Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEligVELOPMENT Permit#: PLM2021-00396
Date Issued: 9/21/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 400
Project: FDIC Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,P1
Project Description: Replace existing fixtures: (1)dishwasher,(1)ice maker and(1)sink.
Contractor: WESTERN PLUMBING Owner: PACIFIC REALTY ASSOCIATES
9460 SW TIGARD AVE SUITE 101 ATTN: N PIVEN
TIGARD, OR 97223 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
1 ea Dishwasher 09/17/2021 $25.02
Specifics: 1 ea Ice Maker 09/17/2021 $12.51
1 ea Sink 09/17/2021 $25.02
Type of Use: COM 1 12%State Surcharge- 09/17/2021 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment- 09/17/2021 $9.95
Occupancy Grp: Plumbing
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: �fOjLY Vra vv�tiW Permittee Signature: Owr�ppli.Ctl.On
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 Applical ECEIVED E - cum
Building Fixtures SEP 1 5 `10t
City Of Tigard Received p
Date/By: r 1 7/2- 4 t Permit Np`M'J M I'oo g%/_
:t i 13125 SW Hall Blvd..Tigard,OR 97p2f1 OF TIGARU �./ �'V v r,
r� � Plan Ravie
Phone: 503.718.2439 Fax: 503.5 I pate/By: Other Permit No.:
Inspection Line: 503.639.4175 Y�Jti��rIN� DIVISION` �i-
I c.,n I:L 1 Date Ready/By: Atari
t El See Page 2 for
Internet: w(ru.tigard-or.gov Notified/Method:7p 7�ZZ
Supplemental Information
TYPE OF WORK 01 l ` 4 FEE' SCHEDULE
New construction ❑'Demolition For special information useckeck/ist.
Description I Qty. I Ea. I l otal
Addition/alteration/replacement I 0 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
0 Accessory building ❑Multi-family SFR(31 bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler(_sq.ti.) Page 2
JOB(SITE:INFORMATION AND LOCATION Site utilities:
Job site address: ,ertG S. �e�-�.W Catch basin or area drain 18.7fi
City/State/ZI P:1\ OQ 0�1'^h FoolDryin l-rainleac(line,or trench drain age 2
I 'L3 J Footingdrain(no.linearft.:_) Paget
Suite/bldg./apt.no.: Project name: r '
C��L Manufactured home utilities 5003
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear fl.:_) Page 2
• Stonn sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backftow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.5I
Clothes washer 25.02
Drier*o � 4 brd(x S _ Dishwasher 25.02 /9S.62
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER l •0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
--- -- Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose hib 25.02
Phone:( ) Fat:( ) Ice maker , 12.51 0.....51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:'��ek1 � t1�1 � 1 J,`fit Medical gas(value:$_) Paget
Contact name: ` Primer 12.51
'-'c'_^`i-t �.k0A1 •� Roof drain(commercial) 12.51
Address: q1/446
`‘ c� Ss,�t�..�e1Q1 Sink/basin/lavatory ` 25.02aDZ.
City/Blatt/ZIP: j �� Solar units(potable water) 62.54
Phone:( 1-Ty -Lj�(,� Fax::( ) Tub/shower/shower pan 12.51
( mail S tP LK vrntee,%.'(\l�,C1xM Urinal 25.02
Water closet 25.02
CONTRACTOR
• Water heater 37.52
Business name` C JJ ^y� �U � ' t` Water pipinglDWV 56.29
Address: 1k cL ` ,S I f J O Other: 25.02
City/State/ZIPi - l `7 Subtotal (0t55�m Minimum permit fee: $72.50 M^�
Phone:(�` _".�'t� Fax:I ) *.�.71)
' 2 `j 2q n�
+ - Plan review (25°a/o of permit fez)
C'C'B Lic.: lumbing l . o.:7r� I' State surcharge(I2/a of permit fee) 43,A1:73 /
Authorized signature: TOTAL PERMIT FEE gl,'WY V/
r This permit application expires if a permit not obtained within ISO days
I rmt name 1�� h Date: q I�C�ZI a after it has been accepted as rompkte.
"Fee methodology set by Tri-County Building Industry Service Board.
I'Budding lPernsIsiPLMII-PernsiAppdoe IIUIII/1P! JJINM11fin INUJ('OM/1VEBI
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qly. 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
3.601 to 7,200 $233.20
• Sewer-Ist 100' 62.E _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 IOU 37.52 Valuation: •
I.Permit Fee:
Storm&Rain Drain-I st 100' 62.54 $1.00 to$5.000.00 Minimum tee$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 8100.00 or fraction thereof to
Other Inspections or Feesand 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-I!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 '
gauntly by Fixture Type Plan review is tequired for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped added aefona 0 Any new commercial building with water service 2"and
Baptistry/font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
W CI Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator shwash : -Commercialirator El Any multipurpose fire sprinkler system.
Domestic 0 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
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
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: -Lav/Bar non-food related
-Bradley
-Com/Sere/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 fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-'toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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