Permit CITY OF TIGARD PLUMBING PERMIT
nii ' COMMUNITY DEVELOPMENT Permit#: PLM2021-00286
T I C'A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/6/2021
Parcel: 2S103DD00500
Jurisdiction: Tigard
Site address: 13727 SW PACIFIC HWY
Project: Schlesinger Building Subdivision: MELROSE Lot: 8
Project Description: Replace irrigation backflow device.
Contractor: DETEMPLE COMPANY INC Owner: VPT LLC
5636 NE HASSALO STREET 610 SW ALDER ST STE 1221
PORTLAND, OR 97213 PORTLAND, OR 97205
PHONE: 503-227-2641 PHONE:
FAX: 503-274-7686
FEES
Quantity Description Date Amount
ea Backflow Preventer 07/06/2021 $31.27
Specifics: 1 12%State Surcharge- 07/06/2021 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 07/06/2021 $41.23
Type of Use: COM Plumbing
Class of Work: OTR
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 952-001-0010 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 Applicatiop�ECE \V ED
Building Fixtures �!'-�( 2 FOR OFFICE USE ONLY
JUN J 2021 Received
City of Tigard 7 Zj de Permit No OLP/2402/-Oda
■ 13125 S W Hall Blvd.,Tigard,OR 97223 Date,By:
Phone: 503.718.2439 Fax: 503.598.1 7Y OF TIGARD Plan Review Other Permit No.:
Inspection nine: 503.639.4175 BUILDING DIVISION Date/By:
T I G A R D Date Ready/By Internet: www.tigard-or.gov Noti / runs ® See Page 2 for
fied/Method:7/2 '2-f a/� G� Supplemental Information
TYPE OF WORK -jLq.-t__ [- 7 FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I La. I total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-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:
Eire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
t/ Job site address:13727 SW Pacific Hwy
Catch basin or area drain 18.76
City/State/ZIP:Tigard/OR/97223 Drywell,leach line,or trench drain 18.76 •
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Schlesinger BF 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.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replace backflow device on irrigation line Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Mark Schlesinger
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:13727 SW Pacific Hwy
Garbage disposal 25.02
City/State/ZIP:Tigard/OR/97223 Hose bib 25.02
Phone:( 503)860-0007 Fax:( ) Ice maker 12.51
is APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:DeTemple
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:CJ Hemnosura
Roof drain(commercial) 12.51
Address:5636 NE Hassalo St Sink/basin/lavatory 25.02
City/State/ZIP:Portland/OR/97213 Solar units(potable water) 62.54
Phone:(503 )471-5248 Fax:: (503)274-7686 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:c.hermosura@detemple.com
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:DeTemple Water piping/DWV 56.29
Address:5636 NE Hassalo St Other: 25.02
City/State/ZIP:Portland/OR/97213 Subtotal ,31 n-
Phone:(503)227-2641 Fax:( 503)274-7686 Minimum permit fee: $72.50 71' S 0
CCB Lie.:2510 Plumbing Lic.no.:26-25PL Plan review (25%of permit fee)
State surcharge(12%of permit fee) Jr Id
Authorized signature: eri rVea.heesuacz TOTAL PERMIT FEE
Print name:CJ Hermosura Date:6/25/21 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete. -e)
13p/�
*Fee methodology set by Tri-County Building Industry Service oard. �[^V
C lBuildingAPermits1PLMU-PermltApp.doe 10/01/09 440-4616T(10/02/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-I'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 Fee:
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 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for i Replace/ Please check all that apply.
Work Performed: Capped Added Relocate pp y'
ElBaptistry/Fontt Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool •
•
engineer.
Car Wash: -Each Stall -' El New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
ElCuspidor/Water Aspirator - Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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
-q •
El Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage -Domestic non-food that meet the qualifications above.
•
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: -lav/Bar non-food related
-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:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Dianna Ornelas
From: #Building Permit Technicians
Sent: Friday, July 2, 2021 6:02 PM
To: CJ Hermosura
Subject: PLM2021-00286 - Schlesinger - 13727 SW Pacific Hwy
Attachments: PLM2021-00286.pdf
Hello CJ,
This permit is ready to issue and the balance due is $81.20(see attached invoice).
The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record
number PLM2021-00286 under the Building tab. Payment can be made by 'card'for a 3%service fee or select the
'check' payment option and there is no service fee.
Please email the permit technicians at TigardBuildingPermits@tgard-or.gov once the fees are paid so that we can
issue the permit and email a copy.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
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