Permit CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM2022-00324
Date Issued: 8/30/2022
T[GARO 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126CD00100
Jurisdiction: Tigard
Site address: 9925 SW GREENBURG RD
Project: Crescent Grove Cemetery Subdivision: None Lot: None
Project Description: Installing approximately 155 LF of 1"water line and backfiow device connecting to existing water meter on
property to serve a yard hydrant.
Contractor: LOVETT INC Owner: CRESCENT GROVE CEMETERY ASSOCIATION
6920 NE 42ND AVE 9925 SW GREENBURG RD
PORTLAND, OR 97218 TIGARD, OR 97223
PHONE: 503-737-8423 PHONE:
FAX: 503-288-1630
FEES
Quantity Description Date Amount
155 if Water Service 08/30/2022 $100.06
Specifics: 1 ea Backflow Preventer 08/30/2022 $31.27
ea Hose Bib 08/30/2022 $25.02
Type of Use: COM 1 12%State Surcharge- 08/30/2022 $18.76
Class of Work: OTR Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $175.11
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
Sire Utilities RECEIVEL FOR OFFICE USE ONLY
City of Tigard Received L/
illi ♦ 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 2 21012 DatelBy �,� �l1- ,Zij21-oO�u y
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit Na
Date/By:
71GARD Inspection Line: 503 639.4175 CITY OF TIGARD _
Internet wstw L1 and ur Gov Date Readyllly orris ® See Page 2 for
g fiedlMelh v Supplemental information
TYPE OF WORK' ' EE*:SCHDli}± 7'7 - _ F
❑New construction ❑ Demolition For.special information use checklist.
Description Qty. I Ea. I Total
®Addition/alteration/replacement ❑ Other New 1-2-family dwellings(includes 100 ft.for each utility connection)
E GORY OF CONSTRI.ICTION SFR(1)bath 312.70
Li 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accessory g 0 Multi-family
Each additional bath/kitchen 25.02
Li Master builder 0 Other: Fire sprinkler( sq. ft.) Page 2
JOB SIT F. INFORMATION AND LOCAL ION' Site utilities:
Job site address: 9925 SW Greenburg Rd Catch basin or area drain 18.76
City/State/ZIP: Tigard OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: eres!CKf £ 1iOVG Manufactured home utilities 50.03
Cross street/directions to job site: et' r, 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.:LED 1. Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
,+ Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Install approximately 155 LF of water line and backflow Dishwasher 25.02
device connecting to existing water meter on property.
Drinking fountain 25.02
I IV R. r I /- . f Ejectors/sump 25.02
/
® PROfER'E1 OWNER ❑ TENANT Expansion tank 12.51
Name: Crescent Grove Elementary Fixture/sewer cap 25.02
Address: 9925 SW Greenburg Rd Floor drain/Floor sink hub 25.02
Garbage disposal 25.02
City/State/ZIP: Portland OR 97223 Hose bib r 25.02
Phone:( ) Pax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Faster Permits Medical gas(value:$ ) Page 2
Contact name: Bradlee Hersey Primer 12.51
Roof drain(commercial) 12.51
Address: 2000 SW 1st ste 420 Sink/basin/lavatory 25.02
City/State/ZIP: Portland OR 97201 Solar units(potable water) 62.54
Phone:(503 ) 913-8811 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Bradlee@fasterpermits.com Urinal 25.02
Water closet 25.02
ONTRACTOR
Water heater 37.52
Business name: Lovett INC
Water piping/DWV 56.29
Address: 6920 NE 42n.1 AVE Other: 25.02 _
City/State/ZIP: Portland OR 97218 Subtotal
Phone:(503 ) 288-1099 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 125507 Plumbing Lic.no.: 26-773PB Plan review (25%of permit fee)
/� State surcharge(12%of permit fee)
Authorized signature: o TOTAL PERMIT FEE
Print name: Bradley Vaughn --,_
Date: 8/23/22 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
I:TuildingNermirs\PLMU-PermitApp.doe 10/01/09 440-4616T110/02/COM/WEB)
Viumbing Permit Application - Cityof Tigard 111111- 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-1st 100' l 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 S I.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 fast$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
p 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
(m n mum 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/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower El Any new commercial building with water service 2"and
Jacuzzi Whvlpool 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"
-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/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Cloths
increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
1:\Building\Petmits\PLMU_PermitApp.doc 2
Plumbing Permit Application _
Site Utilities FOR OFFICE USE ONLY A
Cityof Ti d Received
II'` gan DDate/By: Permit No.:
o : 41 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I GARD Inspection Line: 503.639.4175 Date Ready/By. inns: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition Far special information use checklist.
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(1)bath 312.70
LI I-and 2-family dwelling ❑ Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory ❑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: Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT 177 Expansion tank 12.51
Fixture/sewer cap 25.02
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: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water healer 37.52
Business name: Water Pp g/1 m DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
( )Phone:( ) Fax: Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
This permit application expires if a permit Is not obtained within 180 days
Paint name: Date: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:Building/Pennits\PLMU-PermitApp.doc 10/01/09 4404616T(10/02/COM/WEB)