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Permit CITY OF TIGARD PLUMBING PERMIT : 1 ' COMMUNITY DEVELOPMENT Permit#: PLM2021-00021 and OR 97223 503.718.2439 13125 SW Hall Blvd.,Ti Date Issued: 1/25/2021 TfC;Alii� 9 Parcel: 2S101 BB01500 Jurisdiction: Tigard Site address: 12234 SW GARDEN PL Project: BKM Bldg 1 Subdivision: CROW PARK 217 Lot: 3 Project Description: Replace(1)WC and relocate(1)lay Contractor: PMSI LLC Owner: BKM PARK BC 252 LLC 8295 NW EVERGREEN PKWY#204 1701 QUAIL ST STE 100 HILLSBORO, OR 97124 NEWPORT BEACH, CA 92660 PHONE: 503-466-2222 PHONE: FAX: 503-466-2211 FEES Quantity Description Date Amount 1 ea Lavatories 01/14/2021 $25.02 Specifics: 1 ea Water Closet 01/14/2021 $25.02 1 12%State Surcharge- 01/14/2021 $8.70 Type of Use: COM Plumbing Class of Work: ALT 22 ea Minimum Fee Adjustment- 01/14/2021 $22.46 Plumbing 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: I�' ]/ Permittee Signature: VIVA 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 Building Fixtures i.oiz orhici t si 0'i City of Tigard R EC E I VE Cece ° , 1a Permit No.: \-oOOZ\ 11111 13125 SW Hall Blvd.,Tigard,OR 972.0 Plan Review `Z4Z\ �� _ Phone: 503.718.2439 Fax: 503.598.1960 r�q Date/By: Other Permit No.: TI GARD 7 Inspection Line: 503.639.4175 JAN Ly(l Date Ready/By: %% rods: 6i See Page 2 for Internet: www.tigard-or.gnv OF Notified/Method: 1N Z% tk. 1 Supplemental Information TYPE OF WORK CITY OF 1I J e - 'Lbft7Martb .*.:'SCHEDULE ❑New construction 0 likkiANG DIVISION For special information use checklist. Description I Qty. I Ea. I Total K 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 ❑ I-and 2-family dwelling commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AM) LOCATION Site utilities: Job site address: a Catch basin or area drain 18.76 12 C 1O roc f, 1G„f C Drywell,leach line,or trench chain 18.76 City/State/ZIP: T<GA(ej'ZA I © - calZ.v Footing drain(no.linear ft.: Page 2 Suite/bldg./apt.no.: i Pmject name: '1 `C.IA ?et{n'£1 .1._ 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.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK -- Clothes washer 25.02 \ 6 J i..)C 4- A.Yxzygc'I (V) lax/ Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: \ -ILA 2-a r. c., i''i_ 26 11,-.c Floor draiu/floor sink/hub 25.02 Address: 12.2-1Li g(I) Cane4,-r1e.ri 2\nar.r'.. Garbage disposal 25.02 City/State/ZIP:"1-".c S,,-,3, o'2 0.--1.7...,'-, _ Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 C APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$_) Page 2 s )^1 ( Primer 12.51 Contact name: Avt u...nek - l2 ems{C s Roof drain(commercial) 12.51 Address: gr s 1..)1 Eve.r P y„y4 1 C;,,{c., ' 0t-i Sink/basin/lavatory 1 25.02 °�^j'.CD? . City/State/ZIP: \I r\c.bc,y..y , C) - on 1 z,(.. Solar units(potable water) 62.54 Phone:(5i 3) Lueu_ 7 7 2. Fax::( -ay);,:j _22,0‘ Tub/shower/showerpan 12.51 Urinal 25.02 E-mail:A,rz.y. Se Yin s'i-Sy S"e-m S.GCrr1'1 V 25.02 2 f17 Water closet CONTRACTOR Water heater 37.52 Business name: -PMc,' . 1 L.L', Water piping/DWV 56.29 Address:'z5;Lg5 GVP r'isr'r r-.r2 P k.W,.i I S4 ZC)LA Other 25.02 Subtotal City/State/ZIP: 1-A- 't\S\t,6 p 0 C -112.0 ) (( Fax;( )(l(� Minimum permit fee: $72.50 Phone:( (o la � &- 11 Plan review (25%of permit fee) CCB Lie.: \f 7 R Cn Plumbing Lie.no.:•3q_(4 a,L#R State surcharge(12%of permit fee) Authorized signature g), ,,,„) TOTAL PERMIT FEE eit.'ZO �" �-C! Te: This permit application expires if a permit is not obtained within 180 days Print name: I�..__r..�.�r �' t.,,I e... , (O 2.02..A after it has been accepted as complete. �r s"� -''l *Fee methodology set by Tri-Coanty Betiding Industry Service Board. LU3uilding\Pwoiio\PLMU-ParmitAPPAor 10101/09 440-4616T(10/O2/C0M/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$1.52 for qty: Fee(ea) Total each additional$100.00 or fraction thereof,to Other Inspections or Feesand 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/lu 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 each additional$100,00 or fraction thereof. (minimum charge-1/2 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 0 New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thnt Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. P P 0 Any multipurpose fue sprinkler system. Dishwasher -Commercial 0 Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" -3„ Isometric or Riser.Diagram -4" 0 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 IceMach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related i -Bradley Com/Serv/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 Extractor plumbing permit can be issued. Water Closet-Toilet l Urinal Other Fixtures: - I:\Building\Permits\PLMF_PetmitApp.doc 08/04/2011 2