Permit CITY OF TIGARD PLUMBING PERMIT
'1 2- COMMUNITY DEVELOPMENT Permit#: PLM2020-00342
Date Issued: 9/23/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 570
Project: Dr Andrew Henderson Subdivision: None Lot: None
Project Description: CAP(5)sinks;ADD(3)sinks and(1)clothes washer,water heater and medical gas.
Contractor: QUALITY WEST PLUMBING LLC Owner: LITHIA REAL ESTATE INC
23050 SE FULQUARTZ LANDING ATTN DEBOER, MARK
DUNDEE, OR 97115 150 N BARTLETT ST
MEDFORD, OR 97501
PHONE: 503-289-7095 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 09/22/2020 $25.02
Specifics: 5 ea Fixture/Sewer Cap 09/22/2020 $125.10
3 ea Sink 09/22/2020 $75.06
Type of Use: COM 1 ea Water Heater 09/22/2020 $37.52
Class of Work: ALT 1 ea Medical Gas 09/22/2020 $72.50
Type of Const: 1 12%State Surcharge- 09/22/2020 $40.22
Occupancy Grp: Plumbing
Stories:
Total $375.42
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: /( / ... �'(t7 Permittee Signature:
&f✓ c-74/ L 7'7e,-.‘
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
IVE
Building Fixtures
i
City of Tigard AUG 2020 Rived
t3 j 7 1 Pe,„,ii 2 .� a-� �• j'
13125 SW Hall Blvd.,Tigard.OR 97223 Date By; .�', / G' t f ! 7 G'rG7 �O �j/Z
IN - • Phone 503.7182439 Fax: 503.598.19G((TY QF TIGARD Pkn Revirw Other Pcnnilh 1
Inspection Line: 503.639.4175 Date Rea �,;-.3 i-ar�o le tar -UDIY�j
• t , a.6,i, " • Dale Ready/By: r• .y fN i( kris: ® See Pale
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Internet: www.tigard-or.gor• Naaified'Idethod:I/2''Z/'U' .4V Supplemental Information
TYPE OF WORK P-fS - 7 t FEE* SCHEDULE
❑New construction 0 Demolition For special information use ckecklisr
Description I Qty. I Ea. I Total
Additionialteration/rcplacement 0 Other: New I-2-famly dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑1-and 2-family dwelling _ rnercial/industrial SFR(2)bath a37.7g
C m
❑Accessory building ), SFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION • Site utilities:
t _'J k-- Catch basin or area drain 18.76
Sob site address W r-+,N r^.�
Dtywell.leach line,or trench drain 18.76
City/State/ZIP:"[''r c„jz_ C ''12 S., C
Footing drain(no.linear R.:_) Page 2
Suitc/bldgJapl.no.: Project nante:J Z A hj iNA.2...`- ,0 Manufactured home utilities 50.03
Cross strcevdirections to job site: 1-}-�6 E) S Ors.) Manholes I8.76 '
Rain drain connector 11(.76
Sanitary sewer(no.linear(I.:_) Page 2
Stonn sewer(no.linear ft.:_) Page 2
Water service(no.linear II.: l Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Back(low pro enter 31.27
DESCRIPTION OF WORK Backwater valve 12.51
r ,,G Clothes washer ✓:, I 25.02 .25 AZ,
J ) -)mp. ,,`eS Dishwasher 25.02
�1� um I. Drinking toimiain 25.02
Ejcctors'sump 25.02
0 PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: f,�► ' uJ Qk �`�/� y�( � Fixturcrsewcr cap 5 25.02 /15,1 0
"-'� �,n� v1 ""' -'�! Floor draimlioorsinkzhub 25.02
Address: \1l .A V C- Garbage disposal 25,02
City/State/ZIP: D xNS. LEI . Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
ISNAPPLICANT 0 CONTACT PERSON Ibterceptor/greasetrap 25.02
Business name: Medical gas(value:$ Page 2 y%ctr SO
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: t, Sinkbbasinllav�atory ,,- 3 25.02 95,0 t
City/Staie�"ZIP: <^.1>,, , {pI )1 .--.(] Solar units(potable water) 62.54
Phone:( ) ;�� Fax::( ) Tub'showcr'shower pan 12.51
` ! ,� Urinal 25.02
E-Iran: i 5 c.GL(a r7 �.p 1 Kr st h_,.& 0 -Cc i'1ti_ Water closet 25.02
/ CONTRACTOR
i)t� Water healer 56.29 3f1 sa
Busincssmine: ��r7sAT,.q R'atcrpipingD51'�' 56.29 r
Address: l ,� Other: 25.02
City/State'ZlP: ���v� Subtotal 335,ZO
Phone:( l 2 -'�p�Cj Fax:1 I Minimum permit Ice' $72.50
' 0i� .�� Man re%icy, (25":of permit fee) 83,80
CCB Lie.: ,123 t�,,. Plumbing Lie.no-VS l5 State surcharge(Ir.of permit fee) 1�O,Z2
Authorized signature: •• �i TOTAL PERMIT FEE cis ui
Print nallle:� �, `
V w� Date: I.I,ion n//] TIM permit applka0an expires if n permit is not obtained within ISO days
I,^`�o'- atter h has been aceepled as complete.
"fce methodology set by 3 inCounty Building Industry Scn ice Board.
I:BuiWvw Peran,PI 11i.Perma t ,du, ib(II Sec 4a:1-II 161r l 00t(V:,1 WI tic
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site vtilitles Qty. Fee Oa) Total Square Footage: Permit Fee:
Footing drain-I' 100' 50.03 0 to 2.000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 5169.69
Sewer-lit 100' 62.54 3,601 to 7,200 $23320
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-pat 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 510,000.00 S72.50 for the first S5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(a) Tend each additional 5100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for S 10.001.00 to S25.000.00 $14x.50 for the first S 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-112 hour) and including S25,000.00.
Inspections outside of normal business 90.0090 S25,001.00 to 550,000.(k1 5379.50 for the first S25,000.00 and S1,45 for
hours(minimum charge-2 hours) each additional$100,00 or fraction thereof,to
Reinspection Fees 90.00.70 and including S50.000.00.
Additional plan review for revisions 90.00fir S50,001.00 and up S742.00 for the first S50,000.00 and S1.20 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
Quaatlty by Fixture Type Plan review is requited for any of the following.
Fixture Type for Replace) Please cheek all that apply.
Work Performed: Capped Added Relecata
0 Any new commercial building with water service 2"and
Baptistry/font
Bath: iab5hower •
greater,except systems designed and stamped by licensed
engineer.
-Jacuzzi/Whirlpool
❑Stall New exterior plumbing site utilities for any complex structure
Car Wach: -Eachas defined in OAR9I8.780-0040.
-DriveThru
Cuspidor.-Water Aspirator k'I 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 Submit 2 sets of plans with any of the above.
rye Wash
Floor Drain 2"
Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage -Domestic non-food that meet the qualifications above,
Disposal: -Domestic fond related
-Commercial food related
-Industrial food related
Ice hlach.Rcfrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related 5 - 3
-Bradley _.
-Cora.Scrv/Util 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 Extractot
Water Closet-Toilet plumbing permit can he issued.
Urinal
Other Fixtures:
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