Permit CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMENT Permit#: PLM2020-00331
Date Issued: 8/25/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S101DA00100
Jurisdiction: Tigard
Site address: 13010 SW 68TH PKWY 140
Project: Spec Space Subdivision: YARNS ACRES Lot: 9
Project Description: ADD (1)break room sink,(2)ice makers; RELOCATE(1)break room sink.
Contractor: WESTERN PLUMBING Owner: PACIFIC NW PROPERTIES LIMITED PA
9460 SW TIGARD AVE SUITE 101 STERN FAMILY LIMITED PARTNERSHIP
TIGARD, OR 97223 STERN FAMILY LLC
6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
2 ea Ice Maker 08/24/2020 $25.02
Specifics: 2 ea Sink 08/24/2020 $50.04
1 12%State Surcharge- 08/24/2020 $9.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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
i 1
Issued By: ./CL Permittee Signature:
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 ApplicatioRECEIVED
Building Fixtures AUG 1 7 2020 FOR OFFICE t SF. 0\1 ,
City of Tigard CITY OF TIGARD Rewired
a t •• (f//4,y Zv 4d p,m,i1Nop u-(707o 0022/
• 13125 SW Hall Blvd..Tigard.oR ' ,DING DIVISION P1an RMlen
e- Phone SU3.71 fl.2439 Fax:.503 598. �ne/ey. Other Penni!VSi,Ia 26��/i/3
1 I G A it i, Inspection Line: 503.639.4175 Date Readyd8>: lois ® see Page 2 for
Internet: www_tigard-or.gov Notified/Method: Supplemental Information
- TYPE OF WORK FEE' SCHEDULE
0 New construction 0 Demolition For special Information use checklist
Description I Qty. I Ea. I Total
'Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility.connection)
CATEGORY OF CONSTRUCTION S FR(I I bath 312.70
❑ I-and 2-Family dwelling T]Commercial/industrial
SFR(2)bath 437.78
•
SFR(3)bath 500.32
ElAccessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
(OR SUE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: v3.43.%O Sw 1 K1tr,p 1kw.
Q Drywell,leach line,or trench drain 18.76
C'ily/5tate/Z1 P� G�ogJU•- (iw Footing drain(no.linear ti.:_) Page 2
Suite/bldg./apt.no. ef7s
6 Project namp JUA ( it JQ;I 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.: ) Paget
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Hack flow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/stale/ZIP: Hose bib 25.02
Phone:( I Fax:I I Ice maker ,Q 12.51 07.,.
lk APPLICANT I 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:5t.jas.C�4X�n \3.lrn\UUYX9,;\SRC,- Medical gas(value:S_) PageI212.51
1' _ Primer
Contact name:��t., �aloC01(-t a Roof drain(commercial) 12.51
Address: q(�,t� ` bv��Itrr:;k:aS
^ g Q4k t'lu.FN \CYt Sink/basin/lavatory iD 25.02 f�.
C'ily/State/ZIP: 4 Solar units(potable water) 62.54
Phone: ) Fax::( 1 Tunshower/shower pan 12.51
i 2 '� (pUrinal 25.02
E-mail: do 4,2_01f1(23.k/YY1lAA/YV1 �.0 �� \�lk _
Q Water closet 25312
CON RACTOR Water heater 37.52
Business name c-OUj f(1(\`(') tV�C • Water piping/DWV 56.29
Address:�� Stek) ' . 'O, Other. 25 02
tal
City/State/ZIP: 'IQ oC Subtotal t�131,1,
Plane:(e.p t C 'f _ Fax:( ) Minimum permit fee. 572.50
c9�f t.J Y� _ /e3gP� Plan review (25%of permit tel
COI Lic.: Plumbing Lie.no.: q a
State surcharge 112°i°of permit fed) ,r't
dip v tie-. p,,,s_ 'i1 4 TOTAL PERMIT FEE Rf, Q}
Authorized signature:-�� Wry'^" J
i Ai n j ) • tf , 3 pater i 3) This permit application expires Ira permit is not obtained within 180 days
Print name' �LlA U l after it has been accepted as complete.
"Fee methodology set by Tri•County Building Inlusny Service Board
I•RmWmr Permns.PLMt'-PermiApp.dac laminn 1411-4610T11u 1125 OMM1I1:BI
Plumbing Permit Application -City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(es) Total Square Footage: Permit Fee:
Footing drain-I"100' 50.03 0 to 2.000 $121.90
Footingdrain-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 inn' 62.54 Medical Gas Systems:
Water Service-each additional l OM 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,0 0.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5.001 00 to$10.000.00 S72.50 for the first$5.000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total and hincluding l 510.0.0.00.00 or fraction thereof.to
Inspection of existing plumbing or for $101101.00 to$25 000.00 $14850 for the first$10.000.00 and$1.54 far
which no Ile is specifically indicated 90.00/hr each additional S100.00 or fraction thereof.to
(minimum charge-1/2 hour) and including$25.000.00.
Inspections outside of normal business 90 00/hr $25.(K)I t0)to$50.00).00 $379.50 for the first$25 IN10.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof to
Reinspection Fees 9010Por and including$50,000101.
Additional plan review for revisions 90.00/hr $501x)1 00 and up $742.00 for the first$50.000.00 and$1 20 for
(minimum charge-I l2 hour) each additional 5100.00 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
❑ Any new commercial building with water service 2"and
0aptistn/Font greater.except systems designed and stamped by licensed
Bath: =fuh/shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thm
Cuspidor/Water Aspirator
Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ An}'multipurpose fire sprinkler system.
Commer El Any complex structure as defined in OAR918-780-0040.
-DoiDrinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink '_' •
-3- Isometric or Riser Diagram
4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains • `Comments regarding fixture work:
Oil Separator(Gas Station) (1) .6
6/f'./ 'O t/ S(Aflca /7Z- ' 'xi-
Rac.Vehicle Dump Station / ef//7/7O 470
Shower. -Gang
-Stall
Sink: -I.as/Bar non-food related
-Bradley
-Com/Serv/Util fond 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 Closset-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:1Building\Permits1P1.MF_PermitApp.doc 08/04/2011 2