Permit UPI CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00506
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/21/2021
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 170
Project: WWEX Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: Interior Plumbing: Relocating(1)breakroom sink.
Contractor: ALWAYS FAITHFUL PLUMBING LLC Owner: PACIFIC REALTY ASSOCIATES L P
PO BOX 757 ATTN: N PIVEN
WILSONVILLE, OR 97070 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-780-9486 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 12/20/2021 $25.02
Specifics: 1 12%State Surcharge- 12/20/2021 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 12/20/2021 $47.48
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
I
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: Haw, Va.w De,Wee& Permittee Signature: Oi,,A
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 ApplicatCEIVED
Building Fixtures '�G DEC6 all
FOR OFFICE USE ONLY
City of Tigard C Zall Received
11
4 13125 SW Hall Blvd.,Tigard,OR 97 OF r pr 1 Date/By: ��l f j l,�j / --� Permit No.: �a
_ 7�GARL) Plan Review
Phone: 503.718.2439 Fax: 503.59 Nft'- Other Permit No.: z1. of i_ 77_
DateBy: rr✓ W
Inspection Line: 503.639.4175 `3UILDING DIVISION Date Ready/By: l ® See a e 2 for
TIGARD Y Y /�.� B
Internet: www.tigard-or.gov Notified/Method: Pit Tilt '-9/ Supplemental Information
TYPE OF WORK ef0 Ft/L),1 -ot 1 FEE* SCHEDULE
❑New construction ❑ Demolition Y For special information use checklist
Description Qty. Ea. Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling g Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
0 Accessory 0Multi-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: 12909 SW 68th Parkway Catch basin or area drain 18.76
Cit /State/ZIP: portlandDrywell,leach line,or trench drain 18.76
Y OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 170 I Project name: WIEx 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Relocate break sink Less than 5 ft Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Pacific Realty Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 6650 SW Redwood Ln Ste 290
Garbage disposal 25.02
City/State/ZIP: Portland/ OR/ 97224 Hose bib 25.02
Phone:( 503)624-6300 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Always Faithful Plumbing
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Corey Chamberlain Roof drain(commercial) 12.51
Address: PO Box 757 Sink/basin/lavatory 25.02 1
City/State/ZIP:Wilsonville OR 97070 Solar units(potable water) 62.54
Phone:(503)780-9486 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: alwaysf ai thfulplumbing@yahoo.cornUrinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Always Faithful Plumbing Water piping/DWV 56.29
Address: PO Box 757 Other: 25.02
City/State/ZIP: Wilsonville, OR 97070 Subtotal O,S,p,
Phone:( 503)780-9486 Fax:( ) Minimum permit fee: $72.50 7a ,5-0
Plan review (25%of permit fee)
CCB Lie.: 217284 Plumbing Lic.no.:PB1940
L State surcharge(12%of permit fee) ,7)
Authorized signature: � TOTAL PERMIT FEE 1�{j,
Print name: Corey Chamberlain Date:12/O1/21 This permit application expires if a permit is not obtained withi AO days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbini 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 $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 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 $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 Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
p and including$10,000.00.
Inapertion ofcyisting 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 ro ievv is required for am of the follow,Mg.
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 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: Commercial 0 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
4" 0 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 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 plumbing permit can be issued.
Urinal
Other Fixtures:
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