Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00298
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/6/2020
T IC. l A L� 9 Parcel: 1 S 126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 100
Project: Farmer's Insurance Subdivision: None Lot: None
Project Description: ADD(1)2"hub drain,(1)primer,(1)break room sink and(1)water heater.
Contractor: GRIDLINE PLUMBING Owner: LITHIA REAL ESTATE INC
14844 SW 109TH AVE ATTN DEBOER, MARK
TIGARD,OR 97224 150 N BARTLETT ST
MEDFORD, OR 97501
PHONE: 971-275-6167 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 08/03/2020 $25.02
Specifics: 1 ea Primer 08/03/2020 $12.51
1 ea Sink 08/03/2020 $25.02
Type of Use: COM ea Water Heater 08/03/2020 $37.52
Class of Work: ALT 1 12%State Surcharge- 08/03/2020 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.08
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: GJr/- /p'G
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVE rile t,rl It I I .r t,.l l
City of Tigard JUL 2 7 Received 3
;� n 13125 SW Hall Blvd.,Tigard,OR 97223 20 20 Ph.O R ` ���31��2t l ' r t x Li J ZC ZC ._ �i 0-1Plan ovicw Phone �y 503 718 2439 Fax 503.598.19 TIGARL I lhte/ay: Other 20 ic 4) ,,,'3 3
CITY OF V
1 1 t Inspection Line 503.639.4175 BUILDING DIVIS101` oateReady/By /n Ans 0 See Page 2far
Internet www.tigardor.gov Nodtied/Method 7 -$C Zv <9 Ci Supplemental information
ti .. � *�:£y �. ., s y S:,a, u.,ar.v. 'a-,!z.A�r,3rk mxYi5.6 :;
❑New construction ❑Demolition For special informalion use checklist.
Description I Qty. I Ea. I Total
lAddinon/alteration/replacement 0 Other. New 1-2-family dwellings(includes 100 ft.for each utility connection)
d ( 4* SFR(1)bath 312.70
❑ 1-and 2-family dwelling
Commerctal/industrial SFR(2)bath 437.78
AccessorybuildingSFR(3)bath 500.32
❑ 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler t sq.ft) Page 2
t U!i..w n ur I '''r a vow- F .9 g
Site utilities.
Job site address: _9020 J v � ' 1-1,
..,, Catch basin or area drain t 8.76
d Drywell,leach line,or trench drain 18.76
City/State/ZIP:
I a Y Z2 3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt no.: /0 0 ( Project name:
�//.Slf/i2iZteter s Manufactured home utilities 50.03
Cross street/directions to job si e: / Manholes 18.76
���� _ /2�,J ��rrf./ni �� Rain drain connector I 8.76
r/ t „s!�- ��,��'---C��/// Sanitary sewer(no.linear ft:_) Page 2
Storm sewer(no.linear it.: ) Page 2
Water service(no.linear It:_) Page 2
Subdivision: ( Lot no.:
Fixture or item:
Tax map/parcel no.: Backfltrw preventer 31.27
a •'^ " .r:rs', -r rc;�6itlri: Backwater valve 12.51
Clothes washer 25.02
/FP� j r --"--" "^V Dishwasher 25.02
P� /"/Tfl ` ',/,//K.. 4 re Drinking fountain 25.02
/ LF Ejectors/sump 25.02
;�� a�i Yi9t...Yf S 6i66l 7:.;.'tt4: ii4.4�. ...' : F.. .i. 1-%, li .anion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub )C / 25.02 al-6-7 2
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib
25.02
Phone:( ) Fax:( ) Ice maker 12.51
`} ri tV4 °�« "� 't t. '� ". Interceptor/grease trap 25.02
Y."ss! .�. s w. r.'m.D'"'n v1;.14..k:q Y.'.*>t '.a <%'..c`-..x
Business name: Medical gas(value:$_) Page 2
Contact name: Primer / / 12.51 J,2.5/
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory )(/ 25.02 /2,07'
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
u:9 ,p its^..: !, J }er'3-.,,, . �''''''.v , .... n r + - Water closet y/
�4`ONN,Wa '' k P. M,Y yge' ,v' .N, k Y y;i. T .Ci n,Tx, r. /i I 25.02 ��5Z
� Y Water heater
Business name• en#,- ,0//r. UA /yr9 t 37.52
!!ll����"/ Water piping/DWv 56.29
Address:/9,7 41y 9 ��� Other: 25.02
City/State/ZIP:7, �.`/{/y^ (�A ,7Zz fj� Subtotal ,j6
Phone:(9JI)i75- (' 7 (� Fax:( ) Minimum permit fee: $72.50
CCB Lic.: /Ti,40.5- Plumbing Lic.no.:02C- /� Plan review (25%of permit fee)
State surcharge(12%of permit fee) /`a64
Authorized signature: 400 TOTAL PERMIT FEE /,/a ,C3S-'
Print name;`// vorieeZ-Y7 Date: 7 2, This permit application expires If a penult la not obtained Mthin 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I\BuildinylPmnilsTIAIU-PermitApp.doc IWO I A19 4444616T(111/02/[OM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Footing drain-1`100' 50.03 0 to 2,000 $121.90
Fouling drain-each additional 100' 37.52 2,001 to 3,600 $169.693,601 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
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 AO to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
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 S25,000.00.
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
each additional$100.00 or fraction thereof.
(minimum charge-.1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurate report fixtures could result in increased sewer fees*. . , flllsist krA
aetity by ninny 7Ypt Plan review is required for any of the following.
FLlcarra Type fw „ Please check all that apply.
Work?trfon ed• �' °� Added Rdaame • 0 Any new commercial building with water service 2"and
Baptistry/Funt greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 0 Any multipurpose fire sprinkler system.
Domestic 0 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"
4' 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 Mach.lRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related /
-Bradley
-Curn/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
lumbin permit can be issued.
-Water Cllosetoset-Toilet P g
Urinal
Other Fixtures:
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