Permit CITY OF TIGARD PLUMBING PERMIT
1E ; ' COMMUNITY DEVELOPMENT Permit#: PLM2022-00134
Date Issued: 4/7/2022
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 25101AA09700
Jurisdiction: Tigard
Site address: 12585 SW 68TH AVE
Project: Pahlisch Homes Subdivision: PP1996-024 Lot: 1
Project Description: Interior plumbing for TI:Adding(1)dishwasher;Replacing(1)garbage disposal,(5)sinks,(5)water closets,and
(1)urinal.
Contractor: LIPPOLD PLUMBING& HEATING INC Owner: PARAGON PROPERTIES LLC
PO BOX 895 12585 SW 68TH AVE
BORING, OR 97009 TIGARD, OR 97223
PHONE: 971-404-7012 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 04/07/2022 $25.02
Specifics: 1 ea Hose Bib 04/07/2022 $25.02
5 ea Sink 04/07/2022 $125.10
Type of Use: COM 1 ea Urinal 04/07/2022 $25.02
Class of Work: ALT 5 ea Water Closet 04/07/2022 $125.10
Type of Const: 1 ea Garbage Disposal 04/07/2022 $25.02
Occupancy Grp: 1 12%State Surcharge- 04/07/2022 $42.03
Stories: Plumbing
Total $392.31
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: Permittee Signature:
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.
1 '
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1'lumbir�g Permit Anplica � ./
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I Building Fixtures 14Aft l i. tun" 11,6 ur1 K 1. ( ,1 uyl 1
( City of Tigard114 ka y �( (p -twmdxa, �,M �r-7y
13125 SW Hall Blvd.,Tigard OR 97222 1)1. I s tr0-f pl pevt�, �r,e �yLq /Q�p�,,�7f�, N
I ,ki t r liesi
l• heTM�anLine:
neone: �2439503.639.4175
03..4417550J.596 l•• :' Dine a.dlM4a/hod: -1 7� / 1 1 to See moo W Iof
nt oroAliztl
TYPE OF WORK fir .*...a.tl 2--qe FEE• SCHEDULE mm...
For vrtc,40f Gtfbt*attan ass checklist.
11lli
❑New construction ❑ m Deatition - Oeserlptlbn ,
KAd itiontalletoclonfroplactlrittat 0 Other New,1•IdamUK dw.DIn a(Includes too�8 fore each Wiry 4:o11Faelk111.
S SFR(I)bath 312.70
CATEGORY OF CONSTRUCTION _.,.
.* ....� SFR(2)both •
❑ t-and 2-Family dwelling VI.Coinarerciairindustrial "` _w_-t- 500.32
.-._.:.:,.- �-»- --»- SFR(3)bath i
❑Accessory building 0 Multi-family
.-.v.. Each additional bath/kitchen I 25.02
❑Master builder ❑Other: Fire sprinkler( N.R) Page 2
JOS SFTE INFORMATION AND LOCATION SIN made': _... _._.
a i595 : , 4 1 Catch basin or area drain ) 18.76
lob site address: 7.. Jt
.„ _ -- Drywall,loch line,or trench dram 18.76
City/Slate/ZIP: [
r''� OR- r�7Z'2•aj ,.,. Footing drain(no.linear fl:_) Paget
Suite/bldg.fapL ea.:..._,__ Project name: Pd1A(I Si'. i,'._ D t ie-1 M m
anufactured hoe utilities 50,03
Clogs street/directions to job site: ;Manholes 16.76
- W Beveiand Street }Ica"gala eneeemer
19.76
t Samdry sewer(no linear R _) ... Page 2_
•» gtmm sewer(no.linear R.:,) Pugs.2
m , .... .... ...».,. Water service(no.linear tl,: ) Page
Subdivision. Lotno.: Ft- lag_! , ..._...
Tax map/parcel no.: a.. ,JJ®( a °0 Baokllow preventer
_-
Decimeter valve 12.51
t DESCRIPTION OF WORK Clothes washer -._ --
25.02
4�tr� y r 9I
, t$t%k iota .Ye.filveZeiii,,.. 1 PYI•i✓ mo, .P Dishwasher t.. 2102 Z C.'M__
tiC.%"•••-• Drinking fountain 25,02
6f_W `orslaump � 25.02
0 PROPERTY OWNER I k❑TENAPrr Expansion tank 12.51 1
Frxture/sewcr cap 1 25,02
Name: YvSi'Y.} i ¢Igklle pJe. 94 Lteek' LLB Floordrain/fluorsink/Tub 25.02 , _
Address: 2i0 S✓ La:l}ay.. lot. 4setVI. ft !Oa Garbagedisposal..,_. ` 25.02 'ZS',a't-
." 25.02
City/Stale/ZIP: �,}sasp+ d A'J'i0'L Hose bib -- ^
" 12.51
Ice maker
Phone:(��) '}$5' (A Z(,� Fax:( ) ..._.._-.T
( APPLICANT (] CONTACT PERSON Intwc°ptur� o�elmP .02 ,.
