Permit CITY OF TIGARD PLUMBING PERMIT
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-''' COMMUNITY DEVELOPMENT Permit#: PLM2020-00453
Date Issued: 1/28/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126CD00100
Jurisdiction: Tigard
Site address: 9985 SW GREENBURG RD
Project: Crescent Grove Cemetery Subdivision: None Lot: None
Project Description: Site utilities for a new administration building.
Contractor: NADEANS CUSTOM PLUMBING Owner: CRESCENT GROVE CEMETERY ASS
19376 LELAND RD CRESCENT GROVE CEMETERY
OREGON CITY, OR 97045 9925 SW GREENBURG ROAD
TIGARD, OR 97223
PHONE: 503-869-0416 PHONE:
FAX: 503-650-6078
FEES
Quantity Description Date Amount
300 If Footing Drain 01/13/2021 $125.07
Specifics: 40 If Storm Sewer 01/13/2021 $62.54
1000 If Water Service 01/13/2021 $400.22
Type of Use: COM 1475 If Sanitary Sewer 01/13/2021 $587.82
Class of Work: ALT 1 ea Ejectors/Sump 01/13/2021 $25.02
Type of Const: 1 Plan Review 01/13/2021 $300.17
Occupancy Grp: 1 12% State Surcharge- 01/13/2021 $144.08
Stories: Plumbing
Total $1,644.92
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: -�.y^4'^
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.
S a
Plumbing Permit Application
Site Utilities Q1 ECE.N E 9 FOR 0I1,(I ISL ()NL)"
City of Tigard ! Date/By: 11 A 90607_ Permit No.: Q/ .e'to-.i
Ili 4 13125SW Hall Blvd,Tigard,OR972211n0 y 0 Zo Plan Review /" r
!: ` Phone: 503.718.2439 Fax: 503.598.1 1 Other Permit 3
DatelBY: f�-�1-.�a'lo� C/19 i"�
TIGARD Inspection Line: 503.639.4175 TtGARri Date ReadyBy a, 7nra ® See Page 2for
Internet: www.tigard-orgov 1 OF -irk hSed/Method f �f✓C r,.7 ,-Ty[,s Supplemental it/formation
r I
TYPE OF.WORK t-15`.' "y $' FEE4 SCHEDULE.:
2,1 New construction ❑Demolition For special information use checklist.
Description 1 Qty. I Ea. I Total
Q Addition/alteration/replacement El Other. New 1-2-family dwellings(includes 100 ft.for each utility connection)
y ` 312.70
1 � �-::-.-`� C.A'FEGORY'OF CONS"FRIiGrI � - +r SFR(I)bath
❑1-and 2-family dwelling )8(Comm lalimdustrial SFR(2)bath 437.78
a ff SFR(3)bath 500.32
❑Accessory building 0 Multi-fa 1 y tW�- Each additional bat/kitchen 25.02
❑Master builder 1
0 Other: p j Qn ,}�p�-I�'D Is, Fire sprinkler(_sq.R.) Page 2
q -SOB SITE INFORMATION AND LOCATION 4 t t` • •.. Site utilities:
��� _.Jt r,. r:4" Catch basin or area drain 18.76
Job site addre s: 5 SW Greenburg Rd. 1/411 t'
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard,OR 97223 Footing drain(no.linear ft.: ) 300 Page 2 125.07
SuiteibldgJapt.no.: l Project name:Crescent Grove Cemetery Admin Bldg. Manufactured home utilities 50.03
Cross street/directions to job site:From HWY 217,north on SW Greenburg Rd., Manholes 18.76
on west side of road between SW Washington Square Rd.and Rain drain connector 18.76
Sanitary sewer(no.linear R: 1400.. Page 2 550.30
SW Lehman St. Storm sewer(no.linear ft.:_) 100 Page 2 62.54
Water service(no.linear ft.:_) 1000 Page 2 400.22
Subdivision: Lot no.:100 and 500 Fixture or item:
lax map/parcel no.:WCTM 1 S 126CD,Tax Lots 100 and S00 Backflow preven ter 31.27
Backwater valve 12.51
DESCRIPTION OF WORK i
Clothes washer 25.02
Construct new office administration building of 2,776 SF.Install new Dishwasher 25.02
utilities including sewer,underground electrical,gas,waterline and meters, Drinking fountain 25.02
and stormwater facilities.Install private fire hydrant. Ejectors/sump 25.02
(.,1 sd+l PROPERTY OW\ER El TENANT J Expansion tank 12.51
"As Fixture/sewer cap 25.02
\� Name: Crescent Grove Cemetery 8,Mausoleum dba Crescent Grove Cemetery Association
s Floor drainAloor sink/hub 25.02
i Address:9925 SW Greenburg Rd. Garbage disposal 25.02
City/State/ZIP: Tigard,OR 97223 Hose bib 25.02
' Phone:( 503)639-5347 Fax.( ) Ice maker 12.51
tat.... 0 APPLICANNI t CONTACT PERSON _.. Interceptor/grease trap 25.02
.
Business name: Giulietti/Schouten AIA Architects,PC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Jake Weber Roof drain(commercial) 12.51
Address: 2800 NW Thurman St. Sink/basin/lavatoo, 25.02
City/State/ZIP: Portland,OR 97210 Solar units(potable water) 62.54
Phone:(.503) 975-3376 Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:jakew@gsarchitects.net
Water closet 25.02
OR i h,,t,.t. .0 s t,i.,.!'
