Permit CITY OF TIGARD PLUMBING PERMIT
i COMMUNITY DEVELOPMENT Permit#: PLM2021-00205
Date Issued: 8/16/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112CB00301
Jurisdiction: Tigard
Site address: 15160 SW 81ST AVE
Project: Bella Meadows Subdivision: Lot:
Project Description: Lot 1 Private stormwater improvements as part the Bella Meadows Subdivision
Contractor: OLSON BROS EXCAVATING INC Owner: BIG-VUK PROPERTIES LLC
4515 NW SILVER LEAF DR PMB 360
PORTLAND, OR 97229 4931 SW 76TH AVE
PORTLAND, OR 97225
PHONE: 503-531-0529 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Drywell, Leach Line or Trench 08/16/2021 $18.76
Specifics: Drain
1 If Storm Sewer 08/16/2021 $62.54
Type of Use: SF 2 If Water Service 08/16/2021 $62.54
Class of Work: ALT 1 Plan Review 08/16/2021 $35.96
Type of Const: 1 12%State Surcharge- 08/16/2021 $17.26
Occupancy Grp: Plumbing
Stories:
Total $197.06
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: c Permittee Signature: �` y2 ]�`�
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.
i
Approved plans are required on the job site at the time of each inspection.
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1 Plumbing Permit Applica f C E I VE D e- 5/1( 121
Site Utilities I �L FOR OFFICE L sI t,\l
City of Tigard MAY 1 1 2021 DatyeB _ remit No.:, /1?Z21--002i
:t 13125 SW Hall Blvd.,Tigard,OR J�QF TIGARD t, Plan Review'
r, s Phone: 503.718.2439 Fax: 503.Si rn,mitNo.:
Inspection Line: 503.639.4175 ' Date/By: ���'
1 I GA r;nBUILDING DIVISION di
Date Ready/By: // _1µqg.. la See Paget for
Internet: www.tigard-or.gov Notified/Method:,h0/2, ,k6 11%t Supplemental Information
TYPE OF WORK INob* FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I) 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-familySFR(3)bath 500.32
0 Master builder 0 Other: Each additional bath kitchen 25.02
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15160 SW 81st Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 1 18.76 18.76
City/State/ZIP: Tigard, OR 97224
Footing drain(no.linear ft.:_J Page 2
Suite/bldg./apt.no.: I Project name:Bella Meadows Subdivision 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.: ) J Page 2 ( 1,
Water service(no.linear ft.: a Page 2 /061,1,6
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: 2S 11 2CB Backflowpreventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Lot 1 private stormwater improvements as part of the Bella Meadows
Dishwasher 25.02
Subdivision.
Drinking fountain 25.02
Ejectors/sump 25.02
(Z PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Mark Vukanovich Fixture/sewer cap 25.02
Address: 4931 SW 76th Ave., #360 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Portland, OR 97225 Hose bib 25.02
Phone:(541-350-1060 Fax:( ) Ice maker 12.51
it APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Big-Vuk LLC Medicalgas(value:$_) Page2
Primer 12.51
Contact name: Mark Vukanovich
Roof drain(commercial) 12.51
Address: %1q 3\ St_D Rio Noc_I`- b. Sink/basin/lavatory 25.02
City/State/ZlP:Dcavcrton, OR•"00 r 1 I tJ� Solar units(potable water) 62.54
Phone:(541)-720 3734 co _\pb Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
Etnal"
ltiktekViAk4M°via, (pit i7.c in Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Olson Bros Excavation Waterpiping/DWV 56.29
Address: 4515 NW Silver Leaf Dr Other: 25.02
City/State/ZIP: Portland, OR 97229 Subtotal 19/,36
Phone:(5034 531-0529 Fax:( ) Minimum permit fee: S72.50
CCB Lie.: 69865 Plumbing Lie.no.:34-457 PB
Plan review (25%of permit fee) 1/$.34/
Authorized signatur State surcharge(12%of permit fee) ,,2 / i 76
TOTAL PERMIT FEE t-/1.145
t� Date: This permit application expires if a permit Is not obtained withia 1aa days
Print name: �../�ter ^ V[�O�'�....3.N� Sly �z...l after It has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:01.61ding\Permits\PLMU-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 1
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 r 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
S 3,601 to 7,200 $233.20
Sewer-1st 100'
62.54 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 1 - 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' 1 37.52 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 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 $50,001.00 and up $742.00 for the that$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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain Isometric or Riser Diagram
Garbage -Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor - Increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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