Permit q CITY OF TIGARD PLUMBING PERMIT
:111111 ~' COMMUNITY DEVELOPMENT , ., I Permit#: PLM2022-00191
T I0 A R.Ca 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/23/2022
Ail Parcel: 2S110AD12400
Jurisdiction: Tigard
Site address: 10849 SW ANNAND HILL CT
Project: Annand Hill Partition,Lot 3,Primary Subdivision: ANNAND HILL CT PARTITION Lot: 3
Project Description: Interior plumbing for a new multi-family dwelling on the main level,with(2)attached ADUs. 5/24/22: REPRINTED
permit to include 40 ft.of sanitary sewer.
Contractor: RAZORBLADE PLUMBING LLC Owner: BLUE PALOUSE PROPERTIES LLC
18045 SE MAIN ST 333 S STATE ST STE V452
PORTLAND, OR 97233 LAKE OSWEGO, OR 97034
PHONE: 503-550-6280 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Clothes Washer 05/23/2022 $75.06
Specifics: 9 ea Sink 05/23/2022 $225.18
5 ea Tub/Shower/Shower Pan 05/23/2022 $62 55
Type of Use: MF 5 ea Water Closet 05/23/2022 $125.10
Class of Work: NEW 3 ea Water Heater 05/23/2022 $112.56
Type of Const: 1 12% State Surcharge- 05/23/2022 $72.05
Occupancy Grp: Plumbing
Stories: 40 If Sanitary Sewer 05/24/2022 $62.54
0 12%State Surcharge- 05/24/2022 $7.51
Plumbing
Total $742.55
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 ma obtain a co of th ules
Issued ey: 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.
Plumbing Permit Application
' Site Utilities FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
= •• 13125 SW Hall Blvd.,Tigard,OR 97223 Date By: s/1 /i� Apt/4 -to)
an Phone: 503.718.2439 Fax: 503.598.11RECEIVE11 Review �' n
• C L. V (� �� Other Permit No.:f3/4080?!-�i O
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: 7uris: ® See Page 2 for
Internet: www.tigard-or.gov t a Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
,New construction ❑DemolibAOF '. For special information use checklist.
.._ i1r)ILdiNG.r11t��ION Description I Qty. I Ea. I Total
E Addition/alteration/replacement ❑ Othe . New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION r, SFR(1)bath 312.70
""
❑ 1-and 2-family dwelling ID _ +`
Co i is SFR(2)bath 437.78
+++��� SFR(3)bath 500.32
❑Accessory building ,Multi- mi , yl
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
lob site address: I D g i i AAA`:Mc" vi`\3 G-�'. L' Catch basin or area drain 18.76
City/State/ZIP: �j) (� ! a/� G 6 D/v R�22 1 Drywell,leach line,or trench drain 18.76
( c Y 1 U Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
6 8 5'/ If ! l7 7 Rain drain connector I 18.76
U� Sanitary sewer(no.linearft. �) 1 Paget 62,,Pi
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 31.27
DESCRIPTION OF WORK Backwater valve 12.51
f1,� ' Clothes washer 3 25.02 75.ex,
VI e I..) GL %1.5 j,1^(- a - P1 14 6"✓^5 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
a.APPLICANT 0 CONTACTr PERSON Interceptor/grease trap 25.02
Business name: (A Z. JL 6(, LU M�j� O Medical gas(value:$_) Page 2
Prim
Contact name: 3/1,)AN) W)/J p-t(1/(.S er 12.51
Roof drain(commercial) 12.51
y
Address: I O U 9 5 56- M,a(v s Y''f, Sink/basin/lavatory 7 25.02 5�(f
City/State/ZIP: Po r1,7,A AD 0/l e 6 D/J ell-2-3- Solar units(potable water) �i�/�rs4_
Phone:(503) 5 s o 62 r 6 / Fax::( ) Tub/shower/shower pan *j 12.51 6ja .53
l Urinal 25.02
E-mail: r,,,.„..4t“Jo i.,. .-M p, lnn,C. , c. ,�-,Q
f � Water closet 525.02 I/.J1 0
CONTRACTOR
J Water heater `3 37.52 /A-�
Business name: f i jZ C Lir Oc ti -- Pt'^^"^ ✓1')
Water piping/DW V 56.29
Address: Other: 25.02 t
City/State/ZIP: Subtotal`i a),iiti
Phone:( ' ) Sagerr, Sigleelfg
a Fax:( ) Minimum permit fee: $72.50
CCB Lic.: `L. 3 q il, If-0.3 Plumbing Lic.no.: P f3 L CI ZB' Plan review (12%25%of permit fee)
J State surcharge(12%of permit fee) 7iii ,e5
Authorized signature: it.,5..., 11�/1 �� 7/yf/1 TOTAL PERMIT FE '1;; y51
Print name: r3,r i L 4. 1,f- + .,5 J Date: S-' L.3-ZZ This permit application expires if a permit is not obtained within 180 ays
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Building1Pmmits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
CITY OF TIGARD PLUMBING PERMIT
'2 : COMMUNITY DEVELOPMENT Permit#: PLM2022-00191
Date Issued: 5/23/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S110AD12400
Jurisdiction: Tigard
Site address: 10849 SW ANNAND HILL CT
Project: Annand Hill Partition,Lot 3,Primary Subdivision: ANNAND HILL CT PARTITION Lot: 3
Project Description: Interior plumbing for a new multi-family dwelling on the main level,with(2)attached ADUs.
