Permit CITY OF TIGARD PLUMBING PERMIT
1,1 _ COMMUNITY DEVELOPMENT Permit#: PLM2020-00380
Date Issued: 10/1/2020
T[GAR T3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101 DB00100
Jurisdiction: Tigard
Site address: 7340 SW HUNZIKER RD 102
Project: Waypoint Counseling Subdivision: None Lot: None
Project Description: Relocate break room sink.
Contractor: WESTERN PLUMBING Owner: HILLTOP BUSINESS CENTER LLC
9460 SW TIGARD AVE SUITE 101 9430 NW KAISER RD
TIGARD,OR 97223 PORTLAND,OR 97231
PHONE:
PHONE: 503-639-5296
FAX: 503-684-9015
FEES
Quantity Description Date Amount
1 ea Sink 09/25/2020 $25.02
Specifics: 1 12%State Surcharge- 09/25/2020 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 09/25/2020 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 1 .) 1,yj\1"GyJ^'„ Permittee Signature: S
���,,p 1 ; 1_1 O r
1 � Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicatio►}� lVE
Building Fixtures iiR
riliN
City of Tigard SEP Q 9 Rseeived Dd2�O
Roza Date/By: I �1/ e 64 Permit N !M��I/t
13125 SW Hall Blvd..Tigard.OR 97223 eview
IIPhone: 503.718.2439 Fax: 503.59$.1QTY OF TIGARD DaPlante/RBy: Other Permit Nu.:
Inspection Line: 503 639.4175 BUILDING DIVISION Date Ready/By tuns 0 See Page 2 for
Internet: www.tigard-or.gov v7 NotifiedNelhod f 7/' J v Supplemental Information
•
TYPE OF WORK E44//r -A/'f} FEE" SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
. Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 if for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling 10 Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath Slli)32
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:' ilJ .AJ -Of QX' Catch Drywell,ba le or area drain 18.76
hatch line,or trench drain 18.76
City/State/1.113:7
Footing drain(no.linear II.:_) Page 2
Suite/bldg./apt.no.: Pmjeet name: I .f,, ,i4., k ,�., Manufactured home utilities 50.03
('mss street/directions to job site: Al-
�} Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear Il.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
,-_I� �� /� Dishwasher 25.62
V'( )( "t. �.1._r�\C1!5CL.L�Q� !� Drinking fountain 25.02
� "' C 9'r'�- £-1'l.6 rr-44-00 r1 c,� /"./ .-__ Ejectors/sump 25.02
❑ PROPERTY OWNER [{ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/huh 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( µ) Fax:( ) Ice maker 12.51
NI APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name.istsluen 1�1u v�,Y7►rc re. • Medical gas(value:$_) Page 2
Contact name: ` yt y�a `1� ,�
Primer 12.51
�+^ ,�,I py __ Roof drain(commercial) 12.51
Address: Q �'�`1 )I[f 11TI5ia.7, Lf-�(� 4 Q Solar Sink/basin/lavatory(pota 25.02 (y2
City/State/ZI 11e32 Solar units(potable water) 62.54
Phone:(J �e �-52a�p Fax::( ) Tub/shower/shower pan 12.51
1-mail:(�� u_��/�� T Urinal 25.02
f1�� � �C vCtTW� Water closet 25.02
CO, RACFOR
, � ` Water heater 37.52
Business name:
1A�1[.7��x�� 11hC Water piping/OWV 56.29
Address:Ct4.,DO Cl�i, SIV „nh `C\ Other: 25.02
City/State/Aril 3 1� VVZv3�� subtotal p2
Phone:( ) .5 a fp Fax:( 1 Minimum permit fee: $72.50 -4,�5O
Plan review (25%ofpermit tee)
C'C'B Lic.: °► Plumbing Lic.no. ?q %__ `
State surcharge permit fee)
Authorized signature: It TOTALTAL PERMIT FEE Tvits
Print name: Date:4fq This permit application expires ifs permit is not obtained within ISO days
after it has been accepted as compkte.
•Fee methodology set by'Fri-County Building Industry Service Board.
•
I IBwldma\PermusiPt.Mtl-PermaApp dnc I ;u I.rt 440-N,IOTI I Ma'COMAVER)
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-I" 100' 50.03 0 to 2,00)) $121 90
2.001 to 3.600 $169.69
Footing drain-each additional 100' 37.52 3.601 to 7.200 $233.20
Sewer- 1st 101) 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-I st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-I st 1(ItP 62.54 $I(N)to$5.00000 Minimum fee$72.50
Storm&Rain Drain-each additional 100 37.52 $5.(X)1 0010$I O(N10.1N) $72.50 for the first$5,(NN)00 and$1.52 for
Fee(ea) Total each additional$I(X).00 or fraction thereof,to
Other Inspections or Fees and including$10,000_00.
Inspection of existing plumbing or for $10.00100 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 traction thereof.to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25001.00 to$50,000.00 S379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.01)or fraction thereof.to
Rcinspection Fees 90 00/hr and including$50,001100.
Additional plan review for revisions 90.00/hr $50(N)1.00 and up $742 00 for the first$50,000.00 and$1.20 for
each additional$10000 or fraction thereof.
(minimum charge-12 hour)
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
Baptistry/Font greater.except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher -Commercial ❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
live Wash
Floor Drain/sink: -2-
Isometric or Riser Diagram
❑ 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 Comments regarding fixture work:
Ice Mach/Refiig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall 1 ,9R-- �c c�;ti5 Ci�J ye___
-12v/Bar non-food related if 1 'Ss1 1
-Bradley
-Com/Sen/lltil 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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
l:lBuilding\Permits\PI_MF_PermitApp.doc 08/04/2011 2