Permit CITY OF TIGARD PLUMBING PERMIT
�IN '„' Permit#: PLM2022-00115
COMMUNITY DEVELOPMENT
Date Issued: 3/28/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S101D600103
Jurisdiction: Tigard
Site address: 7360 SW HUNZIKER RD 207
Project: Nielsen Insurance Subdivision: None Lot: None
Project Description: Interior plumbing:replacing(1)dishwasher and(1)sink:installing(1)primer,(1)water heater and(1)hub drain.
Contractor: RAYBORN'S PLUMBING INC Owner: HILLTOP BUSINESS CENTER LLC
PO BOX 69 9430 NW KAISER RD
19990 SW CIPOLE RD PORTLAND, OR 97231
TUALATIN, OR 97062
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
1 ea Dishwasher 03/25/2022 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 03/25/2022 $25.02
1 ea Primer 03/25/2022 $12.51
Type of Use: COM 1 ea Sink 03/25/2022 $25.02
Class of Work: ALT 1 ea Water Heater 03/25/2022 $37.52
Type of Const: 1 12%State Surcharge- 03/25/2022 $15.01
Occupancy Grp: Plumbing
Stories:
Total $14C.10
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: . �`_• ` ' r getb
Permittee Signature: 'Cl
I 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 Application( n �\d
Site Utilities MAR 9 �02' Ftnt ()III( i 1 til (,.I1
City Of Tigard Received - / // fa Permit No.: )ao -oc4I S'
N • 13125 SW Hall Blvd.,Tigard,OR 972J 1 Y OF TIGARU Plan Rev
■ Phone: 503.639.4171 Fax: 503.59 Plan Review
Inspection Line: 503.639.4175 .5UI ING DIVISION Date Ready/By:
✓I/ other PermitNa.: a� _��,
I t, \I:I Date Re J ��q 0 See P 2 for
Internet: www.tigard-or.gov Notified/Method: .31 /`? - i. Supplemental Information
TYPE OF WORK mat AS PEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
laAddilion/alteration/replacement ❑Other
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® I-and 2-family dwelling laCommerciallindustrial SFR(2)bath 437.78
❑ Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 �' Fire sprinkler(_sq.ft.) Page 2
4 tin- ,tr.Raa•. .t9 1 JNFOILD7ATIONAN_D 1.9FATION Site utilities:
lob site address: 731(CJ 5W Y{1)Y►Zj ke r' Catch basin or area drain 18.76
..� Drywell,leach line.or trench drain 18.76
!
City/State/ZIP: 1 012. 97223
,^ Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 201 l Project name: 1/1 'e.\ aei lii' IVnfe 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
Sterna sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Ii ii fop lotA66yie6,5 LeWiret- J Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
�-yno F;}04"VresDESCRIPTION OF WORK Backwater valve 12.51
awlClothes washer 25.02
awl repiatt �/ I'`ici- Dishwasher 1 25.02 ) 5 .3
1 Drinking fountain 25.02 �"1
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub I 25.025 Ga
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib
25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT la CONTACT PERSON Interceptor/grease trap 25.02
Business name: RoY6orns ptuimidni.43
Prunerlgas(value:S_) Pagel
Primer 12.51 6^d' ,C)/
Contact name: Na N I
Q Roof drain(commercial) 12.51
Address: 14Q9Q s� LIpale, Sink/'basirelavatory I 25.02 a F. G�
City/State/ZIP:'batted:,n pR '7db2 Solar units(potable water) 62.54 v
Phone:(503) 642 et139 I Fax::( ) Tub/showedshowerpan 12.51
E-mail: kpItS(ZR y r ns"trow. Urinal 25.02
CONTRACTOR Wutercloset 25,02
Water heater I 37.52 -37
Business name:RAYBORN'S PLUMBING INC Water piping DWV 56.29
Address: P.O.Box 69 Other 25.02
City/Slate/ZIP:Tualatin,OR 97062 Subtotal I Z ,01
Phone:(503)692-4139 Fax:(503)691-2328 Minimum permit lee: $72.50
Plan review (25%of permit fee O
CCB Lic.:87852 Plumbing Lic.no.:34-166PB ) tJ
State surcharge(12%of permit fee)
�///��
Authorized signature: I/.L TOTAL PERMIT FEE iikv(C
Print nme: W_A l`tt Date:3^7-2.2_ This permit application expires ifs permit 6 not obtained within Ito days
after it has been accepted as complete.
"Fee methodology set by Tri.County Building Industry Service Board.
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qiy Fee(ea) Total Square Footage: Permit Fee: •-' _
Footing drain-l'100' 50.03 0 to 2,000 SI21.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 S 169.69
3,601 to 7,200 S233.20
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 Val;a60n' . . -. Permit Fee:
Storm&Rain Drain-1st 100' 62.54 SI.00 to S5,000.00 Minimum fee S72.50
Storm&Rain Drain-each additional 100' 37.52 S5,001.00 to S 10,000.00 $72.50 for the first S5,000.00 and S 1.52 for
Fee(ea): Total each additional S100.00 or fraction thereof,to
_Other Inspections:or Fees QY' and including$10,000.00.
Inspection of existing plumbing or for S 10,001.00 to S25,000.00 S148.50 for the first S10,000.00 and S1.54 for
which no fee is specifically indicated 90.00/hr each additional S100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including S25,000.00.
Inspections outside of normal business 90.00/hr S25,001.00 to S50,000.00 S379.50 for the first S25,000.00 and 51.45 for
hours(minimum charge-2 hours) each additional S100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including S50,000.00.
Additional plan review for revisions 90.00/hr S50,001.00 and up $742.00 for the first S50,000.00 and S 1.20 for
each additional S100.00 or fraction thereof
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
Quantity by(Fixture)Work Performed ❑ Any new commercial building with water service 2"and
Fixture Type: Replace greater,except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font 0 New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower as defined in OAR918-780-0040.
-Jacuzzi/Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall 0 Any multipurpose fire sprinkler system.
-Drive Thru 0 Any complex structure as defined in OAR918-780-0040.
Cuspidor/Water Aspirator
Dishwasher -Commercial Submit 2 sets of plans with any of the above.
-Domestic I
Drinking Fountain
Eye Wash \,� �(, Isometric or Riser Diagram
Floor Drain/sink a -2" e! `I„ 0 Isometric or riser diagram is required for new buildings
�h -3" (a' R15
that meet the qualifications above.
4"
Car Wash Drain
Garbage -Domestic
Disposal -Commercial Comments regarding fixture work:
dustrial
Ice Mach/Refng.Drains I S lln'k,.1 waits-leek+er,-I di6�t.VGt+`t,e4-
Oil Separator(Gas Station) I kohl otres.%vx 0..M4i I prime r
Rae.Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/lavatory 1 -'
-Bradley
-Commercial *Note: If the fixture work under this permit results in an
-ServiceP. increase of sewer EDUs,a sewer permit will be issued and
Swimming Pool Filter AS fees assessed for the sewer increase must be paid before the
Washer•Clothes plumbing permit can be issued.
Water Extractor
Water Closet•Toilet Saki 1 as
Urinal
Other Fixtures:
http://www.tigard-or.govlcity_hal l/departmenlsicd/docs/PL M F-PermitApTdoc
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