Permit 1111 CITY OF TIGARD PLUMBING PERMIT
• Permit#: PLM2022-00197
COMMUNITY DEVELOPMENT
T f GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 5/25/2022
Parcel: 2S 111 ACO2700
Jurisdiction: Tigard
Site address: 14650 SW 97TH AVE
Project: Twality Middle School Backflow replacement Subdivision: TIGARDVILLE HEIGHTS Lot: 44
Project Description: Replace existing 8"device with Wilkins 300AR.
Contractor: CHARTER MECHANICAL CONTRACTORS INC Owner: TIGARD-TUALATIN SCHOOL DISTRICT 23J
7940 SW HUNZIKER ST 6960 SW SANDBURG ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-691-1700 PHONE:
FAX: 503-691-1717
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/25/2022 $31.27
Specifics: 1 12%State Surcharge- 05/25/2022 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 05/25/2022 $41.23
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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
Issued By: �2 cd
/ Permittee Signature: 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 Application
Site Utilities FOR OFFICE USE ONLY
Cityof Tigard Received ' /
- g Date/By: :J 5 ha, yf{ Permit No.: .�n 'G3 7
A 13125 SW Hall Blvd.,Tigard,OR 97223 f f y�1
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No.:
Date/By:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Jails: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
n Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
ElAccesso Accessory buildingSFR(3)bath 500.32
❑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: 14650 SW 97th Ave. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/S[a[e/ZIP: Tigard,OR 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Twality MS Backflow Replacement Manufactured home utilities 50.03
Cross street/directions to job site: SW 97th&SW 96th Ave. 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 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replacement of the existing 8" backflow preventer with a new Dishwasher 25.02
Zurn Wilkins 300AR Series backflow preventer. Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Tigard-Tualatin School District Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 6960 SW Sandburg Street
Garbage disposal 25.02
City/State/ZIP: Tigard,OR 97223 Hose bib 25.02
Phone:(503 ) 431-4000 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Charter Mechancial Medical gas(value:$_) Page 2
Primer 12.51
Contact name: Matt Keikkala
Roof drain(commercial) 12.51
Address: 7940 SW Hunziker Street Sink/basin/lavatory 25.02
City/State/ZIP: Portland,OR 97223 Solar units(potable water) 62.54
Phone:(503 )691-1700 Fax::(503 ) 691-1717 Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
matt.keikkala@chartermechanical.com
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Charter Mechancanical Water piping/DWV 56.29
Address: 7940 SW Hunziker Street Other: 25.02
City/State/ZIP: Portland,OR 97223 Subtotal
Minimum permit fee: $72.50 72.50
Phone:(503 ) 691-1700 Fax:(503 ) 691-1717
CCB Lic.: 171657 Plumbing Lic.no.: BP8 Plan review (25%of permit fee)
// State surcharge(12%of permit fee)
Authorized signature: //� TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name: Matt Keikkala Date: 5/25/2022
after[t has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:1BuildingWennits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
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 $327.54
Sewer-each additional 100' 37.52
Water Service-let 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
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty. Fee(ea) Total
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 $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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath Tub/Shower El Any new commercial building with water service 2"and
-Jacuzzi/Whiripool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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