/ q' Water hcaWr 37.52
Business name: t tID a':.�4 /i iOc l/. Water piping/DWV 56.29
Address: �. 1`137v L e.10 l g, , C-u-401) Pior,b pper: 25.02
City/State/ZIP: Pertfand7e1r 97Z179 U (�4? U� x��
J Subtotal 1138.13
f/ "p I Minimum permit fee: $72.50
(� Fax: )
Phone: }�{j`�(�Y-f%/(�1 ( Plan review (25%of permit fee) 284.53
CCB Lic.r 08G63 r?3-x17 PlumbingLic.no.: P ,�337t) e
State surcharge(12/o of permit fee) 136.58
Authorized signature: - TOTAL PERMIT PEE 1559.24
-`�K Print Warne: Don Tankersley Dare: 10/28l2020 Tide permit application expires if a permit la not obtained within 1S0.day.
after It bae bran accepted as complete.
°Fes methodology set by Tri-County Building IrnTwtry Service Board.
1,\Baildiseermfn'P1 M1J-PermtApp.dor 10/01/09 440-4616T(10/02JCAM/WEa)
3
..... - ....... a .-n
i
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty Fee(es) Total Square Footage Permit Fee:
Footing drain-I'100' 1 50.03 50.03 0 to 2,000 $121.90
Footing drain-each additional I00' 2 37.52 75.04 2,001 to 3,600 $169.69
3,601 to 7, 00 $233.20
Sewer-1st 100' 1 62.54 62.54 7,201 and greater $327.54
Sewer-each additional 100' 13 37.52 487.76
Water Service-1st 100' 1 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' 9 37.52 337.68 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 1 62.54 62.54
$1.00 to S5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 572.50 for the first$5,000.00 and$1.52 for
Other Inspections.00Fees Qb'• . Fee(ea) Total each additional$100.00orfractionthereof,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: 1,138.13
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 Relceate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath - b/Shower 1 / 0 Any new commercial building with water service 2"and
.fa zzi/Whiripool greater,except systems designed and stamped by licensed
Car Wash -Each tall engineer.
-Driver 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commerc,I 0 Medical gas and vacuum systems for health care facilities.
-Domestic 1 Cl Any multipurpose fire sprinkler system.
Drinking Fountain 1 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" 1 Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash D ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food g q g
Disposal -Domestic-food related 1 that meet the qualifications above.
-Commercial-food relat:,
-Industrial-food relat:r
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station c G �);GJ PY) -
Shower -Gang
-Stall
Sink/Lav -Non-fr..related 3
l3radl•
-Co ercial-food related
-S ice
Swimming P.ot Filter *Note: If the fixture work under this permit results in an
Washer- •other 1
Water tractor increase of sewer EDUs,a sewer permit will be issued and
War loset-Toilet 3 fees assessed for the sewer increase must be paid before the
u'..al \ plumbing permit can be issued.
Other Fixtures: 1 I:1B \
uilding\Permits\PLMU_PermitApp.doc 2
- 'lambin Perm
g it Application
Site Utilities FOR OFFICE USE ONLI
Received , PJ q�goTOOgC3
City of Tigard Date/By: ////e /j7,-- Permit No.: f` if of J
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ��1�
= Phone: 503.7182439 Fax: 503.598.1960 DateBy ig-3/-_.132,9 04 Other Permit No.:
T I< A A D Inspection Line: 503.639.4175 Date Ready/By: �-J}m�is�' ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: iks, Supplemental Information
TYPE OF WORK FEE* SCHEDULE
jeNew construction El Demolition For special information use checklist.
Description ( '. I Ea. I Total
❑Addition/alteration/replacement El 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 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
El Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
` ii RA., Catch basin or area drain 18.76
Job site address:
Qq .5 Sr�t) CzY w Uuf, Drywell,leach line,or trench drain 18.76
City/State/ZIP: Titacu.&i O R.gel 15..3
Footing drain(no.linear ft.:3OQ 3 Page 2 Ia5,0 ri
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:1125 f$ Page 2 Fg7 ea
Storm sewer(no.linear ft.: ( Page 2 6;t,5q
Water service(no.linear ft.:MD 1 O Page 2 400,:1,1
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
ttt e_ CAA- 1 i 1 t i e s c r i eL1 O f f±kJ- asi n'�I Vt i S+L Ink�I U'.'1 Dishwasher 25.02
6.1:t i.il Drinking fountain 25.02
Ejectors/sump / 25.02 �5.a
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name:
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DW V 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal /L00,47
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) 300,f 7
CCB Lic.: Plumbing Lie.no.:
State surcharge(12%of permit fee) /(m,oe
Authorized signature: TOTAL PERMIT FEE '6 4132
This permit application expires if a permit is not obtained within 180 days
Print name:
Date: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Buildiag'Permits\PLMU-PermitApp.doc 10/01/09 4404616T(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-I s' 100' / 50.03 5o,63 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 115 tyy 2,001 to 3,600 $169.69
Sewer-1st 100' ' 62.54 der st1 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' i K 37.52 5a5,146
Water Service-1st 100' j 62.54 615Y Medical Gas Systems:
Water Service-each additional 100' fl 37.52 'j32(,$ Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 60.57 $I.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
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
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: 075;
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/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate �1
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 ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial El 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"
Isometric or Riser Diagram
Car Wash Drain
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/Iav -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:
1:1Building\Permits\PLMU_PermitApp.doc 2