Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00156
T[GAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/19/2021
Parcel: 2S101AA09800
Jurisdiction: Tigard
Site address: 12570 SW 69TH AVE
Project: LG2AG HOLDINGS Subdivision: 1996-024 PARTITION PLAT Lot: 2
Project Description: Interior plumbing:Adding(2)sinks; Installing(1)ice maker and(1)water heater.
Contractor: GREEN BOX MECHANICAL Owner: LG2AG HOLDINGS LLC
3265 NW 29TH AVE 12570 SW 69TH AVE
PORTLAND, OR 97210 TIGARD, OR 97223
PHONE: 503-222-0555 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Ice Maker 04/19/2021 $12.51
Specifics: 2 ea Sink 04/19/2021 $50.04
1 ea Water Heater 04/19/2021 $37.52
Type of Use: COM 1 12%State Surcharge- 04/19/2021 $12.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.08
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: � "941rPvcrl':
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 7/Y0) _a
Building Fixtures FOR OFFICE USE ONLY
City of Tigard RECEIVED Received
`J Date/By: L//l> I,.) Permit No.: J-vl ' PI- +
l 13125 SW Hall Blvd.,Tigard,OR 97223 PlsuReview
Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 5 ge 2 j Ca of�l
'. G 11 ���� Date Ready/By: m,� ®See Page 2 for
Internet: www.tigard-or.gov _ Notified/Method: Supplemental Information
TYPE OF WORM'i t Or TIGARD FEE* SCHEDULE
' n'(�
❑New construction 64,2NADtVISfON Far spedal information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement El
m
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION 111T7 SFR(I)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building El Multi-familySFR(3)bath 500.32
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:12570 SW 69th Ave Catch basin or area dram 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard, OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt,no.: I Project name:LG2AG Holdings 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.: 23 f 10/,Q 0 el r8'U6 Backflow prevaner 31.27
l' DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
REPLACE WATER HEATER,ADD BREAKROOM ICEMAKER LINE AND SINK,
Dishwasher 25.02
ADD HANDWASH SINK Drinking fountain 25.02
Ejectors/sump 25.02 1
0 PROPERTY OWNER I ® TENANT Expansion tank 12.51
Name:David Grau of LG2AG Holdings Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:12570 SW 69th Ave Garbage disposal 25.02
City/State/ZIP:Tigard, OR 97223 Hose bib 25.02
Phone:( 503)427-9910 Fax:( ) Ice maker 1 12.51 7,) ,5 j
la APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Green Property Concepts LLC, DBA Green Box Mechanics Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Sarah Fitz
Address:3265 NW 29th Ave Roof drain(commercial) 12.51
Sink/basin/lavatory 2 25.02 321.0 Li
City/State/ZIP:Portland,OR 97210 Solar units(potable water) 62.54
Phone:( 971)940-3082 Fax::( ) Tub/shower/shower pan 12.51
E-mail:Sarah@greenboxmechanical.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 1 37.52 ,j"_
Business name:Green Property Concepts LLC, DBA Green Box Mechanical Water piping/DWV 56.29
Address:3265 NW 29th Ave Other: 25.02
City/State/ZIP:Portland, OR 97210 Subtotal 100.07
Phone:(503 222-0555 Fax:( ) Minimum permit fee: $72.50
ccB Lic.:214076 Plumbing Lic.no.:PB1841 Plan review (25%of permit fee)
State surcharge(12%of permit fee) / )i
Authorized signature: ."41tiffTOTAL PERMIT FEE i 1 a V P
Print name:Sarah Fitz Date:4/1/21 This permit application expires if a permit is oot obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
is\Building\Pamits\PLMU-PennsApp.doo 10/01/09 440-0616f(10/02/COM/WEB)
0 /t L- 014 1nlGr-e-p .4.t.
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 ee:
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(ea) Total" chnaddi $l$11 10,000.00 fraction thereof,to
and iluding Inspection of existing plumbing or for mYt $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*. 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/Pont greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thm
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial esti
❑ Any multipurpose fire sprinkler system.
- om ❑ 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 Drain
that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -fav/Bar non-food related 2
-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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:1Building\Permits WPLMF_PermitApp.doc 08/04/2011 2
Branden Taggart
From: Branden Taggart
Sent: Thursday, April 15, 2021 6:41 PM
To: Sarah@greenboxmechanical.com
Subject: LG2AG Holdings Plumbing & Sewer Permits: PLM2021-00156 & SWR2021-00094 -
12570 SW 69th Ave.
Attachments: Invoices & Sewer Tally.pdf
Hello Sarah,
The Plumbing and Sewer permits for LG2AG Holdings are ready to issue now. I have attached invoices above for you to
reference, and the fees due are as follows:
LG2AG Holdings
Permit# Fees Due
Plumbing Permit $ 112.08
Sewer Permit $ 1,450.00
Total: $ 1,562.08
The above fees can be paid online through our website: https://aca.accela.com/TIGARD/Default.aspx. From there, click
on the Building tab, enter the permit numbers in the Record Number field, and click Search. Once paid, please notify us
at tigardbuildinRpermits@tigard-or.gov so that we may issue these permits and email the permit paperwork to
you. Furthermore, the permit fees for both permits will need to be paid before we can issue either of them.
Thank you,
Branden Taggart
q City of Tigard
, Senior Permit Technician
Community Development
ICARD'
13125 SW Half Blvd
Tigard, OR 97223
(503)718-2449
brandent@trigard-or.gov
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