Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00049
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Date Issued: 3/16/2021
Parcel: 2S102AB04100
Jurisdiction: Tigard
Site address: 12386 SW MAIN ST
Project: Cafe Allegro Subdivision: None Lot: None
Project Description: Replace 60'of sanitary sewer line. See PFI2021-00042 for work in right-of-way.
Contractor: MR ROOTER OF PORTLAND Owner: DWAC INC
PO BOX 789 BY DOUGLAS LEE
GLADSTONE, OR 97027 13340 GOODALL RD
LAKE OSWEGO, OR 97034
PHONE: 503-653-5301 PHONE:
FAX: 503-653-5376
FEES
Quantity Description Date Amount
60 If Sanitary Sewer 03/16/2021 $62.54
Specifics: 1 12%State Surcharge- 03/16/2021 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 03/16/2021 $9.96
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 952-001-001Dthrough 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: }folly Vaw De,Wege Permittee Signature: OlvApplicaturn
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.
RECEIVED
Plumbing Permit Application JAN 2 i 2021
Site Utilities
City of Tigard
B CITY OF Ti GAR
.� BUILDING DIVISIO ss L2//S/ Q q0� � 0f- ('
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Permit N !-s I / i
U Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
I i G A It D Inspection Line: 503.639.4175 Date Ready/By: )ors: 10 See Page 2 Per
Internet: www.tigard-or.gov Notified/Method: Supplemontat lnformattun -
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I QtY. I Ea. I_ Total
IN Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑1-and 2-family dwelling jij Commercial/industrial SFR(2)bade 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION ANDI LOCATION Site utilities:
Job site address: I 2.3 0 e 3 MG.t4 Xi- Catch basin or area drain 18.76
City/State/ZIP: �`�,W,a (oft G . Z3 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear IL:_) Page 2
Suite/bldg./apt.no.: Project name: 173i !?{,e ria,A. St. Manufactured home utilities 50.03
Cross street/directions to job site: C4 F-c ift(per-,ram 0 Manholes 18.76
Rain drain connector 18.76
fi.- �E1�'� T- -is �6 Sanitary sewer(no.linear ft.: GO 1 Paget I,Z_f y
� � r F L�1Z-�"l f i Storm sewer(no.linear ft.: ) Page 2
.,S b6 A-IT A- C rf-c7. t7-1"1 A-i L_ ' P. Water service(no.linear ft.: ) Page 2
Subdivision: / .."-.5 (0 E2- C24 - I Lot no.: Fixture or item:
Tax map/parcel no.: Back-flow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
R�4aty Serw(- Ire, ;Loh 44,303q Pvt. it C+� /►1(A1A Clothes washer25.02
••IIII��,, `/ 81.441119
,,,,/�� ,L�" �� � Dishwasher 25.02
O. 7"" Mu STfk t71- � ' '14' .VfN 8wf/*ill/ r.c4wIvtf Drinking fountain 25.02
Prot, toe 4- 01- 1rr[4 Ejectors/sump 25.02
Fi PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Doi.,4 L-trG-- Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1�3$ Si,/ Mq,i14 S-i-
City/State/ZIP: 7-it r aQ 97LZ3 Hose bib 2.5
Garbage disposal 25.02
li(
Phone:(X3 ) Uf� ,$
mr/q- "f fj Fax:( ) Ice maker 1 12.511
Fsf APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: ihr agpter p1W►l6i Medical gas(value:$_) Page 2
t II -- :Y Primer 12.51
Contact name: &/?taw t�t�i„,
Roof drain(commercial) 12.51
Address: PO 601. }0
�� r Sinkfbasin/lavatory 25.02
City/State/ZIP: Cv 1a1A1J t 0 e )01-7 Solar units(potable water) 62.54
Phone:(e )3 ) (aSS- 5-30( Fax::( ) Tub/shower/shower pan 12.51
E-mail: at:a., L.)Q Ot-E..,0O �CO� Urinal 25.02
v Water closet 25.02
CONTRACTOR
heateBusiness name: �.tih,� 4s- 4600c_
Water ipin Water pipin 37.52
g/DWY 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal (o L, 5 y
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7Z,5i7)
CCH Lic.: (361111 Plumbing Lic.no.:,y-y1tiP8 Plan review (25%of permit fee)
State surcharge(12%of permit fee) f^t 70
Authorized signature: 04„.../-%.-4j' TOTAL PERMIT FEE -i,
2,0
Print name: k
This application expires If a permit-in not obtained within ISO days ax Date: �21/Z This permitafter it has been accepted as complete.
'Fee methodology set by Tr6County Building Industry Service Board
t:\Buikia toaeiintPLMI)-PermitApp.doe 10/01/09 4404616T(10/O2/COMR9Ea)
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' I 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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit.Fee:
$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(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$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$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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate q
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thm ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food 0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:1Building\Permits\PLMU_PermitApp.doc 2