwer/shower pan 12.51
E-mail:permitsubmittals®polygonbomes.eom Ur rani 25.02
: Water closet 25.02
CONTRACTOR Water heater
�C �I 37.52
Business name /' N LLL
J Water pipmg/DYJV 5639
Address; 0 430/i": tt
Other: 25.02
City(State/ZIP: (OlG 4' U/� /10
/- Subtotal
Phone: f/,) 23/f 6, 2)U . . . Fax. Minimum permit fee: $72.50
CCB Lie: 1303 t-/f Plumbing Lie no.' J541) Plan review (254,of permit fee)
State surcharge(12%ofpermitfec)
Authorized si patine: [ .,, "------- TOTAL PERMIT FEE
Print name•Jt.s.....d11 i l:4t(f- 1i4,4,f _ Date: J This permit application ex$ree If a permit Is not obtaloed within ISO days
titer It tree
aecepbd u complte.
' jI *Fee methodology tel by Tri-County Building Induaby Service Board_I:\BwLSng\PcrmunPLMU•PvmkAmdoc I0/01/09 440-4616ntaC/COM:WEB)