Permit •
CITY OF TIGARD PLUMBING PERMIT
= ill COMMUNITY DEVELOPMENT Permit#: PLM2022-00073
Date Issued: 3/9/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY D
Project: Great Clips Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Replacing(1)2"floor drain,(4)sinks,(1)water closet,and(1)water heater.
Contractor: REA MECH INC Owner: PACIFIC CROSSROADS PROPERTIES INC
30330 SW GRABEL RD. BY WYSE INVESTMENT SERVICES CO
HILLSBORO, OR 97124 810 SE BELMONT ST#100
PORTLAND, OR 97214
PHONE: 503-969-6252 PHONE.
FAX: 503-640-9344
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 03/07/2022 $25.02
Specifics: 4 ea Sink 03/07/2022 $100.08
1 ea Water Closet 03/07/2022 $25.02
Type of Use: COM 1 ea Water Heater 03/07/2022 $37.52
Class of Work: ALT 1 12%State Surcharge 03/07/2022 $22.52
Type of Const: Plumbing
Occupancy Grp:
Stories:
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: Edgy o.r Maldm+. 4o- Permittee Signature: 5.6-e,0-1019-U-C-0-41101^'
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 Annlication :
Building Fixtures R E C E I t
City of Tigard Ut9ea
r / �/ Permit No.: P�/1/1 a71"]�1 73
13125 SW Hall Blvd.,Tigard,OR 97223 4 �� g' P�s�Reaew11111 � �I -e�fl rr�Il �- �•V N/V
I Phone: 503.718Z439 Fax: 503.598.1960 Y A Other Permit No.:8 2di9d-0....1„1.7
'fIGARU inspection Line: 503.639.4175 CITY OF TIC,' pats ® Seep 2for
Internet: www.tigard-or.gov 3/ • '.� a�
Notified/Method: //w S lementei Informa8oa
uPP
TYPE OF WORK " ce e FEE* SCHEDULE
F special information use checklist 0 New construction 0 Demolition
Description I Qty. 1 Ea. 1 Total
\15Addition/alteration/replaeement ❑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 Commercial/industrial
SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND.LOCATI N Site utilities:
Job site address: � L Catch basin or area drain 18.76
City/State/ZIP:`� \( {d ' c \ )-1, Drywall,leach line,or french drain 18.76
Footing drain(no.linear ft.:_J Page 2
Suite/bldg/apt.no.: I Project name: '�f��
D • Clr`14�642.5 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_1 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 prevcnter 31.27
151. w cOOO i e>..
r
DESCRIPTION OF WORK Backwater valve 12.51
Zw-,r-s.o.,r ` x ��k V.,-c.r. Clothes washer 25.02
` Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑i PROPERTY OWNER I \j4 TENANT Expansion tank 1251
Name: `;^(`__Sr la �� , Fixtme/sewer cap 25.02
Floor drain/floor sink/hub 1 25.02 a-rJ Address: Garbage disposal 25.02
City/State/ZIP: Hose bib
25.02
Phone:( ) Fax:( ) Ice maker
12.51
0 APPLICANT 0 CONTACT PERSON lntereeptodgrease lap 25.02
Business name: Medical gas(value:$_) ' Page 2
Contact name:
Primer 12.51
Roof drain(commercial) 12.51
Address:
City/State/ZIP: Sink/basin/lavatory 4 25.02 1(fV,;i
Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: . Urinal 25.02
L"ONTRACTOR Water closet 25.02 Oy
Business name r \ ...\ „ Water heater • \ 37.52 S7.5-)„
�\` 1 47. Waterpiping/DWV 56.29
Address: 1 1 1 ( --a Other: 25.02
City/State/ZIP \ v --- g-\ t)-3 Subtotal f g').4,sl
Phone:( ) )e1,\o c1-'1„,,,2‹ Fax:( C i')) lo4C-C15 411 Minimum permit fee: $72.50
CCR Lie.: \ %t<:In Plumbing Lie.no.: `-.y>{_1,,k/c.Q a Plan review (25Yo of permit fee)
\ State surcharge(12%of permit fee) ��
Authorized signature:��\mac. TOTAL PERMIT FEE ,16,
Print name.\\,,itA\ _�•c-\tom_" Date: � �\X\ Y This permit application expires if a permit Ie not obtained within ISO days
_"J " after it
has been accepted as complete.
'Fee methodology set by Tri•Coumy Building Industry Service Aosrd.
b1BaIdm PermiMPLMl1-PamitApp.doc 10/01/09 440 616T(10/02/COM/WBa)
'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 $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 S327.54
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.
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 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$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 CappedAdded Replace/
Please check all that apply.
Work Performed: ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR91 8-780-0040.
-Drive 11rru
CuspidorryVater Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Cpmore cial ❑ Any multipurpose fire sprinkler system.
Comore c 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
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 r�
-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: si.%�+�2 -��•�i,./ \
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2