Permit CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2020-00330
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/21/2020
Tf "� g Parcel: 1S135AA02800
Jurisdiction: Tigard
Site address: 10540 SW HALL BLVD
Project: Guidepost Montessori Subdivision: METZGER ACRE TRACTS Lot: 2
Project Description: ADD(5)sinks,(1)lay,(3)water closets;RELOCATE(5)sinks,(2)lays,(2)water closets and(1)clothes washer.
Contractor: SOUTH CLACKAMAS PLUMBING Owner: WALL, GEORGE E& PAMELA J
13355 S MOLALLA FOREST RD 11600 SW BULL MOUNTAIN RD
MOLALLA, OR 97038 TIGARD,OR 97224
PHONE: 503-480-9630 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 08/21/2020 $25.02
Specifics: 10 ea Sink 08/21/2020 $250.20
3 ea Lavatories 08/21/2020 $75.06
Type of Use: COM 5 ea Water Closet 08/21/2020 $125.10
Class of Work: ALT 1 12%State Surcharge- 08/21/2020 $57.05
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $532.43
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: � Q ( Permittee Signature: 4A/ / 770 /
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
xis RECEIVE !! Received , (ti l it I l
City of Tigard Dam. /12t7/Lt) �7 d Pennrt x LrJ Zd Zp-003s"a13125 SW Hall Blvd.,Tigard,OR 97223 A U G 1 li 2020 PI-Review■ Sher Permit Nq S J/LZO Z.1-pad%.
- ' Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 CITY OF TIGARD Dab'Reedy/By: Jeri. a See Page 2 for
I i s :1 R I7 Internet: www.tigard-Or.gov Notified/Method: Supplemental Informartou
PJILDINC DIVICIOPJ-
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information are cnork ict
Description I Qty. I Ea. I Total
®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 ®Commercialindustrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:10540 SW Hall BLVD Catch basin or area drain 18.76
Drywall,leach tine,or trench drain 18.76
Ciry/statetL[P:Tigard OR Footing drain(no.linear ft.:____) Page 2
Suite/bldg./apt.no.: I Project name:Montessori- 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: I Lot no.: Nature or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer / 25.02
under slab plumbing to add/move fixtures, new water supply lines, Dishwasher 25.02
plumb venting to reconnect to existing Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Higher Ground Education Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:10 Orchard STE 200 Garbage disposal 25.02
City/State/ZIP:Lake Forest, CA 92630 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value$ ) Page 2
Business name:
Primer 12.51
Contact name: Roof drain(commercial) 401,6 12.51
Address: Sink/basiMavatory(fo) fir✓/C5 25.02 150.12
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet ArS 25.02 75.06
CONTRACTOR Water heater 37.52
Business name:Nick Madman Plumbing,LLC DM:South Clackamas Plumbing Water piping/DW V 56.29
Address:13355 S. Molalla Forest RD Other: 25.02
City/State/ZIP:Molalla, OR 97038 Subtotal
Phone:( -) Fax:( ) Minimum permit fee: S72.50
SD3 dial-3nA2 Plan review (25%of permit fee)
CCB Lie.: 216021 P bing Lic.no.:PB 1965
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:Nick D la ---1>a 8/10/2020 This permit application expires if a permit is eel obtained within 180 days
after it has been accepted at complete.
*Fee methodology set by Tr-County Building Industry Service Board.
I:I13uildinglPermits1PLMU-PermitApp.doc 10/01/09 440-4616TIh0/02/COMlWEB)
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- l e 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
WaterService-Ist 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 6254 $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 ec Ins tions 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 S25,000.00 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace! Plan review is required for anyof the following.
Work Performed: Capped Added Relocate ow g'
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities,
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above-
-3"
4" Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food El Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the cualifications above.
-Commercial-food related cj Scwk-� C.9
k t4-tJ .
-Industrial-food related �(y, ' �7-2. _ GCe a�TS I� '4 1 Z
Ice Mach./Retiig.Drains -4-xy.-1.a- ' I .i r •,_ /;A r 41
Oil Separator(Gas Station) Comments regarding fixture*or
Rec.Vehicle Dump Station Fixtures relocated!-1-2-compartment sink,4-sinks,2-WC;1-Washer,2-rev sink
Shower -Gang Fixtures added.1-3 compartment sink,4-sinks,3-WC.1-lay sink
-Stall
Sink/lav -Non-food related b • Types of sinks installed:3 compartment ss sink,2 compartment ss sinks,
-Bradley t compartment ss sink,SS hand washing sink
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes 1
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet 2 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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