Permit CITY OF TIGARD PLUMBING PERMIT
114
z COMMUNITY DEVELOPMENT Permit#: PLM2021-00439
Date Issued: 11/2/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134DD00102
Jurisdiction: Tigard
Site address: 10505 SW TIGARD ST
Project: Sit Means Sit Dog Training Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Adding(1)clothes washer and capping(1)water closet
Contractor: COLUMBIA MECHANICAL INC Owner: SCHAEFER, DONALD M
PO BOX 2164 SCHAEFER, MILYNN P
WOODLAND,WA 98674 BY TIGARD STREET PROP LLC
18655 NE CHEHALEM DR
NEWBERG,OR 97132
PHONE: 360-225-1600 PHONE:
FAX: 360-225-8755
FEES
Quantity Description Date Amount
1 ea Clothes Washer 10/27/2021 $25.02
Specifics: 1 ea Fixture/Sewer Cap 10/27/2021 $25.02
1 12%State Surcharge- 10/27/2021 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 10/27/2021 $22.46
Type of Const: Plumbing
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: Permittee Signature:
IoUAJ Vain.De,Wege O..Ap-to-lic.,614i,031,
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 ApplicatRECEIVED
Building Fixtures
OCT 1 4 2021 FOR OFFICE USE ONLY
City of Tigard Received III • 13125 SW Hall Blvd..Tigard,OR 97GITY OF TIGARD Dateiny: id1�i / ) 6,� Permit No.: �!n,1 t);t/„{flue.(
Phone: 503.718.2439 Fax: 503. Plan Review ........ u ��" U/
Inspection Line: 503.639.4175f'L`bING DIVISION Date/By: Other Permit No.:fM ,_L {TIGAi{p p DateRea /B ✓"� ✓�
Internet: www.tigard-or.gav Ready/Br o ter' S ent 2 for
Notified Method: SuIremental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist.
❑New construction ❑Demolition
1 Addition/alteration/replacementDescription Qty. Ea. Total
0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath
31..,
70
❑ I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
0 Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq,ft.) Page 2
JOB SiTE INFORMATION AND LOCATION Site utilities:
Job site address: ` r) C)I; S IA/ , -7r-6 A rt.n Catch basin or area drain 18.76
City/State/ZiP: T t C 1 r 0 , O(tom 't 7 Z. 2 Dtywelt,leach line,or trench drain I R.7G
Footing drain(no.linear ft.:_) Page 2Suite/bld •la t.no.: (Project name: S,t � _.-
., -.7----;),,,Manufactured home utilities 50.03
Cross street/directions to job site:
Manholes 18.76
/h,i MA-w t i r 6:42-7 ,j. Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: Water service(no.linear ft.: ) Paget
_ I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
,"�JT:'t'14 •.t-16 T.'/ t I ✓ . 1 o d cf t N I Clothes washer
( 25.02 ,.. ,(y),
k �' Dishwasher
shwaser U Iu lJ.�SN!-'r2 25.0�2
,4
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER , ❑'.'TENANT Expansion tank 12.51 -
Name: Fixrure/sewer cap 1 25.02 rL ...,
Address: Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:
' Hose bib
Phone:( ) Fax:( ) - 25.02
Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.(1_2
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Address: Roof drain(commercial) 12.51
Sink/basin/lavatory
City/State/ZiP: - 25.02
Solar units(potable water) 62.54
Phone:( ) Fax::(
Tub/shower/shower pan 12.51
Email: mL t r r ty'�+� Urinal 25.02
CONTRACTOR - Water closet 25.02
Business name: e:t,,�l,,,q , Water heater 37.52
j11 e(iti--:4-, 7�r
Address: e. j3.,, 2. i Water piping/DW V 56.29
f x,1 Other: 25.02
City/State/ZIP: t.; t,IJCt,ry.-0) w,1 61 iL! -i �/
Phone:(3l i ) C j p Subtotal 50.t"l l
/ 5 % t Fax:(f Eel ) <<�) - s? `3 Minimum permit fee: $72.50 "72 �7
CCB Lic.: /r//Z 2- Plumbing Lic.no.: y-ys 7r�' Plan review (25%of permit fee)
Authorized signature: /1� State surchargeif/(12%of permit fee) O -70
�4,,e4" TOTAL PERMIT FEE },.,
Print name: L_W t K/4 641/LA I Date:jC/j bj/` 1 f This permit application expires if a permit is not obtained within 180 days
/ I after it has been accepted as complete,
"Fee methodology set by Tri-County Budding Industry Service Board.
f:'Building'.Pmnits`PLMU-PcnnitApp.doc 10,0 I'09
440-4616T(I0/021COMhYE B)
/Ud LOC_-144=r /A/0 cr 1 f.
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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 SI21.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-I st 10(1' 62.54 3,601 to 7200 $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 S1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100- 37.52 $5,001.00 to S 10,000.00 S72.50 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 S1.54 for
which no fee is specifically indicated 90A0Atr 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 S50,000.00 $379.50 for the first S25,000.00 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 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 pP y'
Baptistry/Font ❑ Any new commercial building with water service 2"and
Bath: -Tub/Shower greater,except systems designed and stamped by licensed
-Jacnri/Whirlpool engineer.
Car Wash: -Each ❑ New exterior plumbing site utilities for any complex structure
StallTlir as defined in OAR918-780-0040.
-DriveCuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial CI Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as damned 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
4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice MachJRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station) all13 t .S(i.L-/ Gyve/ 4`,-4"T.4,-G ftr
Rec.Vehicle Dump Station
Shower: -Gang �G`.(r� .f�(hL jC�tw✓[ t/u/tom• 7je�
-Stall Ca
�5 �-mot 4eL SC ett"A/ 1,e_��t�Y�r
Sink: -Lay/Bar non-food related p��^ ,,,•f e j,II�j f-{i t �
-Bradley /
-Com/Serv/tjtil 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 i
Water Extractorfees assessed for the sewer increase must be paid before the
Water Closet-Toilet ii plumbing permit can be issued.
Urinal •
Other Fixtures:
1:\Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2