Permit CITY OF TIGARD PLUMBING PERMIT
.. COMMUNITY DEVELOPMENT Permit#: PLM2021-00357
T r GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/8/2021
Parcel: 1 S126CD00100
Jurisdiction: Tigard
Site address: 9985 SW GREENBURG RD
Project: Crescent Grove Cemetery Subdivision: None Lot: None
Project Description: Interior plumbing for new building: ADD(1)dishwasher,(1)drinking fountain,(1)2"floor drain,(1)garbage
disposal,(1)shower stall,(4)lays/sinks,(1)clothes washer,(3)water closets and(2)hose bibs.
Contractor: NADEANS CUSTOM PLUMBING Owner: CRESCENT GROVE CEMETERY ASSOCIATION
19376 LELAND RD 9925 SW GREENBURG RD
OREGON CITY,OR 97045 TIGARD,OR 97223
PHONE: 503-869-0416 PHONE:
FAX: 503-650-6078
FEES
Quantity Description Date Amount
1 ea Clothes Washer 09/02/2021 $25.02
Specifics: 1 ea Dishwasher 09/02/2021 $25.02
1 ea Drinking Fountain 09/02/2021 $25.02
Type of Use: COM 1 ea Floor Drain/Floor Sink/Hub 09/02/2021 $25.02
Class of Work: ALT 1 ea Garbage Disposal 09/02/2021 $25.02
Type of Const: 2 ea Hose Bib 09/02/2021 $50.04
Occupancy Grp: 4 ea Sink 09/02/2021 $100.08
Stories: 3 ea Water Closet 09/02/2021 $75.06
1 ea Tub/Shower/Shower Pan 09/02/2021 $12.51
1 12%State Surcharge- 09/02/2021 $43.53
Plumbing
Total $406.32
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 re set fQrlhhiinn OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: �G/�%i'• / Permittee Signature: l r_ l,�,(
'C� �/CC';(/l�l(
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.
Plum bin g Permit ADDlicatio4RECEIVE
Building Fixtures AUG 17 2021
11 City of Tigard DateBy. a�,2`f,eay, de per...ldo f Lj 1 2o7 i-0035'
.. 13125SW Hall Blvd.,Tigard,OR9722CITYOFTIGARD Plan Review
Phone: 503-718 243 9 Pax: 503-5913M1DING DIVISION nalen3y: Other Permit J Q Zc)Z/-C O2.23
Inspection Line: 503.639.4175
TIGARD Internet: www.tigacd-or.gov Na /By. e�y/�/ a!J l hair B See Page
na2for
ti
ei Supplemel lefornuos
TYPE OF WORK En1'a" 4-- FEEa SCHEDULEXI New construction ❑Demolition For special information use checklist
DescriptionDescription I
❑Addition/alteration/replacement ❑Other. ' I I Total
New 1-2-family dwellings(includes 100 R.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling 1g Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-familySFR(3)bath 500.32
Each additional bathlkitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 9985 SW Greenberg Road Catch basin or area drain 18.76
IN
City/State/ZIP: Tigard,OR 97223 Ywell leach line,or trench drain 18.76
Footing drain(no.linear R.:_) Page 2
Suite/bldg./apt.no.: J Project name:Crescent Grove Cemetery Made.Bldg. Manufactured home utilities 50.03
Cross street/directions to job site: From HWY 217,north on SW Greenberg Rd,on Manholes 18.76
West side of road between SW Washington Square Rd and SW Lehman St. Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Stone sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: Page 2
Subdivision: 1 Lot no.100 and 500 Fixture or item:
Tax map/parcel no.: WCTM 15126CD,Tax Lots 100 and 500 Buekflow prevents 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer / 25.02
New whole-building plumbing for new office building 2,776 SF Dishwasher ! 25.02
Drinking fountain 1} 25.02
Ejectors/sump 25.02
14 PROPERTY OWNER 0 TENANT Expansion tank ,�, a ' 12.51
Name: Crescent Grove Cemetery&Masoleem dba Crescent Grove Cemetery Assn. Fixture/sewer ca'p`kn/d EK DE'iyt;5 !'� 25.02Floor drain/floor sink/hub �/7 25.02
Address: 9925 SW Greenberg Rd.
