Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
Permit#: PLM2021-00191
Date Issued: 6/17/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16165 SW 72ND AVE
Project: Ednetics Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Relocate sink
Contractor: ALWAYS FAITHFUL PLUMBING LLC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 757 ATTN: N PIVEN
WILSONVILLE, OR 97070 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-780-9486 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 06/11/2021 $25.02
Specifics: 1 12%State Surcharge- 06/11/2021 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 06/11/2021 $47.48
Plumbing
Class of Work: ALT
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 r 1.800.3 2.2344.
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 Applicati° 5-4 21/24
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard APR 2 9 2021 ReceivedDate/By:
-.1�'2'\ �/ Permit No.:PV(1202.1_CV(A\
ill 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ ' Phone: 503.718.2439 Fax: 503.598.1 OF TIGARD Date/By: Other Permit No.:
Inspection Line: 503.639.4175 BUILDING
�+ Date Ready By: Tun: ® See Page 2 for
T1c'RD BUILDING DIVISION' 5\S12� Supplemental Information
Internet: www.tigard-or.gov Notified Method: Frr^c"1i� ' Supp
TYPE OF WORK cocGO FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description Qty. Ea. Total
2 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 SFR(2)bath 437.78
®Commercial/industrial
SFR(3)bath 500.32
0 Accessory building 0 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:
Catch basin or area drain 18.76
Job site address: 16165 sw 72nd
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard OR 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Ednetics 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 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
relocate sink Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Pacific Realty
Floor drain/floor sink/hub 25.02
Address: 6650 SW Redwood Ln Ste 290 Garbage disposal 25.02
City/State/ZIP: Portland/ OR/ 97224 Hose bib 25.02
Phone:( 503) 624-6300 Fax:( ) Ice maker 12.51
El APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:Always Faithful Plumbing
Primer 12.51
Contact name: Corey Chamberlain Roof drain(commercial) 12.51
Address: PO Box 757 Sink/basin/lavatory 1 25.02
City/State/ZIP:Wilsonville OR 97070 Solar units(potable water) 62.54
Phone:(503)780-9486 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: alwaysfaithfulplumbing@yahoo.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Always Faithful Plumbing Water piping/DWV 56.29
Address: PO Box 757 Other: 25.02
City/State/ZIP: Wilsonville, OR 97070 Subtotal
Phone:( 503)780-9486 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 217284 Plumbing Lic.no.:PB1940
State surcharge(12%of permit fee)
Authorized signature:e-----j ( - - TOTAL PERMIT FEE �\•ZU
Print name: CoreyChamberlain Date: 4/30/2 021 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\Permits\PLMU-PermitApp.doc 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-1 s'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
Y report re ort fixtures could result in increased sewer fees eview 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/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El 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
4 ❑ 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: -Lay/Bar non-food related 1
-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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2