Permit (5) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00325
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/26/2022
Parcel: 1 S 126DC00902
Jurisdiction: Tigard
Site address: 9500 SW GREENBURG RD
Project: Crown Oaks Apartments Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: Building 1.Replacing fixtures and re-piping water and waste lines.
Contractor: MODERN PLUMBING Owner: OREGON SUNSHINE LLC
11120 SW INDUSTRIAL WAY BY CARPENTER, HARRIET
TUALATIN,OR 97062 15435 SW WOODWIND CT
BEAVERTON, OR 97007
PHONE: 503-691-6166 PHONE:
FAX: 503-691-6771
FEES
Quantity Description Date Amount
8 ea Expansion Tank 08/26/2022 $100.08
Specifics: 8 ea Garbage Disposal 08/26/2022 $200.16
16 ea Sink 08/26/2022 $400.32
Type of Use: COM 8 ea Tub/Shower/Shower Pan 08/26/2022 $100.08
Class of Work: ALT 8 ea Water Closet 08/26/2022 $200.16
Type of Const: 8 ea Water Heater 08/26/2022 $300.16
Occupancy Grp: 1 12%State Surcharge- 08/26/2022 $156.12
Stories: Plumbing
Total $1,457.08
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.
Plumbing Permit Application
9 U(:t2p -6012 S-
Building Fixtures M=310
City of Tigard Dnp
Deceived 208/1Permit No.,
WA a-
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit No_
Phone: 503.718.2439 Fax: 503.598.1960 DatclBy: seepage
Inspection Line: 503.639.4175 Date Ready/By: 0 2 for
Internet; www.tiprd-or.gov Notifwd/Mcthod: S!gpicusental inform I ation
TYPE OF WORK FEE* SC*OLME
❑ For 50!yd i�*-adon use checklist
New construction ❑Demolition Dtscription Qty. I Fa. Total
*Addition/alteration/replacement New I-2-familly dwelfings(includes 100 ft.for each utility cortnection)
C&TV*RY OF CONSTRUCnON SFR(1)bath 312.70
❑
SFR(2)bath 437.78
I-and 2-family dwelling El Commercial/industrial SFR(3)bath 500.32
❑Accessory building 1W Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other. Fire sprinkler L_sq.ft) Page 2
'JOB SITE Site affilties-
Catch basin or area drain 18.76
Job site address: P,b Drywell,leach line,or trunch drain I-8.76
_City/State/ZIP: G1 6 6 A R Footing drain(no.linear ft: 2
SuitelbldgJapt.no.: Project name: nDjons AA% Manufactured home utilities 50.03
Cross street/directions to job site: Manholes --- 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.-.__J
Page 2
Storm sewer(no.linear ft.: Page 2
d Water service(no.linear ft.: Page 2_
Subdivision:1.T,-L4H_ AWJ AUZ TRACff 7 TT�t.7.7 Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.: Backwater valve 1151
ftSCRIPTION OF WORK -
25.02
Clothes washer
AG �J j4&)b Wr WATES,fEAlEk"S 21 Dishwasher 25.02
,A�6Mjgj LjA_SrF N - fountain 25.02
C Drinking
Ejectorstsurnp 25.02
PROPERTY_OWNER 0 TENANT Expansion tank 12-51 100.04
Fixture/sewer cap 25.02
Name: 096GO&,.) SLADSMWE UC Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP:_ Vick-7-r'A' 1b Hose bib 25.02
Phone:( Fax:( Ice make, 12.51
❑ APPLICANT CONTACT PERSON Interceptor/grease hap 25.02
Medical gas(value:$ Page 2
Business name: Primer 12.51
Contact name: litE�A-MvA RAP-WA126 Roof drain(commercial) 12.51
Address: 1 !ISD Sr
oU A L LA kv, Sink/basin/lavatory 25.02 qW."A;L
City/St2tC1ZIP,--(L_4i AC=A J W 9-261-2 , . Solar units(potable water) 62.54 -
Phone:(513)16511- V 64, Fax; 1 :? l Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: Water closet 25.02 oqCb.I
C NT-
0 , "CT04 Watcr heater 37.52 1_
Business name: Mrjllf
A,)C
., L4 D Water pipinf/DWV 56.29
Address: I I 12-b �,L3 I A-)OLA Other: 25.02
Subtotal
City/Statc:/ZIP: T-JAJ Minimum permit fee: $72.50
Phone:(c Fax:(Sl?)(A I,(;-r-I I
3b3)&>q I-(0 t(0 4p Plan review (25%of permit fee)
Plumbing Lic.no.: &
CCB Lie-: 871_qb(Q '2 :2 S-b State surcharge(121/6 ofpermit fee) TWA
Authorized signature: TOTAL PERMIT FEE 114Ea 6
A 1§0 days
This permit application expires if a permit Is 1301 obtained within
Print name: )'�OA Date: after it has been accepted is complete.
'�6p_ 4:;�22= -Fee methodology set by Tri-County Building Industry Service Board.
1:\BuiWinl;�Permits\PLMU-PermiLAppdm 10Y01109 440-4616T(101021C0WWEB)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule•. Residential Fire Suppression Systems:
Site Utilities Qt- Fee(eit) Tont Square Foota e: Permit Fee:
oting drai
Fon-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 S169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Sys ms:
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$10,000.00 572.50 for the first$5,000.00 and 51.52 for
Qty. Fee(ea) Tolxl each additional S 100.00 or fraction thereof,to
Other Ills olll or Fees and including$10.000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first S 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 51.45 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*. Plan Review for PIUMbkg Installations
Q�Mn by Fixture Type Plan review is required for any of the following.
Mature Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water idorlWater As irator El Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial El Any multipurpose fire sprinkler system
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain
Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
-3" Isometric or.Riser jD m
-4" 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./Refri .Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Roc.Vehicle Dump Station
Shower. -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/UtiI 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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