Permit Support Document CITY OF TIGARD KVISQ PLUMBING PERMIT
IN • COMMUNITY DEVELOPMENT Z1 1 Permit#: PLM2021-00104
Date Issued: 3/22/2021
T I[ A R L) 3125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 136CD00101
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 86
Project: Columbia Bank Subdivision: None Lot: None
Project Description: Interior plumbing:Adding(2)floor drain/sinks and(2)sinks.
Contractor: II S MECHANICAL INC Owner: COLUMBIA STATE BANK
PO BOX 639 PO BOX 2156 MS 3300
STAYTON, OR 97383 TACOMA,WA 98401
PHONE: 503-769-3738 PHONE:
FAX: 503-769-4374
FEES
Quantity Description Date Amount
2 ea Floor Drain/Floor Sink/Hub 03/22/2021 $50.04
Specifics: 1 ea Sink 03/22/2021 $25.02
1 ea Lavatories 03/22/2021 $25.02
Type of Use: COM 1 12%State Surcharge- 03/22/2021 $12.01
Class of Work: ALT Plumbing
Type of Const: 45 Misc Administration Fee 03/30/2021 $45.00
Occupancy Grp:
Stories:
Total $157.09
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: \ \1 ` �A�\�e� e Permittee Signature: O� Gv_vILat1 �0"
� �Q ` \J 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 3 \\ Z\ - a
Building Fixtures RECEIVE' FOR OFFICE USE ONLY
RECEIVE 1.�City of Tigard ReceivedDate/By: 3 13121 21 - Permit No.: i_ooi
• 13125 SW Hall Blvd.,Tigard,OR 97223 �AR 11 1 ,.� �Q 1 �f
• I• Phone: 503.718.2439 Fax: 503.598,1960 Dale/B Review Other Permit No.: )W/� I_ 5-
y:
TIGARD Inspection Line: 503.639.4175 Avis:OF TIGARL Date Ready/By: A el See Page 2 for
Internet: www.tigard-or.gov CITYotifedaMethod: ark: Supplemental Information
TYPE OF WORK BUILDING DiVralvFEE* SCHEDULE
0 New construction D Demolition
For special Information use checklist
Description I Qly, I Ea. I Total
„CV'Addition/alteration/replacement ❑Other: New I-Yfamily dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-and 2-family dwelling Al Commercial/industrial SFR(2)bath 437,78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I/1075 T i pi c., ( 1 Catch basin or area drain 18.76
Dryty (tetra G�{ 9-7 2 3 Footell,ing nh line,netrench drain 1g.76
e2
City/State/ZIP: ''('' 2 � - . -
-T� Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: C'olunr�UcOL 1�:e1n� t ip{8 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitarysewer(no.linear IL:_) 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: 15 xv%�• GDr7L iUf) ' ( Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
V y 1 _4 _ Clothes washer 25.02
Ack�. FI pU r �I I'1 F-) l oG r drQ11')I }.�+1 Y� _ Dishwasher 25.02
Si n1L rib() y T- Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER to TENANT Expansion tank 12.51
Name: C6 1 bt(j_ - Fixture/sewer cap 25.02
Floor drain/floor sink/hub 7i 25.02 6)•04
Address: Mils A) ?at�C-k1`, \kw\-1 Garbage disposal 25.02
City/State/ZIP: T. G( c - "n!- ZZ , Hose bib 25.02
Phone:( ) Fax: ( ) Ice maker 12.51
(I APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: _.s.t:`�' �QL`fy")i( e Q M�G Medical gas(value:$_) Page 2
Primer 12.51
Contact name: r� Roof drain(commercial) 12.51
Address; � � C?p)( &Sq 1 Sink/basin/lavatory 2 25.02 50.04
q
City/State/ZIP: +I „ ,'Y ce., cii 3g Solar units(potable water) 62.54
Phone:(5 n3 1to1:11 -3-1 3'' Fax: :( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: M2\(SS0. ZSMCC.\-vo s s CAA . COm
Water closet 25.02
CONTRACTOR -t-,, Water heater 37.52
Business name: -% �IC r.v.t . Waterpiping/DWV 56.29
Address: (j - L039 Other: _ 25.02
City/State/ZIP: Sk.co_{4 rm 042. 9 r' p.?) Subtotal 100.o
Phone:( 3) lk,a(i l-Is 7 3' Fax:( ) ,I Minimum permit fee: $72.50
CCB Lie.: Sy `i(P"1"P Plumbing Lic.no.: z.'7-/''5 P B Plan review (25%of permit fee)
,,// State surcharge(12%of permit fee) IS..
Authorized signature: %it TOTAL PERMIT FEE t\z..0
Print name: ! .4 -� .{ ,-� S Date: -ill l (7.ca" ( This permit application expires If a acceptedl is not obtainedp within 180 days
t ►►`nn�------^^R-- et, alter it has been as complete.
*Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Po inilh,PLMU-PcnnilAppdou 10/01/09 440.4515T(1t1/02/COM/WEB)
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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-cach additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer 1st 100' 62.54
Scwcr 7,201 and greater $327.54
each additional 100' 37.52
Water Service-1st 100' 62.54
Water Scrvicc-each additional 100' 37.52 Medical Gas Systems:
Storm&Rain Drain-1st 100' 62.54 valuation: Permit Fee:
Storm&Rain Drain•cach additional 100' $1.00 to$5,000.00 Minimum fcc$72.50
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
Inspection of existing plumbing or for and including$10,000.00,
which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 each$148.50 for the first$10,000,00 and for
(minimum charge—1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr and including$25,0 0.00.
hours(minimum charge—2 hours) S25,00 1.00 to$50,000.00 $379.50 for the first$25,000.00 and for
Reinspection Fees 90.00/hr each additional 0,0000 or fraction thereof,to
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*. 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 a 1 Work Performed: Capped Added Relocate PP Y•
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath: Tub(Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure
Drive Thn, as defined in OAR918-780-0040.
Cuspidor/WaterAsnive 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ID Any multipurpose fire sprinkler system.
Domestic 0 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,. 'L
Isometric or Riser Diagram
Car Wash Drain El Isometric or riser diagram is required for new buildings
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-In food related
Ice MachJRef Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/Bar non-food related I
-Bradley
-Com/Serv/Util food related
-Service 1 "Note: If the fixture work under this permit results in an
Swimming Pool Filter
washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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