Permit CITY OF TIGARD PLUMBING PERMIT
.t COMMUNITY DEVELOPMENT Permit#: PLM2020-00437
Date Issued: 11/3/2020
T1 f,AR.1_i 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136DC03300
Jurisdiction: Tigard
Site address: 11754 SW 72ND AVE
Project: The 72nd Subdivision: 72ND AVE APARTMENTS Lot:
Project Description: Interior plumbing for a salon:Adding(1)2"floor drain/sink,(5)sinks,(1)clothes washer,and (1)water closet.
Installing(1)water heater.
Contractor: CROMWELL PLUMBING Owner: 72ND AVENUE PROPERTY LLC
25599 SW 95TH AVE STE B BY RICHARD CASSINELLI
WILSONVILLE, OR 97070 4804 NW BETHANY BLVD#I-2
PORTLAND,OR 97229
PHONE: 971-224-5304 PHONE:
FAX: 503-266-4792
FEES
Quantity Description Date Amount
1 ea Clothes Washer 11/02/2020 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 11/02/2020 $25.02
5 ea Lavatories 11/02/2020 $125.10
Type of Use: COM 1 ea Water Closet 11/02/2020 $25.02
Class of Work: ALT 1 ea Water Heater 11/02/2020 $37.52
Type of Const: 1 12%State Surcharge- 11/02/2020 $28.52
Occupancy Grp: Plumbing
Stories:
li
Total $266.20
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: _ Permittee Signature:
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 i`- ,1 -it. !7
Bu
ilding ng Fixtures RECEIV i FOR OlII(r, FSF. tivl1
City of Tigard Receive / ,
13125 SW Hall Blvd.,Tigard,OR 97223 OCT
2 f/� ' ?t Perms lV°.: ,4�1�I, �7 ^7 iiii nt Ol✓ I 6 2021 DatelBy: g 1�"' "i71� �'o "i�.e"i�>.+�C.7
Plan Review
M m Phone: 503 718 2439 Fax: 503.598.1960 /-,/ Late/By: Other Permit No.:
s( 0>_/ O 01/3
Inspection Line: 503.639.4175 CITY OF TIGA' (Lan Ready./By: huffs: ® See age 2 for
. Internet www.tigard_or govu No,Mee/Method: Supplemental Information
I • TYPE OF WORK FELL SCHEDULE-
„ New construction ❑Demolition For special information use checklist
- Description P I Qty. I Ea. I Total
1 ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
-_- CATEGORY OF-CONtiTItUCTION i SFR(1)bath 312.70
❑ 1-and 2-fannly dwelling Q/ Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder N,r-sI"�' j' ❑Other - F re sprinkler(_sq.ft.) Page 2
+1.75al{JOOB SITE.:. FORMMAT1ON AND.:LOCATION Site utilities:
Job site address: ' I ;,, t;,J. '/ r ;;;.,?di, Catch basin or area drain 18.76
City/State/ZIP: 'f'�(.')t) ° r n�J?
f Drywell,leach line,or[reach drain 18.76
4t t t �/�(' ��4�`� r-- p _Footing drain(no.linear IL:: ) Page 2
Suite/bldg./apt.no.: Project name: i y t 1{JaLk/77_- marmfactured 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: Lot no.: Future or item:
Tax map/parcel no.: 30 J Beekflow preventer 31.27
`3 i. .y't���fJ"5� Backwater valve 12.51
DR CR1PT'1ON OF WORK
"c I Clothes washer ! 25_02 /.-, Cll.
J,'tle, i)'rp p °l k,'., 1 Y4 4r' s ,•�tx, /.! ., s
_,,` , , ..0,, ,; Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Namc: 2 kt7e( Fixture/sewercap 25.02
t I irA @I - s
Address: "'I 0(/(f 14.4 eE t 41 I p ° I -2 Floor i pwc sink/hub I 25.02 ,0
Garbagege dispose! 25.02
City/State/ZIP: 96,111A0 (1 flit Hose bib 25.02
Phone:( ) Fax:( ) Iee maker 12.51
❑ APPLICANT "D CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
-- - Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address:
_ S¢ilc/basin/tavatory _5 25.02 !j 1.id
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: - Urinal 25.02
CON CRACTOla Water closet 1 25.02 zK.H`^*-
(_ -- - i Water heater I 37.52 3�t5'Z
Business name: �iil tli`I ltffi(1 104fe'b"1t;Ilhi' Water piping/DWV 56.29
Address: mac.?, $>uJ ;?s�' t f
1 e �m f�. vV1{"+%x. Ta Other: 25.02
City/State/ZIP: 11,1(cif lV1/2.4it IA. f/hf'o subtotal 23 ,1,5
Phone:(i 11 ) Zt,sll. 4:- .) ! Fax:( ) Minimum permit fee: $72.50
C:C:B !Lie.: `lI"t"� 2. Plumbing Lic.no.: 311 Plan review (25%of permit fee) r e m^
State surcharge(12.%of permit fee) Zi j2.
Authorized signature: �� TOTAL PERMIT FEh
Print name: 04 ( itet p(411 .t's"t( Date: l`o i r Igog� Tait permit application t boa s if a permit is not obtained within 180 days t
after it best been accepted as complete. (/Y/
*Fee methodology set by Id-County Building Industry Service Board.
REt ldkv\Pc..dt.tPr.MU-Permd App.duc 10/01/09 440-1616T(10%o2/COM/WE0) //] S � �� (�+
-Pllimbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site�Utilities Qty ;fatal : Square Footage: Permit Fee:
Footing drain-1"100' 50.03 0 to 2,000 S121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer3,601 to 7,200 $233.20
-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$1.52 for
Other Inspections or Fees Qty. Fee tea) 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$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$511,000.00.
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
� v'
accurately report fixtures could result in increased sewer fees*. fim;; Plan Review for Plumbing IrdstallStiolls
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type fur 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
engine
-Jacuzzi/WhirlpoolNew r.
Car Wash: -Each Stall 0exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thin
Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water
Dishwasher
-Commercial ❑ Any multipurpose fire sprinkler system.
Co - ❑ 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"
3" isometric or Riser Diagram -
4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Dram that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach..rRefrig.Dina Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Earnon-food related 5
-Bradley
-Cotn/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EllUs,a sewer permit will be issued and
Washer-Clothes 7- fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures: 4-
t w4rt,a.
1:1Building\Pcmuts\PLMF_PernutApp.doc 08/04/2011 2