Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00256
T I C A R f3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/24/2021
Parcel: 2S102AD03200
Jurisdiction: Tigard
Site address: 9045 SW BURNHAM ST
Project: Little World Childcare Subdivision: 1998-032 PARTITION PLAT Lot: 2
Project Description: ADD(1)pedestal lavatory and(2)water closets.
Contractor: INFINITY PLUMBING LLC Owner: TKWA LLC
2315 NE 41ST AVE 4900 SW GRIFFITH DR#124
PORTLAND, OR 97212 BEAVERTON, OR 97005
PHONE: 503-744-1176 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 06/23/2021 $25.02
Specifics: 2 ea Water Closet 06/23/2021 $50.04
1 12%State Surcharge- 06/23/2021 $9.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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 503.23 .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
Building Fixtures RECEIVE
City of Tigard .'1 r <. ' L'' Rn e/By 6 /t/2/ d, r�1NyeL/y2h2/-D)25
-+ 13125 S W Hall Blvd.,Tigard OR 97223
3 Phone: 503.718.2439 Fax: 503.598.19ft4-ry OF TIGARD wt�y. omerPermitNccgd/e 4 ZI 41/5J
I I t n I:lt �pe�on Line: 503.639.4175 Date Ready/By:/ lwn 0 3s Parr 2 for
Internet: www.tigafdor.gov RI IILDING DIVISION NOtibcd/Melao /f .J/'/ B•PP �y14r rm.00a
TYPE OF WORK �1 FEE' SCHEDULE
❑New construction ❑Demolition For special infonna6on use checklist
Description I Qty. I Ea. 1 Total
`[iAddition/alteration/replacement ❑Other New I-2-redly dweWaggs(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ i-and 2-family dwelling ommercial industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath dtchen 25.02
❑Master builder ❑ r Fin sprinkler(__sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
nn 1- Catch basin or arcs drain 18.76
Job site address: �Oy.S Cu..) 1'VI�1",,Q�1�1 t D�,tiu,leach line,or trench drain 18.76
City/State/ZIP: e ( Footing drain(no.linear ft.:_J Page 2
SuitelbldgJapt,no.: I Project name: / 4 -�-f /Ai/. J Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_j Page 2
Storm sewer(no.linear R:_) 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
add'
Y1Li }() {ter eei -111 tgI s 4- �r Dishwasher 25.02
rd IA1.(/51.. 5 in K Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 0 TENANT Expulsion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/LH': Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
\APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: �h,6 ktl,ha pi,Ly( jl i�ry Medical gas(value:S ) Page 2
"l 1 Primer 12.51
Contact name: ) i h �iLL\ �r A Roof drain(commercial) 12.51
Address: Z3 t 5 ie j e -1/Sr. llv e- Sink/basin/lavatory I 25.02
City/State/ZIP: fist-1,k\mil i 1 jMC. Z,I Z . Solar units(potable water) 62.54
Phone:(54 ) -Nei l/2 (, Fax::( ) Tub/shower/shower pan 12.51
_ Urinal
E-mai►: V I�. 3_. L'1-/ij Zdi eaYk I Water closet 'a 25.02
' CONTRA(
R
Water heater 37.52
Business name: p/„e, Gl,,$ QbQ1R. Water piping/DWV 56.29
Address: Other 25.02
City/State/ZIP: Subtotal
Phone:( ) I Fax:( ) Minimum permit fee: S72.50
Plan review permit 25%of t fee)
( �
CCB Lit.: 2231 58 8 Plumbing Lie.no.:1.7$ZI 65 State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: U I h �A i li((,1✓D Date:WZ/2,624 This permit application expires if a permit Is not obtained witala 180 days
after It W ban accepted a complete.
•Fee methodology het by Tri-Counry Building Industry Smice Board
I:Sis uglPwmata7.Itt1-Pamnnppdoc IO,VIO5 41646I6T(Ia/tr7/COM/W138)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(a) Total Square Footage: Permit Fee:
Footing drain-I.100' 50.03 0 to 2,000 S 121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 S 169.69
3,601 to 7,200 S233.20
Sewer-1st 100' 62.54 7,201 and greater _ S327.54
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 S 1.00 to S5,000.00 Minimum fee S72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to S10,000.00 S72.50 for the fast S5,000.00 and S1.52 for
each to
Other Inspections or Fees Qty. Fee(a) Total and includ
ing$S100.00
0 0 00 00 fraction thereof,
Inspection of existing plumbing or for S10,001.00 to S25,000.00 S148.50 for the first S10,000.00 and 51.54 for
which no fee is specifically indicated 90.00/hr each additional S100.00 or fraction thereof.to
(minimum charge-1/2 hour) and including S25,000.00.
inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first S25,000.00 and 51.45 for
hours(minimum charge-2 hour) each additional S100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including 550,000.0D.
Additional plan review for revisions 90.00fir S50,001.00 and up S742.00 for the first S50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional S t00.00 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 Reptseoi Please check all that apply.
Work Performed: Capped Added Rd.eate
0 Any new commercial building with water service 2"and
Bapustr,'I ont greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-lanoz/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall - as defined in OAR918-780-0040.
-Drive Thru
-Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher; -Commercial - 0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Eye king Fountain
Eye WashSubmit a sets of plans with any of the above.
Floor Drain/sink: -2" -
3~ Isometric or Riser Diagram
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
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/Bar non-food related
-Bradley
Com/Sm/Util food related
-Service
Swimming Pooliber *Note: If the fixture work under this permit results in an
Washerclothes 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 a plumbing permit can be issued.
Urinal
Other Fixtures:
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