Permit CITY OF TIGARD PLUMBING PERMIT
t COMMUNITY DEVELOPMENT Permit#: PLM2021-00019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/1/2021
Parcel: 2S111ACO2700
Jurisdiction: Tigard
Site address: 14650 SW 97TH AVE
Project: Twality Middle School Subdivision: None Lot: None
Project Description: Site utilities to disconnect and remove(19)modular buildings from inside the middle school track.
Contractor: TRIPLETT WELLMAN INC Owner: UNION HIGH SCHOOL DISTRICT
PO BOX 160 NO. 3 JT
WOODBURN, OR 97071 00000
PHONE: 503-982-4188 PHONE:
FAX: 503-982-0390
FEES
Quantity Description Date Amount
11 ea Catch Basin or Area Drain 04/01/2021 $206.36
Specifics: 195 If Sanitary Sewer 04/01/2021 $100.06
913 If Storm Sewer 04/01/2021 $400.22
Type of Use: COM 435 If Water Service 04/01/2021 $212.62
Class of Work: ALT 1 Plan Review 04/01/2021 $229.82
Type of Const: 1 12%State Surcharge- 04/01/2021 $110.31
Occupancy Grp: Plumbing
Stories:
Total $1,259.39
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 / 4,21 -j
}' `Site Utilities DEMO APPLICATION FOR OFFICE USE ONI.t
City of Tigard RECEIV 2'vcd i wit
/�— Permit"Jo.: Y..,. j.J).
- 13125 SW Hall Blvd.,Tigard,OR 97223 Review
/� / "��l +�"'^r--_K-"�-1
Plan Review
t 2 Phone: 503.718.2439 Fax: 503.598.1960 y �+ q qq , Other Permit No. 7a
JAN V LULl Date,uy -.?C�Z0.1I C. �TJ,�y
TIGAR D Inspection Line: 503-639.4175 v Date ReadylBy ,ti ® See Page z for
Internet: www.tlgarTYPgo OF WORK Cf-fY OF 11GAPD'nlwd;Method. �1/yS <p Supplemental Information
1�� I f� DIVISION
�+ r,� -,.r+t,2..,4 ♦Jl y./h LE* SCR?Ul LI;_
❑New construction ®DertrUILrDI1VG DIYISIO V For special info natlatlosecLechlisr-
Description J Qty. 1.a. rota:
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 li.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
—
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 1
SFR(3)bath 500 32
❑Accessory building ❑Multi-family
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:14650 SW 97th Ave Catch basin or area drain 1 1 18.76
Drywell,leach line.or trench drain 18.76
city/state/ZIP:Tigard, OR 97224 ,-
Footing drain(no. linear Il.:_) Page 2
Suite/bldg./apt.no.: Project nameTwality Middle School-Modulars Manutactured home utilities 50.03
Cross street/directions to job site: 97th & Murdock Manholes 18.76
—.
Rain drain connector —
18 76
SSanitary srwer(no linear ft_j) 2 Page 2
tone sewer(no linear li:'�.145 12 Page 2
Water service(no.linear IL 435 5 I Page 2
Subdivision: Lot no.: Fixture or item:
Back now preventer 31.27
Fax map/parcel no.:
_ _ �--
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Disconnect and remove 19 modular buildings from inside the Dishwasher 25.02
middle school track. Drinking Fountain 25 02
Ejectors/sump 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.5'
Namc:Tlgard-Tualatin School District
Fixture/sewer cap
Floor drain floor sink/hub 8 25.02
Address:6960 SW SandburgStreet
Garbage disposal 25 02
Clry/State/ZIP:Tigard, OR 97223 Hose bib 25.02 ! _I
Phone:( ) 503-431-4000 Fax:( ) Ice maker 12.5 I
_ ❑,APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 2=02 ____I
Business name:Day CPM/Otak Medical gas(value.$ ) -i Page 2
Primer 125 I
Contact name:Shawn Christensen
Roof drain(commercial) I2.51
Address:14650 SW 97th Streeter 25 Sink basin.lavatory t i _02
City/State/ZIP:Tigard, OR 97224 _-_ Solar units(potable water) I pl 62 54�_-
Phone:( ) 971-727-4168 Fax::( ) Tub/shower/shower pan /3 T. 12.51
E-mail:shawn.christensen@ otak.com Urinal i. . 8 25.02
Water closet(8jAra/40 i'l.‘ij I1-14t" 19 25.02 I
CONTRACTOR — _._ _._—_.._ i
Water heater at, Ie23 /°"r 5 ` 37.52
Business name:Triplett Wellman Contractors Water pipingiDW V Lit i 56.20
Address:1717 Mt Jefferson Ave Other I 25 07
City/State/ZIP:Woodburn, OR 97071 , w a..1/✓ 615i/Iv) )• St btotal
Phone:( ) 503-982-4188 Fax:( ) t 113 J)d Minimum permit fee: $7250
g_ Plan leview 125%of permit Ric;
CCB Lie.: 43496 Plumbing Lie.no.: I
i/ State surcharge i 12 of permit tee) �__--_
Authorized signature: fiJ•lf/� TOTAL PERMIT FEE
Shawn Christensen 01/06/2021 This permit application expires if permit is not obtained within 180 days
Print name: Date: after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I\nuiiding\P"rmis`,PLtdU-PurninApp doc Ill/(ll/119 440-061CT)I 0/12/COMAWEBI
•
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- ' 100' 50-03 0 to 2,000 _ $121 90
