Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00169
Date Issued: 5/17/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101 DB00100
Jurisdiction: Tigard
Site address: 7320 SW HUNZIKER RD 204
Project: Discovery Counciling Subdivision: None Lot: None
Project Description: Tenant Improvement: Capping(1)sink;Relocating(1)dishwasher and(1)sink.
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
Specifics:
Description Date Amount
Type of Use: COM
Dishwasher 05/09/2022 $25.02
Class of Work: ALT Type of Const:
Fixture/Sewer Cap 05/09/2022 $25.02
Occupancy Grp: Occupancy Load: Sink 05/09/2022 $25.02
Dwelling Units: 12%State Surcharge-Plumbing 05/09/2022 $9 01
Stories: Height: ft
Bedrooms: Bathrooms:
Value:
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $84.07
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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 or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � /I l All Permittee Signature: Cm I ljq Z,11
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.
DH
Plumbing Permit Applicatic ECEIVEco
Building Fixtures APR 8 2012 FOR OFFICE LSE Oy1.v
City of Tigard Received l w l
ll Dare/BY: 5I5�a� Permit No.: U�� Gd I(P
• 13125 SW Hall Blvd.,Tigard,OR 9722`.'9'I I-Y OF i 1(,iHili..
' Phone: 503.718.2439 Fax: 503.5913 f OING 1r s /�p Plan RYiew Other Permit No.: r
Inspection Line: 503.639.4175
1 I xiA 1<U Internet: www li and-or. ov Date Reed/ thy: /5/�� ® See Pape 2 for
g g Notitied/Method �/�/ Supplemental Information
TYPE OF WORK FEE* SCHEDULE
New construction For special information use checklist.
❑� i ❑ Demolition P f
Description I Qty. I Ea. I Total
®Addition/alteration'replacement ❑ Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder El Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 5 Nun Li ke r Catch basin or area drain 18.76
ty x J�O� w���� Drywell,leach line,or trench drain 18.76
City/State/ZIP: 'qQ `T Footing drain(no.linear ft.:_) Page 2
JJ 8
Suite/bldg./apt.no.: I Project name: px$Covtr COLIKCIVONS Manufactured home utilities 50.03
Cross street/directions to job site: 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 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
ratan.j' I v 1.1 DV►rY.[,vt+ Dishwasher I 25.02 Z$ds
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture-sewer cap 1- 25.02 �Z-
Name:
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
0 APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name: Ray6c rv„r�S PlurwtAint Medical gas(value:5_) Page 2
7 Primer 12.51
Contact name: NQMS l4
!77,10 f5kJ L'cok Roof drain(commercial) 12.51
Address: t Sinlobasintlavatory 1 25.02 244'Z
Tih
City/State/ZIP: a 1Q4 p OR Tian_ Solar units(potable water) 62.54
Phone:(603) 69Z gi39 Fax::( ) Tub/shower/shower pan 12.51
E-mail: Hitns Roy born5.(OVV Urinal 25.02
• Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: 0 e � PlukiAli'ete, Water piping/DWV 56.29
Address: 19'gg /,�0 tAi ` 0die kidOther: 25.02
City/State/ZIP:Two.IQ4i 1'L roe 970L2 Subtotal 760
Phone:(603) (42 'i 131 Fax:( ) Minimum permit fee: 572.50 ....--^
CCB Lie.:8785z. Plumbing Lic.no.:3Y-166 A3 Plan review (25%of permit fee)
State surcharge(12%of permit fee) yam_
Authorized signature: +?il -' TOTAL PERMIT FEE 1 fi 0
This permit application expires If a permit is not obtained within 180 days u
Print name: b ems.. \ pe`e� Date: 11-5 after it has been accepted as complete.
C•�� "Fee methodology set by Tn-County Building Industry Service Board.
LIBuildinatPemrits`PLMU-Permit Appdac 10,Ol.Ot 440.4616T110•'ONCOM/WEB)
1
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 S 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 S327.54
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$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
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 90.0041r 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$110 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
Quanti -by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
-Drive Taro as defined in OAR918-780-0040.
Cuspidor/Water Aspirator - ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
-Domestic ( 0 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 •
4" 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
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: -LavBar non-food related I I
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,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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