Permit Support Document Plumbing Permit Applica CEIVED
Building Fixtures FOR oFFI(L USE ONLY'
FEB 2 : 2021 City of Tigard // Permit N.
13125 S W Hall Blvd.,Tigard,OR 9ii..�� DatelBy`Raetived '� �, -�T�G�"`�i��I<�
$ Phone: 503.718.2439 Fax: 503.5 .1'' 60 TIGARD Dan ReviewatelBy: Other Permit No.:
r I c,,,r;n Inspection Line: 503.639.4175 3UILDING DIVISION! Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑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
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building }Multi-family -
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16853 SW SUNSHINE COAST ST Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City,'Stale/ZlP:Tigard,OR 97224
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name 'olygon at Roshak Ridge 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:Roshak Ridge Lot no.: 130 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
5th lavatory added after plan review Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
2 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixturelsewer 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 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
►:4 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Tonja Morris
Roof drain(corn ial) 12.51
Address:703 Broadway St.,Ste 510 Sink/ba ' avato i / 25.02
City/State/ZIP:Vancouver,WA 98660 Solar u potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals@polygonhomes.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water piping/DWV 56.29
Address:P.O.Box 92 Other. 25.02
City/State/ZIP:St.Paul,OR 97137 _ Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: S72.50
CCB Lie.: 184372 Plumbing Lie.no.:pb634 Plan review (25%of permit fee)
` State surcharge(12%of permit fee)
Authorized signature: �` �, _..,.-� TOTAL PERMIT FEE
Print name:Steve Fowler I Date: 10/30/20 Tbis permit application expires If a permit is not obtained within Igo days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1.1rL.ilAmn,P...nOuP1 MI I.Perm i,Ann dew In wry 440-4616TII0d02/COMM'EBl