Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit#: PLM2021-00244
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/14/2021
Parcel: 2S102AB04700
Jurisdiction: Tigard
Site address: 12448 SW MAIN ST
Project: West Wood Spa Subdivision: None Lot: None
Project Description: Replace 150 ft of water service.
Contractor: PACIFIC DRAIN SERVICES Owner: CACH, CHRISTOPHER J
6103 NE ST JAMES RD SUITE B 14420 SW 114TH AVE
VANCOUVER,WA 98663 TIGARD, OR 97224
PHONE: 360-326-8800 PHONE: 503-893-0049
FAX:
FEES
Quantity Description Date Amount
150 If Water Service 06/11/2021 $100.06
Specifics: 1 12%State Surcharge- 06/11/2021 $12.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
}foUyVativDe/Wage OwAppLLcatba
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 r(iR t)I l It 1- 1 ' F e),l.l
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R' Rtxxivod
City of Tigard UN 0 thI Date/By: &(/ 24 /I Pensul No. 1 ?jai GYJo 4-,
• 13125 SW Hall Blvd.,Tigard,OR 97223 J � /"�
i Phone: 503.718.2439 Fax: 503.598.1960 ��Review Other Permit No.:
Inspection Line: 503.639.4175 /+ QF �'� , sae y:
1'WARD Internet: www.tigard-or.gov CO �„cs1 Ready/By: luris 63 See Page 2 for
C'�' Notified/Method: Supplemental Information
TYPE OF WORK QA-1"-1� FEE* SCHEDULE
❑New construction 0 Demolition For cid in
s ormation use checklist
Description I Qty. I Ea. I Total
XAddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
'❑ 1-and 2-family dwelling ommercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 50032
--- Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:
ijv (l l n Jtr Drywe Eootmage2tc/ZIP: (,
�/ 1, r Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.mi.: Project name: k/ a Manufactured home utilities 50.03
Cross street/directions to job site: •�+ Manholes 18.76
+�1t 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: Lot no.:UF+ Mt Fixture or item:
Tax map/parcel no.: 1....S\ 6 01 7 W Back flow preventer 31.27
DESCRIPTION��/� OF WORK Backwater valve 12.51
rDVt vilrill Si VVL'1/t ft- aCe tS Clothes her washer 25.02
jj rr,�� Dishwasher 25.02
itS4fx. ' ./ Wth V I ce Drinking fountain 25.02
f Ejectors/sump y 25.02
PROPERTY OWNER ( 0 TENANT Expansion tank 12.51
Nance: r r��//,Sl Fixture/sewer cap 25.02
t j� Floor drain/flag sink hub 25.02
Address: i `�-11-
.�; n,,�/ Garbage disposal 25.02
City/State ZIP: (�ga/e/, ( j q 3-2/,1 lime bib 25.02
Phone:()) Cog"I') 004CI Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name', `��� } m��)1 i�(� OM Di Mtxiical gas(value:$ ) Page 2
Contact name: tt --�. �>�' J I Primer 12.51
y� p / y Roof drain(commercial) 12.51
Address: ' d� NJ (1/c- /! . t ct {,� C-r, Sink/basin/lavatory 25.02
City/State/ZIP: s� W OD Vet), W Or? Solar units(potable water) 62.54
Phone:()) !)C ` �' (.t Fax::( ) Tub/shower/shower pan 12.51
E-mail:it l / I Cpl tP1 14 n/ai f Urinal 25A2
4�,, ,,��'' CM Water closet 25.02
CONTRACTOR
^` Water heater 37.52
l.{ 91 Business name' � �,� / Water pipingfDWV 56.29
c l VVV
Address: . •
R 'jjffll Other: 25.02
City/State/ZIP: r i! fd , J ) C/U1 o .L i i -- - Subtotal
tl Minimum nit fee: $72.50
Phone:(9 ,r 5 ,2�// -_ Fax:( ) ��� t
- /i Plan review (25%of permit fix)
CCB Lie.: 7 r2 I r aj Plumbing Lic.no.: 44"If
{--F t4ju�� State surcharge(12%of permit fix)
Authorized signature: JJ 1V . _ TOTAL PERMIT FEE
Print name: y 4 t1t tp Date: (1 i li Ili This permit application expires if a permit is not obtained within 180 days
1 t1' 111 after it Ins been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:Uluidfing\Pemits\Pi NU-Permit App.doc 105115$/ 440•4616T(10/02/C01.4lWEn)
Plumbing Permit Application -City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Footing drain-1'100' 50.03 0 to 2,000 S121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 S 169.69
Sewer-1st 100' 62.54 3,601 to 7,200 S233.20
7,201 and greater $32734
Sewer-each additional 100' 3732
Water Service-1st 100' 1 62.54 21 Medical Gas Systems:
Water Service-each additional 100' i 3732 , •
Storm&Rain Drain-1st 100' 62.54
51.00 to 55,000.00 Miairmrm fee 57230
Storm&Rain Drain-each additional100' 3732 S5,001.00 to S10,000.00 S7230 for the first$5,000.00 and$132 for
each additional$100.00 or traction thaoo1 to
`: k.pYz ' . B�OB'L� :. .' and including S10,000.00.
Inspection of existing plumbing or for S10,001.00 to S25,000.00 S14830 for the first$10,000.00 and$134 for
which no fee is specifically indicated 90.00/hr each additional S 100.00 or fraction thereof;to
(minimum charge—1/2 hour) and including S25,000.00.
Inspections outside of normal business 90.00/hr S25,001.00 to$50,000.00 S37930 for the first$25,000.00 and S1.4S for
hours(minimum charge—2 hours) each additional S 100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr S50,001.00 and up S742.00 for the fast S50,000.00 and S120 for
(minimum charge—1/2 hour) each additional S100.00 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*. ,
Quay by Fixture Type Plan review is required for any of the following.
Fhb=Type far Please check all that apply.
Work Pesformedc Capped Added Relents 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-7 /whirlpool
Car Wad: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Duo
Cuspidor/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" :: Ipetl c.or.: ram .
-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 ig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Roc.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv1Ua1 food related
-Service *Note: If the fixture work under this permit results in an
Swimming fool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Cbthes fees assessed for the sewer increase must be paid before the
Water Closet
Extractor
plumbingcan be issued.
Water -Toilet permit
Urinal
Other Fixtures:
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