"I+t Medical gas(value:$_1 Page 2
(��
Business name. ),,1ii5L\.s._ I-tflvvv45 Primer 12.51
Contact name . t.P CiT Roof drain(comnxuctkl) S 12.51
Address: 7.-10 Si.," yl(Sov,- A.m. 4vt�•t'0" 1(�a ..__,.. Sink/basin/lavatory 2502 ('Z, ./0
City/Slate/ZIP: a,41k E)P. ` y i 0 I Solar units(potable water) mm 62.54
Phone:((Lit ) -ifs- (,'7 '? .. Fax::( ) 9 lub/dhowcr/shower pan
-_.. .. _-.,.,.r...,. t Urinal l 25.02 ' ,O
E-mail: 5 '✓ Q Qalv1,ISLE - LO w i Water closet S.-'.,»» 25.02 lyS I10
_..CONTRACTOR -
Water heater I 37,52
I _
Business name: L:Q�iQallil P(tPMah't, 4, }(4A(tn� Lvst. Witterpiping/0WV 56.29
Address: 9'0 (Ij 3 q f Other. 25.02
rt tL' ,-... Subtotal 7"j .�'
City/Sla torDP: VpY3w 014. 4-9 '^ �
��+ -""'^""`"' Minimum potmu foe: 872.50
Phony(Oil) 64-7 bi Z. ..1.Fax:( ) ..__r._... f "
. ,.. ._ - __ Plan review (25%orpermit fee)
PlumbingLift.no.: pet +ti 1 l
CCE Lie.: a0(S State surcharge(12%of permit fee)
Authorized signature: 7 r---s _ �� " TOTAf PERMIT ICE ry���'
Pfint nemtl. - 4 '----
Foote.' 3 11 Z0 Thk Permit epplkadnn expires Ili perml/h not osrdaea Kit t days
0.0„ `,.•wiseafter It nes been steepled as complete
•tee methodology net by Tn-County sukbng Industry Sew Ce(aonm
tbuilding\Rrmib\PLMIYPennknyp doe lemtfae di0-tal aril QIOSICQM/WEUI
/ 3 MA -r
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. mo(a.) Total S uare Footage: . Permit Fee:
Footing drain-1'100' 50.03 0to2 ; S121.90.
Pootng drain•each additional Ina` 37.52 ;Wt 1o3,. $169-6A
l 3.0)1 to 7,200 $233.20
Sewer-1st 100' 62,54 -
7 1 and neater $R7.54
..,..._..n ... r...
Sewer-each additional 100' 77.52
Water Service-lac 1001 62.54
- Medical Gas$ sterns:
Water Service-each addilronai 100'- 37.52 ""'""`"""'-""` 1
€ Valuation: Permit Fee:
Storm&Rain Drain-1at 100' 62,54 ; ----•--
Stom.&Rain Drain-each addilluna1 100' 9752 S1.001035.000.00 - 87M2 so fo foe 572,511
` $5.001 A0 to$10.000.00 $72.50 for the 0rH$5000.00 and$1.52 for
Miler Inspections or Fees Qty. Pee(a) Twat each additional 5100.0(1W r fraction thcreaf,to
and itwhrding 510.003.00.
Inspection of existing plumbing or for .$10,001.0010$25,000.00 $14850 foe the first$10,000.00 and$1,54 toe
which no tie is specifically indicated 90.00/hr each additional 5100.00 or fraction thereof,to
(minimum ch.srnc-1/2 hour) _ andinclul5n 525.000.00.
raspeetlons outside of normal business 90.00/hr ,001.00 w"`- .00 $379.50 for the first --
000A6a u151.45 far
hours rminlmum charge-2 boast each additional 5100.00 or fraction thereof,to
Retnspection Peso 90.00Mr and Motorbus.$50,000:00-
Addirkmal Plan review For revisions 90.0 1—r a $50;001.00 and up S742.00 for the brat$50,000 00 and$1 20 for
,xminimum charge-1/2 hour) - .,.__- Nob additional 3100.00 at fraction thereof 1
Subtotal:
t
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
Q,rarai5 hr Fixttar®Type Plan review is required fix any of the following.
Fixture Type for aeplecei Please check all that apply,
Rork Performed: espprd Added R<Wan< ❑ Any new commercial building with water service 2"and
Balilu°rr/Fani greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
Jacuai/Whid:wol engineer.
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drive Thru
-1 as defined in OAR918-780.0040.
'.. Cuspidor/Water Aspirator "°- 0 Medical gas and vacuum systems for health care facilities,
tlishwuBar. -Commercial ❑ Any multipurpose lire spdklersystem.
-Commie. I 0- Any complex structure as defined in OAR918-780-0040.
brinkina Fountain
Eve Wuh _�.,.._....,. Submit 1 sets of plans wills any of the above.
FloorDrainlslnk: -3"
3 .... Isometric or Riser Diagram
0 Isometric or riser diagram is required for new buildings
-Car wash Drain that meet the:ivalifications above.
Garbage -Domaalic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial fbod related . -�. ..
Ice Mach/Refio,Drains " Comments regarding fixture
��fi`�x�t��u���r��e work:
Oil Separator'Gas Stationl lt..hOl.c.iva4. 'C7' t9Sar.xtl
Rec.Vehicle Dump Station _... ._ ---s o Ls t-r'xt A/.G,J ta
ffit
Shawn: -Gang ,
-Stoll
rotated-Lev/Bar non-rood ,ti
-Bradley
-Com/Serv/Utit food related
-Service �� *Note: If the fixture work under this permit results in an
Swimming Pool Fitter increase of sewer EDUa,a sewer permit will be Issued and
Wisher-Clothes
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
-riUrinal 1
"biller Fixtures: -Y..
1:\Building\Permits1PLMF PermitApp.dac 0S/04/20II 2