Permit CITY OF TIGARD PLUMBING PERMIT
I Permit#: PLM2021-00381
COMMUNITY DEVELOPMENT Date Issued: 9/9/2021
T I G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111AB01000
Jurisdiction: Tigard
Site address: 14080 SW 93RD AVE
Project: Alvarez Subdivision: ELROSE TERRACE Lot: 7
Project Description: Install 70'of sanitary sewer line to connect existing dwelling to public sewer. Provide certificate that septic
system has been properly decommissioned by pump/fill or removal of septic system.
Contractor: PDX PROPERTY INNOVATIONS Owner: ALVAREZ, BRADLEY
6792 SW FLORENCE LN 14080 SW 93RD AVE
PORTLAND, OR 97223 TIGARD, OR 97224
PHONE:
PHONE: 503-869-2913
FAX:
FEES
Quantity Description Date Amount
70 If Sanitary Sewer 09/08/2021 $62.54
Specifics: 1 12%State Surcharge- 09/08/2021 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 09/08/2021 $9.96
Type of Use: SF
Class of Work: ALT Plumbing
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
Issued By: � '' Permittee Signature: OVIi��� ���
Ncr77y VctrvVe VVe
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 Applica CElVED u-q j2 2-1
Building Fixtures SEA, t
Received _n Permit N
City of Tigard /(p `2/ <t d PLr1 207.1-D 0 3Pi
.1 . 13125 SW Hall Blvd.,Tigard,OR 9tAIY OF TIGARD Nan R view Other Pemtil� �7(�'ZI�D.z 3�
Il ■ • Phone: 503.718.2439 Fax: 503. mate ay:
1 NG DIVISION
Inspection Line: 503.639 4175 Date Ready/By: yyir;�„ S See Pent 2 for
T(c�.V.r) Internet: www.tigard-orgov Notified/Method: ( `r s• Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty, I Ea. 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 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:14080 Southwest 93rd Avenue
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard, Oregon 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: SW McDonald Street Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: 70) 1 Page 2 65 2e 5(
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no..
Backwater valve 12.51
DESCRIPTION OF WORK Clothes washer 25.02
Sewer line installation of approximately 70 feet and connection to the City lateral with 4" Dishwasher 25.02
HDPE,ABS and PVC pipe and fittings via drilling and excavation to decommission and Drinking fountain 25.02
disconnect from existing septic system. Ejectors/sump 25.02
® PROPERTY OWNER .A;:iia»r,. El TENANT
Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Bradley Alvarez br t-I-GA,r) 2._(H' c;' vs.i-r (. L:e.'t^-
Floor drain/floor sink/hub 25.02
Address:14080 Southwest 93rd Avenue Garbage disposal 25.02
City/State/ZIP:Tigard, Oregon 97224 Hose bib 25.02
Phone:(503) 523-73165 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name: PDX Property Innovations, LLC 12.51Primer
Contact name:Bruce Zielsdorf Roof drain(commercial) 12.51
Address:6792 SW Florence Ln Sink/basin/lavatory 25.02
City/State/ZIP: Portland, OR 97223 Solar units(potable water) 62.54
Phone:( 503)833-2449 Fax: :( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:sales@axiompdx.com 25.02
Water closet
CONTRACTOR Water heater 37.52
Business name:PDX Property Innovations, LLC Water piping/DWV 56.29
Address:6792 SW Florence Ln Other: 25.02
City/State/ZIP:Portland, OR 97223 Subtotal
Minimum permit fee: $72.50 72,se)
Phone:(503)833-2449 Fax:( ) Plan review (25%of pe mit fee)
CCB Lie.:202227 Plumbing Lic.no.:PB1769 State surcharge(12%of permit fee) iet 70
Authorized signature:aq�in.0, 4:1214 i TOTAL PERMIT FEE /, e74)
Date:09/02/21 This permit application expires if a permit is not obtained within 180 days
Print name:Bruce Zielsdorf after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\PeanilslPLMU-PermitAPP.doc 10/01/09 440-4616T(10102/COM/WEB) l (0 . 0 ` LT)
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
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62s4 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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 Re tacd
p Please check all that I
Added Relocate apply.
Work Performed: Capped
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath: tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ElMedical 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
-4"
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
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
-Bradley
-Com/Serv/Util food related
-Service *Note: if the fixture work under this permit results in an
Swimming Pool Filter
Washer-Clothes 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 plumbing permit can be issued.
Urinal
Other Fixtures:
l:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2