Permit 11114 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00136
Date Issued: 4/11/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DC01700
Jurisdiction: Tigard
Site address: 15785 SW 72ND AVE
Project: Ace Car Reconditioning Subdivision: 1994-006 PARTITION PLAT Lot: t
Project Description: Backflow preventer installation inside of building near entrance.
Contractor: PIPELINE PLUMBING Owner: NADEAU, LINDA
333 S STATE ST SUITE V-108 16115 HERITAGE LN
LAKE OSWEGO, OR 97034 SANTA CRUZ, CA 95062
PHONE: 503-624-1906 PHONE;
FAX: 503-624-1926
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/11/2022 $31.27
Specifics: 1 12%State Surcharge- 04/11/2022 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 04/11/2022 $41.23
Class of Work: OTR Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total S81.20
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
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iiisgIssued By: sot. / tae-Signature: p
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.
Ph'jIbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard ReceivedDate/By: tj/I1�,?� Femur No.:/k� a)i
III • 13125 SW hall Blvd.,Tigard,OR 97223 D Plan Review t
11 Phone: 503.718.2439 Fax: 503.598.1960.1 Date/By:
Other Permit No.:
T I G R D Inspection Line: 503.639.4175 Date Ready/By' loos: ® See Page 2 for
Internet: www.tigard-or.gov Noted Method: 7 Supplemental Information
TYPE OF WO]II.-," t 1 • is F Li FEE' SCHEDULE
El New construction ID Demolition For special infornration use checklist. -
Description I Qly. I Ea. I Total
/i i]Addition/alteration/replacement 0 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 Ai Commercial/industrial SFR(2)bath 437.78
j - - SFR(3)bath 500.32
❑Accessory building ❑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: IS 1B ' S w 12{'1 IA v e......, Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -1,1 9 fA YZ Op, cirl 24,4-
Footing drain(no.linear ft.: ) Page 2
Suite bldg:'apt.no.: I)roject name: Aco. /.A e -i-
� r f�C1 t > Manufactured home utilities 50.03
Cross street/directions to job site: I, 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.: Backflow preventer I 31.27 31 21
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
-S--AS A-A. 11 2 t` cl i bli2_- Lin e c,L4. Dishwasher 25.02
Drinking fountain - 25.02
Ejectors/sump 25.02
XJ PROPERTY OWNER gJ TENANT Expansion tank 12.51
Name: k�- W r act. d� l -o ►l i 1� Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: C.)IA,YY1 e- CkS 0.1- 27\'.Q Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax:( ) Ice maker 12.51
„El APPLICANT J CONTACT PERSON Interceptor/grease trap 25.02
Business name: 4(pe I 1 r/�1.>�y., b i Medical gas(value:S_) Page 2
Primer 12.51
Contact name: S txYY1 0......v.-`+Vt.& 141( If Roof drain(commercial) 12.51
Address: `2 Z) S S-}-4-{-e S-I-- y -to b Sink/basin/lavatory 25.02
City/State/ZIP: La OS Vv.112.h b t CV -(QZ,9. Solar units(potable water) 62.54
1 Phone:50 3) (o Zy-• t gapcJ Fax: : -3) j • I Cl Z(p Tub/shower/shower pan 12.51
E-mail ScYr�'2 pip e I Ij-�_9J_t I IA-1- -- Urinal 25.02
-1' Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: 'Pi Y p€_L J IN 01.\J11'� P�P P
rl,l Water r m DWV 56.29
Address:-3 6 7 S . .,. �•__et � J-l"' V// 6 Other: 25.02
City/State/ZIP: LD1 Vi„ CS-w Q. a 0-1L_C1"L o Subtotal
Phone:
u-' l�p� Minimum permit fee: $72.50 ,Z,S D
1�"7,. �2►}-• (���D Fax:(��J) la. '1i J
Plan review (25%of permit fee)
CCB Lie.: 15 9 r 2 Plumbing Lic.no.: 77-5 J 0 10 12
State surcharge(12%of permit fee) 8 .--la
Authorized signature: TOTAL PERMIT FEE
Print name:
� ,-1,�J i, `,••I-I- ' Date: J 1- -L.,, 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.
I:\Building\Pcrmits'PLMU-Pem6.tApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
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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 S233.20
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 S10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees • Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for S10,001.00 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 S50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional S100.00 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 Replae/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ElMedical 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)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-fiwd related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDI)s,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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