Permit CITY OF TIGARD PLUMBING PERMIT
114
_ COMMUNITY DEVELOPMENT Permit#: PLM2020-00182
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/05/2020
T f i;A R.- 9 Parcel: 2S 102 DA00401
Jurisdiction:
Site address: 13125 SW HALL BLVD
Project: City of Tigard-PD Subdivision: None Lot: None
Project Description: Add(1)clothes washer and(1)water heater for processing uniforms during COVID-19.
Contractor: TK PLUMBING Owner: TIGARD, CITY OF
4044SE7THST 13125SWHALL •
GRESHAM, OR 97080 TIGARD, OR 97223
PHONE: 503-720-7888 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 05/03/2020 $25.02
Specifics: 1 ea Water Heater 05/03/2020 $37.52
1 12%State Surcharge- 05/03/2020 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 05/03/2020 $9.96
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:4
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
` i'lumbin2 Permit Application
Building Fixtures FOR OFFICE USE ONL1
City of Tigard RECEIVE' Received Permit
13125 SW Hall Blvd.,Tigard,OR 97223 APR 2 7 2020 Datn BY.9/� �n ` ���r .-&t ii.�
8 Phone: 503.718.2439 Fax: 503.598.1960 PlanRevi Otter PemiltNNaj/�o`V,20 -000,7
Inspection Line: 503.639.4175 CITY OF TIGARD Date 8y:
i I G Alit) Date Ready/By: Boris: ® See Page 2 for
Internet: www.tigard-orgov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction El Demolition For special information use checklist
Description Qty. I Ea. Total
MAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El I-and 2-family dwelling XCommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
13 I ac s• 1fN `F�'�A i 2,1 U + Catch basin or area drain 18.76
Job site address: ` t�
Drywall,leach line,or trench drain 18.76
Ci
Ty/State/ZIP: ( t R-A. V,it p 9 7 ZZ 3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 1 l) (ce_ 11 D r''11
" j>CI.kIw� plot Mi.tc ManulBctured home utilities 50.03
Cross street/directions to job site: J 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�� W 0. If� {� 1 Clothes washer / 25.02 , �
S L7t'c 1 _1` �i 2-'S .t1ttb.... wa Dishwasher 25.02
IIN2&A CC'. Drinking fountain 25.02
�/ Ejectors/sump 25.02
M PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: JCANT-5c Fixture/sewer cap 25.02
t ( ' 2 (Vd Floor drain/floor sink/hub 25.02
Address: 13l 2 s 51r3 l� Garbage disposal 25.02
City/State/ZIP: j 5prQ cj c 2. 5^72-2 3 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT $,CONTACT PERSON Interceptor/grease trap 25.02
e2
Business name: ( A Q L w-b 1 1\ ( L� 1 MPrime al gas(value:$_) Pager 12.51
Contact name: - r h Li,SOl1 )c-rjr1� Roof drain(commercial)commercial 12.51
Address: L/Ot f q c -ire-- Sa-- Sink/basin/lavatory 25.02
City/State/Z5 3 ( re s w, ria Cj 7 p b Solar units(potable water) 62.54
Phone:( _ e 7213-iff11( Fax::( ) Tub/shower/shower pan 12.51
E-mail: • Urinal 25.02
Water closet 25.02
CONTRACTOR 3
, / Water heater f 37.52 7 )
Business name: K e(wt s.L '5 tt_c_ Water piping/DWV 56.29 /"
Address: 110 yq Se' 71.--s- S+}-- Other. 25.02
City/State/ZIP: Gpre61,..k ARC 6n 5 7i<0 Subtotal (vi 511
Phone:(,SO'j) 7 7.0-7ssK Fax:( ) Minimum permit fee: $72.50 `, 5t.)
CCB Lie.: 'Z2(1 9l)2.- Plumbing Lie.no.: e B L! g-3 Plan review (25%of permit fee) I)--
State surcharge(12%of permit fee) S 7U
Authorized signature 7 TOTAL PERMIT FEE I. , J
Print name: li5e,.../ pr 5 k Q✓ Date: /te: -Z 2^COW This permit application expires if a permit is not obtained wit in AO days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Buadmgtpemmts1PLMU-PermitApp.doc 10/01n9 44-4616T(t 0/a?/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain- Is 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
water service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total , each additional$100.00 or fraction thereof,to
p and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate pP y'
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
D- rive as defined in OAR918-780-0040.
ElCuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
D- omestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
-3" Isometric or Riser Diagram
' D Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice MachJRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes / fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:94.1d 1'p idcbtie 1 4& 1
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2