Permit (2) l' CITY OF TIGARDlil
PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00274
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 r 4 f ' Date Issued: 6/29/2021
i Parcel: 2S102AC01701
• )i j GN/1d 4% Jurisdiction: Tigard
Site address: 12700 SW PACIFIC HWY
Project: Pipeline Plumbing Subdivision: None Lot: None
Project Description: Interior plumbing: Relocating(1)sink,(1)clothes washer,and(1)water closet;installing(30)ft.of sanitary sewer.
7/22/2021: REPRINT permit to ADD(1)service sink and(1)hose bib.
Contractor: PIPELINE PLUMBING Owner: FARENHEIGHT LLC
333 S STATE ST SUITE V-108 1885 CREST DR
LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034
PHONE: 503-624-1906 PHONE:
FAX: 503-624-1926
FEES
Quantity Description Date Amount
1 ea Clothes Washer 06/29/2021 $25.02
Specifics: 1 ea Sink 06/29/2021 $25.02
1 ea Water Closet 06/29/2021 $25.02
Type of Use: COM 30 If Sanitary Sewer 06/29/2021 $62.54
Class of Work: ALT 1 12%State Surcharge- 06/29/2021 $16.51
Type of Const: Plumbing
Occupancy Grp: 1 ea Hose Bib 07/27/2021 $25.02
Stories: 1 ea Sink 07/27/2021 $25.02
0 12%State Surcharge- 07/27/2021 $6.01
Plumbing
Total $210.16
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: C
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.
r
Plumbing Permit ApplicatioPECEI Y ED
Building Fixtures JUL 1 5 2021 FOR OFFICE USE ONLY
City of Tigard CITY OF TIGARD Da eB Z �� 10 Permit No jL �,/
13125 SW Hall Blvd.,Tigard,OR 9SUILDING DIVISION , L 1 Zv21 ^rU��
i Plan Revie ` k�� i rt7
Phone: 503.718.2439 Fax: 503.598.1960Other Penni
Date/By:
Inspection Line: 503.639.4175 Date Read /B Inds: ® See Page 2 for
TIGARD Internet: www.ti and-or. ov y Y /l t.' Supplemental Information
g g Notified/Method:? �-/�2/
TYPE OF WORK ejki.frff.,- T4 yL.4.4/2_FEE* SCHEDULE
❑New construction ID l For special information use checklist.
, - ../S Description 1 Qty. I En. I Total
®Addition/alteration/replacement ❑Other: /l//bi 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
SFR(3)bath 500.32
❑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:
Job site address:12700 SW Pacific Hwy Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard, OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:F I r(^"Li t r Lt.�M€//g ufactured 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.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
EXISTING PLUMBING PERMIT PLM2021-00274 Dishwasher 25.02
NEED TO ADDITION FIXTURES TO PERMIT(1-hose bib, 1-sink) Drinking fountain 25.02
Ejectors/sump 25.02
❑ 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 1 25.02
.2S.d z-,
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:Pipeline Plumbing
Primer 12.51
Contact name:Taylor Lotten
Roof drain(commercial) 12.51
Address:333 S State St. Suite V-108 Sink/basin/lavatory 1 25.02 ,75 ,�r�--
City/State/ZIP:Lake Oswego OR 97034 Solar units(potable water) 62.54
Phone:( 503)624-1906 Fax::(503)624-1926 Tub/shower/shower pan 12.51
E-mail:taylor@pipelineplumbing.net Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Pipeline Plumbing Water piping/DWV 56.29
Address:333 S State St. Suite V-108 Other: 25.02
City/State/ZIP:Lake Oswego OR 97034 Subtotal Sd ,eV
Minimum permit fee: $72.50
Phone:( ) Fax:( )
CCB Lie.: 158260 Plumbing Lic.no.: 3-510PB Plan review (25%of permit fee)
�_ / � State surcharge(12%of permit fee) ‘',d f
Authorized signature: 7 74'4., .L .41i TOTAL PERMIT FEE 34, ,OS
Print name:Taylor Lotten Date:7/15/2021 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building" Industry Service Board.
L\Building\Permits\PLMU-PermilApp.doe 10/01/09 440-4616T(10/02/COM/WEB) • � �' . ( // /5 4
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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 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601-to 7,200"• $233.20
Sewer-1st 100' 62.54
7,201 andsriag„-.. $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 $1.00 to S5,000.00 Minimum lee$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$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
❑ 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 ElNew exterior plumbing site utilities for any complex structure
-Drive Thr as defined in OAR918-780-0040.
Cuspidor/Water Aspiator El Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic El 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
0 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 Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station) Adding 1-laundry sink
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service t *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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Dianna Ornelas
From: #Building Permit Technicians
Sent: Thursday, July 22, 2021 5:23 PM
To: Taylor Lotten
Subject: PLM2021-00274 & SWR2021-00198 - 12700 SW Pacific Hwy
Attachments: SWR2021-00198.pdf; PLM2021-00274.pdf
Hello Taylor,
These permits are ready to issue and the balance due is shown below(see attached invoices):
• PLM2021-00274 (revised) -$56.05
• SWR2021-00198- $1,156.15
The fees can be paid online at https:JLaca-prod.aaccela.com/TIGARD/Welcome.aspx by searching for each permit record
number under the Building tab. Payment can be made by 'card' for a 3%service fee or select the 'check' payment
option and there is no service fee.
Please note that the sewer permit SDC fee must be paid prior to issuance of the revised plumbing permit.
Please email the permit technicians at TigardBuildingPermits@tgard-or.gov once the fees are paid so that we can
issue the permit and email a copy to you. The original will be mailed along with the sanitary sewer control card that
must be completed and returned to Clean Water Services.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
1