Garbage disposal 25.02
City/State/ZIP: Tigard,OR 97223
_ Hose bib Z, 25.02
Phone:( 503 ) 639-5347 Fax:( ) Ice maker 12.51
❑ APPLICANT kg CONTACT PERSON Interceptor/grease trap 25.02
Business name: Don Tankersley Construction Medical gas(value $_) Page 2
Contact name: Ashley Anderson Primer 12.51
Roof drain(commercial) 12.51
Address: 1623 NW Everett Street Sink/basin/lavatory y 25.02
City/State/ZIP: Portland,Ore.97209 (porle..water) 62.54
Phone:( 503 ) 232-0918 Fax:( ) 'l f?"rr ower pan), ! W 12.51
E-mail: ashley@dtcportland.com 25.02
Water closet 3 25.02
CONTRACTOR
Water heater 37.52
Business name: NaDean's Custom Plumbing
Water piping/DWV 56.29 u
Address: 19376 Leland Road Other: 25.02 .16.7 ? /
City/Stata/ZIP: Oregon City,OR Subtotal
Phone:( 503 ) 704-7795 Fax( 503 ) 650-6078 Minimum permit fee: $72.50
CCB Lie.: 173767 ///Q / PI Plan review(25%of permit fee) 1f3.$3
L3 Plumbing Lie.no.: PB270 -/
Authorized signature a ��t3 State surcharge(12%of permit fa)
TOTAL PERMIT FEE I�� %8T
Print name:age/4. 1Q }.h c- Dowel. II r . 2-4 This permit application eydrta if a permit is not obtained with® d alter it his been accepted as complete. (f 4 .
"Fee methodology set by Tri-County Building Industry Service
NBa Ith Pmmb\PLMU-PunrApp.doc 10'01N9 440.4616T(1 nrouCOMIWEB)
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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
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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 fcc$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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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$50,00 0 9.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) h additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr / , nd including$50,000.00.
Additional plan review for revisions 90.00/hr $5 ,00I.00 and/up VVr $742.00 kr the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) l ach add Tonal$100.00 or fraction thereof
Subtotal: (�/ \ !1 V/
P
Commercial Fixture Work: 1......),0 A\
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 Replace/ Please check all that apply.
Work Performed: Capped Added Relocate 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower 1 ✓,/ engineer.
Jacuzzi Whirlpool / ❑ New exterior plumbing site utilities for any complex structure
Car Wash: Each Stall as defined in OAR918-780-0040.
Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
ElAny complex structure as defined in OAR918-780-0040.
-Domestic 1 ,i
Drinking Fountain 1 V
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" 1
3„ Isometric or Riser Diagram
4" eft/ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain 9 C SV that meet the qualifications above.
Garbage -Domestic non-food 1 1S
Disposal: -Domestic food relate. `1\'
-Commercial food r ated
-Industrial food ,ated
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station
Rec.Vehicle Dump Station
Shower: -Gang
., -Stall 1 -
' Sink: ' -LavBar non-food related 2 4
-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 1 fees assessed for the sewer increase must be paid before the
Water Extractor Water Closet-Toilet 1 3 plumbing permit can be issued.
. Urinal
Other Fixtures: hn¢p hih 2
1:lBuilding\Permits\PLMF_PermitApp.doc'08/04/2011 ,� G/� 2
/ RECEIVED
SEP 0 2021
Plumbing Permit Application - City of Tigard
CITY Cr I IGARD
Page 2 -Supplemental Information BUILDING DIVISION
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) I otal Square Footage: Permit Fee:
Footing drain-1"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' 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
QIY: 'Fee(ea) total each additional$100.00 or fraction thereof,to
Other Inspections orFees 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 futures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is requited for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: capped 4aasa Retauor 0 Any new commercial building with water service 2"and
Baptistry/Fnnt greater,except systems designed and stamped mped by licensed
Bath: -Tub/Shower X ✓ engineer.
-lacrrai/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive 71rru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
Domestic I ✓ 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain I ✓
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" 1 V.-3" 4,4 Isometric or Riser.Diagram
Wash C�v� 0 Isometric or riser diagram is required for new buildings
-CarGarbage -Domestic non-food i ti oel✓ 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 1 ✓
Sink: -Lav/Bar non-food related 2 4 V
-Bradley
-Com/Serv/Util food related _
-Service *Note: lithe 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 1 3 ✓ plumbing permit can be issued.
Urinal �,�` 2
Other Fixtures: hngP hih lt�
1:\BuildinglPexmits\PLMF_PermitApp.do 8/04/2011 ,r ,,�' 2