Contractor: RAZORBLADE PLUMBING LLC Owner: BLUE PALOUSE PROPERTIES LLC
18045 SE MAIN ST 333 S STATE ST STE V452
PORTLAND, OR 97233 LAKE OSWEGO, OR 97034
PHONE: 503-550-6280 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Clothes Washer 05/23/2022 $75.06
Specifics: g ea Sink 05/23/2022 $225.18
5 ea Tub/Shower/Shower Pan 05/23/2022 $62.55
Type of Use: MF 5 ea Water Closet 05/23/2022 $125.10
Class of Work: NEW 3 ea Water Heater 05/23/2022 $112.56
Type of Const: 1 12%State Surcharge- 05/23/2022 $72.05
Occupancy Grp: Plumbing
Stories:
Total $672.50
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 rule 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 o t e. les
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.
Plumbing Permit Application
' Site Utilities FOR OFFICE USE ONLY
CI Of Tigard Received
. g Permit No.:
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Date By: /, /}� / - +Q(/�j,y - `1 I
r Plan Review `��J
Phone: 503.718.2439 Fax: 503.598.19R F( r� _ Date By: Other Permit No.:/3/ �/.��, e,
TIGARD Inspection Line: 503.639.4175 - Date ReadyBy: Ions?. El See Page 2 for
Internet: www.tigard-or.gov Non fled/Method: ', 7i Supplemental Information
TYPE OF WORK FEE* SCHEDULE
.New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. Total
❑Addition/alteration/replacement ❑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 ElCommercial/industrial SFR(2)bath 437.78
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:
lob site address: I 0 if Li c AAA c,,A t\ \l Ct\ Catch basin or area drain 18.76
Drywe6
City/State/ZIP: 71 F /)(1, Oa(G p� q�2'La Footing
1,leach line,or trench drain 18. 2
(�'lY 1 l Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
1 6 t-5`I &- / 4 -? Rain drain connector 18.76
rj Sanitary sewer(no.linear ft.: G1) 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 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 3 25.02 ?J ,0(0
0e 1.-.) (lb dWNC-i.:+,-" t' 1 toAA`�'^') Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER Cl TENANT - Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax:( ) Ice maker 12.51
IX APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name: ,,„i.ai-L-)y , �+LOM('vl'I(:'
Contact name: ,3 R I f y rJ w) N��/(c' Roof d Primer 12.51
�� c A� Roof drain(commercial) y 12.51
Address: sl& /V ,ct.r\ El Sink/basin/lavatory ` 25.02 �37(y
City/State/ZIP: PottruAJN / V ti 61)N) ell 2'Tj3 Solar units(potable water)
Phone:(503) S SD /O'$ I J Fax::( ) Tub/shower/shower pan S 12.51 642 -53
E-mail: ///�J (/I I Q pitft yyy�{{ /(�� +1 Urinal 25.02
CONTRACTOR Water closet 5 25.02 a 51 /D
Water heater `3 37.52 7/A.5-1,Business name: ft' f C Lie Ir., ?I ' lot^)
Water piping/DW V 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal'/
d
6 at) ,y,...,--
Phone:("j' ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: '1. ' { 111
a /N Plumbing Lic.no.: pia Lq 28' Plan review (25%of permit fee)
+ State surcharge(12%of permit fee) 7d 425
Authorized signature: 1 /1, 1 f_ 711109 TOTAL PERMIT FE )1 51
v I'A"AV/�
Print name: f3 v.ii e,„� 1 ,"y Date: 5-- 7,3-Z,Z This permit application expires if a permit is not obtained within 180 ays
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:tB°ilding\PemdtsTLMU-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-I' 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-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 S5,000.00 Minimum fee S72.50
Stone&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and S I.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
l? 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 Repiare/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate ow g'
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thar ❑ 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"
-4" Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
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/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
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:
l:\Building\Permits\PLMU_PermitApp.doc 2