Permit CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMENT Permit#: PLM2021-00382
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/9/2021
Parcel: 2S112DD01400
Jurisdiction: Tigard
Site address: 15686 SW SEQUOIA PKWY
Project: Courtyard by Marriott Subdivision: PACIFIC CORPORATE CENTER Lot: 5
Project Description: Site utilities for TI:venting 80 ft.of sanitary sewer.
Contractor: JRT MECHANICAL INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 1450 PO BOX 58990
BATTLE GROUND,WA 98604 SEATTLE,WA 98138
PHONE: 360-666-0330 PHONE:
FAX: 360-666-0830
FEES
Quantity Description Date Amount
80 If Sanitary Sewer 09/09/2021 $62.54
Specifics: 1 12%State Surcharge- 09/09/2021 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 09/09/2021 $9.96
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: _-=: r � ' f Permittee Signature: y J
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
Site Utilities FOR onFICE I SE ON I,‘
City of Tigard Reserved 1 m Pemdt xo.:/ _.
g ORE udt6nly: q ,�1_
13125 SW Hall Alvd.,Tigard O pap Renew
1 s Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
I)e dify.
Inspection Line: 55003.639.4175 Date Ready/By: 6 / 1 kris: r 61 FSee Page 2 or
t ltinitl7 �' �Z� 1 !� }
, Internet www.tigard-or.gov Notified/Method: -/ i1 �' j]�� Supplemental information
TYPE OF WO43ITY OF TIGA o `_ , ,m. FEB* SCHEDULE
❑New construction t II ipfilePDIVISION For special information use checklist
Description I Qta Ea. Total_
Egf Addition/alteration/replacement ❑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 ®Commercialcndustrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Eachadditional bath/kitchen25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:__.
-
l„ t, Catch basin or area dram l 18.76
fob site address: I LJ b fe 6 sLtc 'a4 4,1 ..FC i.(A._..Po`(:ki.1e�.
-....._..Y...._ ;. `� ......... Drywell,leach line,or trench drain 18.76
City/State/ZIP: Ti Ft R r p '„ -7 2 2.4 Footing drain(no.linear ft.:__) Page 2
V
Suite/bldg/apt.no.: Project name: Coult,,,kif at D fet pt j044, Manufactured borne utilities 50.03
Cross street/directions to job site: 1 Sir-94 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:1D ) g D Page 2 ,•E
...,,_._...,_.__..........._-__._-__-...-.-.--.....` Storm sewer(no linear ft.: ) Page 2
--___ -__.- ------- Water service(no.linear ft.:_) Page )
P e2
Subdivision:
Lot no: F1R1a9`l or lion:
Tax map/parcel no.: Backflow preventer 31.27
-• -•- --'- Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
b r ._.( .._._ I W' { Dishwasher _ 25.02
IP i l w 4. .L la.-' t Drinking fountain 25.02
Ejectora/sump _ 25.02
-_
•`.PROPERTY OWNER 0 TENANT Expansion tank 12.51
* -" ¢°" Fixturelsewer cap 25.02
Name: 1)ri L'11Z u-St _
_. Floor drain/floor sink/hub 25.02
Address: a tk
�•1�5 �tW r Sc rn ��1�K.v+)�`�__._ Garbage disposal 25.02
City/State/ZIP:/State/ZIP: ? Hose bib 25.02
ty k toh f (� __.__....__ a ___ --
Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
fit t,,,._ p - •"-�' - Medical gas(value:S ) Page2
Business name:'Z T yvlue'�1!' L Primer 12.51
Contact name: -._... Roof drain(commercial) 12.51
Address: � r1` f(A_ '.c Sink/basin/hry Cory 25.02
City/State/ZIP: t• 0‘,0,,.."C: O - 4?4011 Solar units(potable water) 62.54
Phone:(3 I,b) t�i j
a Fax::( ) Tub/shower/shower pan 12.51
i_ 25.02
Urinal _-_. .. ,.m._ ....
E mail t `a Gf^- G r l 25.02
...�. watec closet
CONTRACTOR w.�.._
.. - .. ( Water heater 37.52
Business name: J' I, i c 1--- __,.___._._..__ -...._ Waterpiping/DWV � 56.29
Address: Other: 25.02
City/State/ZIP Subtotal g�7, 'ti
Phone:( ) Fax:( ) Minimum permit fee $72.50 A : 131
---- --- .-.. -- ---°�--,..-_ ---'- Plan review (25%e of permit fee)
CCBLic: bilge) r.umbmgLic.no.: P .`•..
'I�tl p$ �..-- -_.__-_ I $11 .______- State surcharge(12%of permit fee) "r 7
Authorized sign tore: j/ TOTAL PERMIT FEE ;
r /f, f� p 0(,�✓� Thta permit application expires if a permit is not obtained wi I a 780 d
1 Print name: jet yle- tic. ei..,ag,Fc Data. b' after It has been accepted as complete. f/'i.1)
*Pee methodology set by Th-County Building Industry Service Board.
I;\BuldmgWmmaz\PLMU-PermitApp.dee I0/01/09 440-4ai6r(10/02/COMWVnB)
,
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Sup 3ression Systems:
Site Utilities QV. Fee tea) I 1ateI ; S care Footage: Permit Fee:
Footuau drain-la 100' 50.03 ( 0 to2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169 69
_____ 3,C,0!to 7 200 $233 20
Sewer-1st 100' 62..54 __. ..__.._.-_..�_ _ 5
,. .... .... __
7,201 and gmater 327 54
Sewer-each additional 100' gib 37.52 CA
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-eachadditional100' -. --. 37.52 _
------ Valuation: Permit Fee,
Storm&Ram Drain-1st 100' 62.54
$1.00 to$5,000.00 Muumutn 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 Ins actions or Fees QV' Fee(ea)
each additional$100.00 or fraction thereof,to
_ ........ .._-_ andtaclurlsi�y ait:00000
Inspection of existing plumbing or for S 10,001.00 to$25,000.00 $145.50 for the first$.10,000.00 ace S 1.54 for
which no fee is specifically indicated 90.00/hr III each additional$100.00 or fraction thereof,to
(minimara char e—I/2 hour) i and including$_5,000.00 I
Inspections outside ofnormal business 90.00/hr `000` . d'$
P $25,OOI.00 to S50 D00.00 $379.50 for the first$25 Ot10 00 and j 1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Re
ainspeotlon Fees 90.00/ty and malueiinp+se a110.00.
_� __.__-_._-___ $50,001.00 and $742.00 for the first$50,000.00 and$2 20 for
Additional plan review for revisions H0.001krr �
(minimum dense 1/2 hou) - 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 T le 1 Plan Review for Pin nibin , Installations
Fixture Type for Rep / ,--.
Work Performed: Capped Added Relocate . Plan review is required for any of the following.
Baptistry/Font 1 Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
- ]pool '- greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Tlrru ❑ New exterior plumbing site utilities for any complex structure
Cnspidor/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 OAR918-78D-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
3., I
-4„ Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food 0 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.iRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station - -
Shower -Gang ,
-Stall
Sink/lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Finer *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:
l:UBuilding\Pcnnits\PLMU_PermitApp.doc 2