Permit Plumbing Permit ApplicatCEIVED
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0e1-110A7
Building Fixtures OCT 15 2021 ' �7FOR 4)141( 1: EST O11.1
City Tigard Received
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III • 13125 SW Hall Blvd..Tigard,OR 970TY OF TIGARD Plan Re icse
II Phone: 5(13.718.2439 Fax: 503.5 Other Permit No.:
'uftbING DIVISION Uate R).
Inspection Line: 503.639.4175 Hate Ready�li
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Intern www.1il'ard-or gov Notiti Method: (
J ��' (� pplemental Information
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TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. J Ea. I Total _
Addition'alterationireplacement E Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR it)bath 312.70
❑ 1-and 2-family dwelling onmrercial/industrial SFR(2)bath 437.78
-a-Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
- Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.II) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain _ 18.76
Q Lkv 3 •�i,J 1�j s;,, t,n ,VL1/ c `:) l".,I y A
Dtywell,leach line,or trench drain 18.76
City/State/ZIP: T.ocrt �-� 2
1 Footing drain(no.linear ft.:_) Page 2
Suite'bldg./apt.no.:M2, Project name: (' J F"31 S 7-J r i n�1r n r
Manufactured home utilities 50.03
•
j Cross street/directions to job site: S4t4 4 /7 Manholes 18.76
V
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
i
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: l.ot no.: Fixture or item:
Tax map/parcel no.: Backtluw preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�
Clothes washer 25.02
\cvs 11rx.klo -v at'n V�� ,(1nt'ji� 'CtlX"t'1Jrc_ Dishwasher 25.02
Drinking fountain 25.02
- Ejectors/sump 25.02
0 PROPERTY OWNER - TENANT Expansion tank 12.51
Fixturc'sewer cap 25.02
Name:
t''X u La Floor drain/floor sink hub s • 25.02
Ad
dress: LIDO 0 ) V xcl c 3 T-'1 Garbage disposal 25.02
City-State/ZIP: (l,t,-N ,()\--\ ) j7 u -) Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
4iTAPPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: PIAS1_ .--� Medical gas(value:$_) Page 2
1 Primer 12.51
Contact name: AMA ro,ea Rc-1 f.j Roof drain(commercial) • ', i • 12.51 12 SI
Address:22AS?L Eve miler P .+t Sit.. 20 I-{ Sink/basin/lavatory • • ) . 25.02 2c.02.,
City/State/ZIP: k\-1 iV5bOr c i ci ?._ q--) i 2 CA Solar units(potable water) 62.54
Phone:(VP) 14Cp(,-7,,,2Z2?c.12-7, Fax::( ) "Tub/shower/shower pan 12.51
E-mail:O�'(`C...1e 5 'MS t 5�( sirc M 5.C.G rYt Urinal 25.02
Water closet i • 1 • 25.02 25 o Z
CONTRACTOR
Water heater • • \ • 37.52 ' -'1. Z
Business name: 'PP A _ , I i Water P iP g m-D1b'V 56.29
Address:�2c\S ME E x/,G,fC (-ti en 1P- k>,ul t C,{r, 2.0 H Other: 25.02
City/State/ZIP: r[L l Se,r'r �- 0,-)1 2,0 Subtotal 1 UCJ t %�_
Phone:(GG.6,,) 4(a t, . ZZ , t2.- Fax:( )
Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: `�2 Plumbing Lie.no.:-N-Li 3L(p&
State surcharge(12'i,of permit fee) 1 CL
Authorized signature: I'O'FAL PERMIT FEE 12 ,f; t
/J This permit application expires if a permit is not obtained within 180 days
Print name:�'(Y✓i 2 N!� .. Date: IL)1 )2- after it has been accepted as complete.
*Fee methodology act by Tri-County Building Induznv Service Board
I.Boadntg'PermitsPLMU-PenrulApp dor I oat'Us 44n-461hr(lau2HY)M/W'EBi
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-l''100' 50.03 0 to 2.000 $121.90
Footingdrain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $23320
Sewer-1st 100' 62.54 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
Storm&Raiu Drain-1st 100' 62.54Valuation: Permit Fee:
$1.00 to$5.000.00 Minimum 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 Yaapeetions or Fees Qfy. ;Fee(ea) Total each additional$100.00 or fraction thereof,to
and including S10.000.00.
Inspection of existing plumbing or for $10.001.00 to$25,000.00 S 145.50 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 includin S25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to S50,000.00 S379.50 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 S50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up S742.00 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 requited for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: tapped Added Relocate
❑ Any new commercial building with water service 2"and
,3 Baptistry/Font greater,except systems designed and stamped by licensed
y Bath: -Tub/Shower eng ineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
; -Domestic •
❑ Any complex structure as defined in OAR918-7R0-0040.
Drinking Fountain
'It Eye Wash Submit 2 sets of plans with any of the above.
( Floor Drain/sink: -2"
N • X • Isometric or Riser Diagram
❑ isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
,t5 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: -Lav03ar non-food related • • 1 •
-Bradley
`' -Com/Serv!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 • • 1 • plumbing permit can be issued.
Urinal
Other Fixtures:
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