Permit Support Document M
Plumbint7 Permit Aunlic CEIVED
BuildingFixtures C V GG
rou olt R. i lac tl.l.\-
City of Tigard MAR 6 2020 Received
batcll3y: y (% Z21 Permit N9,'?S ai9�3.2 /
SW ,F TIGARD Plea Review/
Phone: 503.718.2439 Fax 503i591196V OtberPermft No.:
1-16,",D Inspection linei 503.639.4175 BUILDING DIVISION °atn`lte/Met •
e
e: H See Pass 2 for
Internet: ww
w�tigard-or.gov Notified/Method: . Supplemental Idfarniation
i
TYPE OF WORK PEE*. SCHEDULE
El New construction
Demolition . For special information usecheafisk
QV. I Ha. I Total
❑Addition/alteration/reptaceinent El Other. New 2.'2•family'dwellingr(includes 100 ft for each utilityconnection)
CATEGORY OF CONSTRUCTION SFR.(I)bath 312.70
tg;1-and 27family dwelling I 0 Commercial/industrial SFR(2)bath _ _ 437.78
0 Aocessoiybuilding i Multi-family SFR(3)bath 500335.02,
Each additional bat4/Icitchen
2
❑Master builder ❑Other Firesprinkler .
JOB Sick INFORMATION AND LOCATION Site utilities:
lob site address (3 22 rp - Catch basin or area drain 18.76
brywall,leech kW,or trench drain 18.76 City/State/ZIP:Tigard,OR97224
Footing drain(no.linear ft.: *) Page 2
Suite/bldg./aptno.: i Projeci name:-}+4llerTerr22ee.635E.It 7_,. Manufactured home utilities 50;03
Cross atreet/directione to job site: ,Manholes 18.76 .
-Rain drain connector 18.76
Sanitary sewer(no Hamill.:_,,,-,) Page;
L.... - .:. __. - Storm sewer(no.linear i.: ) Page
.2 .>-
Subdivision. toey- Ttcc4Ct 8t5t.. as Z Lotno.: Q Wxlurcovice(na.lineariL: 1 prey
4 ZZq Fixture or Item: -
Tax_map/parcel no. Backflow preventer 3127
• ILESCRIPTION OF.WORK Backwater valve 12S]
_ Clothes washer 25.02
IYKT 2,0(4- f03 Z Dishwasher
25.02
t hle-rl/t ZN Go Drinking fountain 25.02
''qectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expai sion:tank .- ..
1251_
Name.Polygon WLH,LLC Flxturelsewer cap 25.02
Address:703 Broadway St.,Ste 510 Rom:drain/floor sink/hub 25.02
Garbage disposal 25.02
City/StateiZiP:Vancouver,+WA98660 }losebib 25.02
Phone:(360)695-7700 i Pax:( ) Ice maker
12.51
® APPLICANT ❑ COPi'rACT PERSON Interceptor/grease trap 2502
Business name:Polygon WLIi,LLC Medical gas(value:S )
Page 2
Contact name:Tuxtla
Monts ! Primer 12.31,
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 5l0 Sink/basin/lavatory 25,02
City/State./ZIP:Vancouver,WA 98660 Solar units(potable water) . .6254
Phone:(360)6957700 Fax::(360)693-4442 Tub/ahtwedshowerpan 12.51
pi-mail:peeml6ubmtttals®palygonhome,.com Urinal 25.02
/ CONTRACTOR
Water closet 25.02
C tl //i/ ��� Water heater 37.52
business mm�e: ��y,���yyyy��}}}
,_ Water piping/DWV 56,29
Address: 4Q �O,f^, Other 25.02
City/State/ZIP:
/ X/ Co/p�h.G. + a/G 9,�' 1 y _. Subtotal
Phone:C* � 23 ,rl .'D L/ Fax: Minimumpermit fee: S72.50
CCB Lic. �fp L l�Q 1. Plan review (25%of fee)
10 � ��� Plumbing Lic.-nor //ot pmmit ,
State surcharge(12%of permttfec)
Authorized signature t TOTAL PE TF PEE
Print name:3t Pi flL.- I C. /14 C f Date: I This permit appsulosoI teLre ifo a permt
tillau tocotobtlattoe.
a within ISO days
1 • *Fee methodology set bylri-County Building
Iadeatry5ezvu:e Board.
b\BuadglPamasTIMU•Pamkapp.doe 'N01/09 440-46 t6T(t0/02 MNrua)