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Permit IN CITY OF TIGARD PLUMBING PERMIT Permit COMMUNITY DEVELOPMENT #: PLM2021-00432 T FGART) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2021 Parcel: 2S102AD03450 Jurisdiction: Tigard Site address: 8777 SW BURNHAM ST Project: Public Works Subdivision: None Lot: None Project Description: Interior plumbing: RELOCATING(1)lavatory and(1)water closet. Contractor: RAYBORN'S PLUMBING INC Owner: TIGARD, CITY OF PO BOX 69 13125 SW HALL BLVD 19990 SW CIPOLE RD TIGARD, OR 97223 TUALATIN, OR 97062 PHONE: 503-692-4139 PHONE: FAX: 503-691-2328 FEES Quantity Description Date Amount 1 ea Lavatories 10/20/2021 $25.02 Specifics: 1 ea Water Closet 10/20/2021 $25.02 1 12%State Surcharge- 10/20/2021 $8.70 Type of Use: COM Plumbing Class of Work: ALT 22 ea Minimum Fee Adjustment- 10/20/2021 $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: f �/ Permittee Signature:A4/..- <^ V,,/ y fri 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. . 4 RECEIVED Plumbing Permit Application OCT 1 1 2D1i - E- I v 1111 2 Building Fixtures FOR OFFICE USE, MIN City of Tigard GITY OF TIGARD Received II • 13125 SW Hall Blvd,Tigard.OR iUl DING DIVISION ti - / �j'/�'�: ��`�Plan Review I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: /i�"• N,! - 0D!7 7 I l GAIt D Inspection Line: 503.639.4175 Date Ready/By. ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: 042,(�/1,2.( 1 Supplemental Information TYPE OF WORK R I FEE* SCHE ULE ❑New construction ❑Demolition For special information use checklist. Description i Qty. ] Ea. Total igi Addition/alteration/replacement ❑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 IX Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: _ - Q-7-� Catch basin or area drain 18.76 Job site address: �Q Tl3 �r� 5;' - Drywell,leach line,or trench drain 18.76 City/State/ZIP. !,at 04 ? 22 3 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: L, cif-Tt-. . Manufactured 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: Lot no.: Fixture or item: Tax map/parcel no.: Back flow prevcnter 31.27 Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 Atiete 1 1 Ana/ tlebd lay. - 12e_to(47S ts-- fr/ Dishwasher 25.02 117`4M S s r i _ Drinking fountain 25.02 t Ejectors/sump 25.02 0 PROPERTY OWNER 0 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 R APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: t7714'l5 Rom f!'1 G� Medical gas(value:$_) Page 2 J Primer 12.51 Contact name: N� Roof drain(commercial) 12.51 Address: 1977o ,5 W G t Pia le Rd Sink/basin/lavatory ` 1 25.02 25 O L City/State/ZIP: 1Ua4a rt Op_ /7GW... Solar units(potable water) 62.54 6/)? e z ei ! Fax: :( ) Tub/shower/shower pan 12.51 Phone:( ) 25.02 E-mail: 1/416 t -corn Urinal YWater closet ' 25.02 /5 d�- CONTRACTOR Water heater 37.52 Business name: kaylavr n.S PLUM bin) Water piping/DWV 56.29 Address:/ 5 J _ _ Other: 25.02 / City/State/ZIP: i1QIq in z y7ab Subtotal 50 col Phone:(5 )6 yz yr3� Fax:( ) Minimum permit fee. $72.50 �z�� V f '/C?L� Plan review (25%ofpern»t fee) CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE 7260 r�le�Print name: D Ralf: 10 ////� �2/ This permit applicationafterit hasres if a permit is not been accepted as complete.ed within 180 daa `Fee methodology set by Tri-County Building Industry Service Board F 28uilding Permits'.PLMU-Pcrrnu App.do< 10'01119 440-46167t 10i02d'OM/WEBI 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-1"100 50.03 0 to 2,000 S121.90 37.52 2,001 to 3,600 $169.69 Footing drain-each additional 100 3,601 to 7,200 $233.20 Sewer-1st 100' 62 54 7,201 and greater $327.54 Sewer-each additional 100. 37.52 Water Service-1st Io0' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st I00' 62.54 $1.00 to S5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 S5,001.00 to$10,000.00 S72.50 Pori the first $1 S5,0 0.00 or 0aat do It.52 e2 forof,to Qty. Fee(ea) Total eand including$10,000.00. Other Inspections or Fees Inspection of existing plumbing or for $10,001.00 to S25,000.00 $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 90.001hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and S 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. 90.00/hr $50,001.00 and up $742.00 for the first S50,000.00 and$1.20 for Additional plan review for revisions each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) 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 ❑ New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial ❑ Any complex structure as defined in OAR918-780-UU4U. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" Isometric or Riser Diagram 4` ❑ 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 Comments regarding fixture work: Ice Mach.%Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower. -Gang -Stall Sink: -Lav/Bar non-food related I -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 plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:'\Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2 v Branden Taggart From: Hans Halverson <Hans@rayborns.com> Sent: Friday, October 8, 2021 10:04 AM To: #Building Permit Technicians Subject: RE: Plumbing permit Follow Up Flag: Follow up Flag Status: Completed Categories: Branden Warning!This message was sent from outside your organization and we are unable to verify the sender. To whom it may concern: We started a small project across the street from you at the public works building. We are relocating one toilet and one lavatory in an existing restroom for ADA clearances. The work is complete. Please let me know my timeframe to expect the permit in order to call in my inspection and schedule repour of the floor. Thank you! Hans A Halverson Project Manager Rayborn's Plumbing, INC. Office: 503-692-4139 Ce11:503-899-3236 hans@rayborns.com From:Andrew Pelett Sent:Thursday, October 7, 2021 9:37 AM To:Tigardbuildingpermits@tigard-or.gov; Hans Halverson<Hans@rayborns.com> Subject: Plumbing permit Drew Pelett Rayborn 'S PLUMBING, INC. ccLL o f dour pLuvu.bi,vtcJ ikeeds si,vvice License #34-166PB • CCB #87852 • Metro #1806 19990 SW Cipole Road - PO Box 69 Tualatin, OR 97062 Phone: 503.692.4139 Project Engineer/ Service Dispatcher i Julie Drinkwater From: #Building Permit Technicians Sent: Wednesday, October 20, 2021 8:28 AM To: hans@rayborns.com Subject: PLM2021-00432, 8777 SW Burnham, City of Tigard, Public Works Attachments: Invoice.pdf Hello Hans The permit for The City of Tigard, Public Works, is ready to be issued. The balance due is$81.20. Attached please find the invoice for your review. The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record number under the Building tab. There is a service fee of 3%for payments by card, and there no service fee for payments made by e-check. On the payment screen, select the payment method from the dropdown list next to the 'payment' field. Please email the permit technicians at TigardBuildingPermits@tigard-or.gov once the fees are paid so that they can issue the permit and make it available for pick up. Thank you Julie Drinkwater Permit Technician City of Tigard Building Department 13125 SW Mall Blvd Tigard,OR 97223 503-718-28(14 Due to an increased demand for services, please expect longer wait times for responses to emails,voice messages and building inspections. Requests for permit status may not be responded to until the permit is ready to issue. Other requests deemed non- essential,such as fee estimates, may take longer to respond. In the meantime, please view this quick guide on how to submit common service requests. 1