Footing drain-each additional 100' 37.52 2,O01 to 3.600 $169.69
3,601 to 7.200 $233 20
Sewer-1st 100' 1 62.54 7,201 and greater $327.54
Sewer-each additional I00' 1 37.52
Water Service-1st 100' 1 62.54 Medical Gas Systems:
Water Service-each additional 100' 4 37.52
Storm&Rain Drain-1st 100' 1 62.54 Valuation: Permit Fee:
$1 00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 1 1 37.52 $5,001 OO to S10,000.00 S7250 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 S25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional S 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 an of the following
Work Performed: Capped Added Relocate q y e
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
acuzzi/whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ 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 OAR9I8-780-0040,
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3,
Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food ❑ Isometric or riser diagram is required for new buildillas
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach.iRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -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:\Building\Permits\PLMUPermitApp.doc 2
a
1 Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLY
Received /3/ , PLM^� -003i9
1
of Tigard J y� Permit No.: d •
City g Date/By: / I. /f
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: h�6....2.all CAI Other Permit No.:
l 1 tI A R I) Inspection Line: 503.639.4175 Date Ready/By: June: PI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 'Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-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 ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: i q(,50 S.W. 9'1" A..t Catch basin or area drain (l 18.76 .166.34
l Drywell,leach line,or trench drain 18.76
City/State/ZIP: Ti V 0.r try O Ft. 912 2 q Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: lust M:aals SCkoo I - Manufactured home utilities 50.03
Cross street/directions to job site: (noeiv I0.r S Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:1.15) Z. Page 2 (00.0 G
Storm sewer(no.linear ft.Q(1) i p Page 2 4(l0.2t
Water service(no.linear ft.:4/35) 5 Page 2 2(a,.62.
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
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 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: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWv 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal ('q,a C.
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCH Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) a'aq.8a
State surcharge(12%of permit fee) (IQ,3 I
Authorized signature: TOTAL PERMIT FEE 1a59.39
Print name: Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:Building'Permils&PLMU-PermtApp.doc 10/01/09 440-4616T(I0/02/COM/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 61474
7,201 and greater $327.54
Sewer-each additional 100' l 37.52 3q.$3
Water Service-1st 100' ! 62.54 41,5q Medical Gas Systems:
Water Service-each additional 100' L,' 37.52 f50.0 8 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 b1,5C� $1.00 to$5,000.00 Minimum fee$72.50
Storm R Rain Drain-each additional 100' q 37.52 331,03(g $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 faction 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
(minimum charge-1/2 hour) andclo additional5,$100.00. or fraction thereof,to
aid including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 '$379.50 for the rust$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 faction thereof.
Subtotal: /l/a.g0
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 e9
Baptistry Font Please check all that apply.
Bath Tub Shower El 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 Thru ❑ 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 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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.
-3"
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/Lav -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:\Building\Permits\PLMU_PermitApp.doc 2
... _
711 _ Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map&tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS-Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Peimits\PLMF-PermitApp.doc 12/30/05