Permit CITY OF TIGARD PLUMBING PERMIT
IN11 . COMMUNITY DEVELOPMENT
Permit#: PLM2020-00357
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/11/2020
T I ,;1 R I3 Parcel: 2S101 DA02000
Jurisdiction: Tigard
Site address: 6980 SW VARNS ST
Project: Madrona Recovery Subdivision: VARNS ACRES Lot: 3
Project Description: Remodel(2)existing restrooms and add(1)restroom;ADD(1)drinking fountain,(1)lay and(1)water closet;
REPLACE(2)lays and(2)water closets. Property is on septic system-no sewer EDUs.
Contractor: POINT PLUMBING Owner: MRC RE LLC
4510 SW 182ND AVE 7000 SW VARNS ST
ALOHA, OR 97007 TIGARD, OR 97223
PHONE: 503-265-1708 PHONE:
FAX: 503-268-1567
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 09/11/2020 $25.02
Specifics: 3 ea Lavatories 09/11/2020 $75.06
3 ea Water Closet 09/11/2020 $75.06
Type of Use: COM 1 12%State Surcharge- 09/11/2020 $21.02
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $196.16
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 OUNC77 by calling 503.232.1987 or 1.800.332.2344. �_q /
Issued By: j,t;',�A� 7{ /n.. _/��-/ Permittee Signature: "eV ("T./D4./Ati-�I"'7ON
//(mil v,�'W 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
C y iE r •
Building Fixtures l� 1(IR ual l( I I SI I Iy1.1
City of Tigard AUG G ; ' Received
g l, evy: II)I 7.0 4/0 Permit Nfal Z.ZO-00357
°t 13125 SW Hall Blvd.,Tigard,OR 97223c+, Plan Review
s Phone: 503.718.2439 Fax: 503.598.19MI I Y OF TIGARD DateBy Other Permit No.:
TIGARU Inspection Line: 503.639.4175 BUILDING DIVISION Date Reedy/BY: q' / Jurn: ® See Page 2for
Internet: www.tigard-or.gov Notified/Method: 4 it 7{`1 0 Supplemental Information
TYPE OF WORK s5 aili j CAtiQ(S f r‘J E FEE* SCHEDULE
0 0 led`-3"a3 t4"For special information use checklist
New constructionDemolition
Description I Qty. I Ea. I Total
171 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 •
❑ I-and 2-family dwelling (Commercial/industrial SFR(2)bath 437.78
. ❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /Q q9j 0 4 Vv V. J r ; c..-T . Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -t‘ 0 E }ZZ 3. Footing drain(no.linear ft.: I Page 2
Suite/bldg./apt.no.: Project name: M Ac 09,014 A Manufactured home utilities 50.03
Cross street/directions to job site: (ZS-CC-Li�--14.1 Manholes 18.76
Rain drain connector 18.76
p le-e-p --r�� 0 n1 S T 1 G so Air
sewer(no.linear ft.: ) Page 2
e -w- 1 -its Uj f Stormsewec o.linear ) Page 2
Water service(no.lineearr t ft.:_) Page 2
Subdivision: t no.: Fixture or Item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
•pp M00EL 2 �)<1511N(a V 1 ZQnlvtS Dishwasher 25.02 --
° 490049 A- 12�ES1 oZ&4 Drinking fountain .l-- 25.02
a Pc 0 p 11•I tp 1 V124 r<i N tp FOLI gift I t\ Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT 10 CONTACT PERSON Interceptor/grease trap 25.02
M�1((W 11 i-
j Medical gas(value:$ ) Page 2
Business name:
Contactname: Primer 12.51
�0 dVOMvN�s�iH Roof drain(commereial) 12.51
Address: 4,�t7 Siii‘) 1 2,..NA7 pA
Sink/basin/lavatory ; 25.02 ;j
City/State/ZIP: A U;ick-A • Q>✓4' otl-0-3127 Solar units(potable water) 62.54
Phone:(99) 2$.. I 8 Fax::(91 ) 2_4,tit 151,7- Tub/shower/shower pan 12.51
E-mail: (.)0 �w i1/ti
94 6,0 i trc o t mo) ' Nt T G' � Urinal 25.02
Water closet 3 25.02
CONTRACTOR
Water heater 37.52
Business name: p01 hcf [�7 W M$I b.1(40 sit. . Water piping/DWV 56.29
Address: 1-t.,31Q S1 J 324.47 kvc Other: 25.02 17 1 Ili
City/State/ZIP: Aa.,,.1A CM Gt11.113 Subtotal
Phone:(0�j )242( -r-ity� V Fax:(t�'77 )�-tP 9 i J 941- Minimum permit fee: $72.50
CCB Lic.: Di fI 4@ Plumbing Lic.no.3?41 Val
+ Plan review (25%of permit fee)
+/ � State surcharge(12%2%of permit fee) 2/, dy
Authorized sign t6re. Z --- TOTAL PERMIT FEE !if; r 1110
This permit application expires if a permit is not obtained within ISO days
Print name:, (,`�� - ^� Date: L�f' � after it has been accepted as complete.
J" *Fee methodology set by Tri-County Building Industry Service Board.
I:rBuilding\t'cttmhaWLMU-PermhAppdoe 10/01/09 440-46161(101011COM/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-1"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 S 1.52 for
Other Inspections or Fees Qty. Fee(ea) Total 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 S10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional S 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*. Plan Review for Plumbing Installations
Quantity by Future Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
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
-Drive as defined in OAR918-780-0040.
ElCuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 0 Any multipurpose fire sprinkler system.
-Domestic ❑ Any complex structure as.defined in OAR918-780-0040.
Drinking Fountain j
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
-3" Isometric or Riser Diagram
4 0 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./Refrig.Drains Comments regarding fixture work: er Oil Separator(Gas Station) t (.jl\h 1--.(AV t-A j 0 ,
'
Rec.Vehicle Dump Station ^ . �,
Shower: -Gang e Iv1
-Stall S�c �i 1 { V� 5-AA) '�
Sink: -Lav/Bar non-food related 1 4- \n t j -V (c C �' -T V)Lf l 1✓12 I ti k
-Bradley V :L 17 K1: '12 y L' ,iv-t" 1(li pk--- 1 A CI..
-Com/Serv/Util food related
-Service `Note: If the fixture work under this permit results in an
Swimming Pool Filler increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase be paid before the
Water Extractor must
Water Closet-Toilet 1, plumbing permit can be issued.
Urinal
Other Fixtures:
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