Permit CITY OF TIGARD PLUMBING PERMIT
-! COMMUNITY DEVELOPMENT Permit#: PLM2020-00337
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8l27/2020
Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY K
Project: Tigard Town Square-Spec Space Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: Add(1)primer,relocate(1)lay and(1)water heater for ADA compliance.
Contractor: GRIDLINE PLUMBING Owner: SN PROPERTIES PARTNERSHIP
14844 SW 109TH AVE 1121 SW SALMON ST
TIGARD, OR 97224 PORTLAND, OR 97205
PHONE: 971-275-6167 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Primer 08/25/2020 $12.51
Specifics: 1 ea Lavatories 08/25/2020 $25.02
1 ea Water Heater 08/25/2020 $37.52
Type of Use: COM 1 12%State Surcharge- 08/25/2020 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.06
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: `, / ,Q Jp �/ e rid
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
`T'
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
City of Tigard AUGceived k/2s 2d 40O NrmitN 1L/`72020 00 37
• 13125 SW Halt Blvd.,Ti U`,7 1 8 2020 Plan Rayless
= Tigard,OR 97223
Phone: 503.718.2439 Fax: SU3.598.196U Date/Fly: Other Permit No.:
T I G h.u Inspection Line: 503.639.4175 CITY OF TI GAR D Date Ready/0y: him. El See Page 2 for
Internet: www'.tigard-0Ggov .;! U iJ JIV I {Uti Nuited/Mehod: Supplemental lnt'nrmation
-
TYPE OF WORK FEE* SCHEDULE
For special use checklist.
0 New construction 0 Demolition
Description I Qly. I Ea. I Total
KAddition:alterationreplacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(l)bath 312.70
❑ I-and 2-family dwelling �Conmrercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other
Fire sprinkler I sq.ft.) Page 2
JOB SITE INFORMATION AND VOCATION Site utilities:
Job site address: D Sp) / /e ii
Catch basin or area drain I8,7G
Dall,leach line,or trench drain 18.76
l/ Manufactured
Footing dur oam ft.:_) Page. 2
Suite/bldg./I[pL no.: Project name: / home utilities 50.03
Cross
street/dirfeti s to job
�site:
----��� / Manholes 18.76
/ L` - , .( 7f�df J `//� Rain drain connector 1 2
j , ,�C `�7�� Gfrv+V� !P�/ Sanitary sewn o.linear
liar tl: Page 2
l/ Storm sewer(no.linear ti.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: ( Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRI TION OF WORK Backwater valve 12.51
�` Clothes washer 25.02
��- a •CS Dishwasher 25.02
Or
r
f��/rr/O�J�J' �f,� ' 4 Drinking fountain 25.02
,�/D ' eve, Ejectors/vamp 25.02
0 PROPERTY OWNER 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/State/ZIP: Ilose bib 25.02
Phone:( ) Fax:( I lee maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:S_) Page 2
Business name:
Primer X / 12.51 47, 5'�
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory x/ 25.02 ,0
City/Slate/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: C i�.irl i I'PI i.r I r�loierr, I' , r r Urinal 25.02
l / Lt 1'h� Water closet 25.02
-� CONT T V
• Water heater x / 37.52 37,
Business n>m eC l� D_ %m Water piping/DR'V 56.29
1 ` C
Address: ► / t 4Jiff • Other: 25.02
City/State/ZIP:��/(7�/ 7 Subtotal
Phone:
(��)Z7�_ / Fax:( ) Minimum permit fee: $72.50
/�
CCH tic.: 7�/D K� Plumbing Lie.no.:.,2(p Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print nam • l�A1, 1 Date: Q�B� �JJ1 This permit app0uter expires If a permit is not pleteed within 180 days
ria✓r! !J 4(/ after It has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:1IIuildine\PuniIsTL 11J PmntApp.dm' 10101419 eda-FlkT(10N12VCOMIWEB)
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 •
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62 3,601 to 7,200 $233.20
7,201 and greater S327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52ightithakt, -, _
Storm&Rain[rain-1st 100' 62.54 -'
S1.00 to$5,000.00 1 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
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 S148.50 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 S25,001.00 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
Reinsspection Fees 90.00/hr and including S50,000.00.
Additional plan review for revisions 90.00/hr _ $50,001.00 and up $742.00 for the fun$50,000.00 and$1.20 for
(minimum charge—1/2 hour) each additional$I00.00 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*. 'i
- 42u100try Fi're Plan review is required for any of the following.
w t Capped. a Please check all that apply.
464 allocate
Baptistry/Font 0 Any new commercial building with water service 2"and
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 Thm as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ClAny multipurpose fire sprinkler system.
-Domestic ❑ 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"
Wash Drain d Isometric or riser diagram is required for new buildings-Car
Garbage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related •
-Commercial food related
-industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -1avBar non-food related I
-Bradley
-Com/Serv/Ulil food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUa a sewer permit will be issued and
Washer-Clothes e
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
L1Building\Pcrmits\PLMF_PermitApp.doc 08/04/2011 2