Permit CITY OF TIGARD PLUMBING PERMIT
�. COMMUNITY DEVELOPMENT Permit#: PLM2022-00319
Date Issued: 8/29/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102AC00202
Jurisdiction: Tigard
Site address: 9100 SW BURNHAM ST
Project: Universal Plaza Subdivision: BURNHAM TRACT Lot: 3
Project Description: Interior plumbing(13)floor drains,(1)hose bib, (4)sinks.(2)water closets
Contractor: HARDER MECHANICAL Owner: CITY CENTER DEVELOPMENT AGENCY
2148 NE MLK BLVD. 13125 SW HALL BLVD
PORTLAND, OR 97208 TIGARD, OR 97223
PHONE: 503-764-6434 PHONE:
FAX: 503-287-5284
FEES
Quantity Description Date Amount
2 ea Rain Drain Connector 08/25/2022 $37.52
Specifics: 1 ea Drinking Fountain 08/25/2022 $25.02
1 ea Expansion Tank 08/25/2022 $12.51
Type of Use: COM 13 ea Floor Drain/Floor Sink/Hub 08/25/2022 $325.26
Class of Work: NEW 1 ea Hose Bib 08/25/2022 $25.02
Type of Const: 1 ea Interceptor/Grease Trap 08/25/2022 $25.02
Occupancy Grp: 3 ea Primer 08/25/2022 537.53
Stories: 4 ea Sink 08/25/2022 $100.08
4 ea Water Closet 08/25/2022 $100.08
1 ea Water Heater 08/25/2022 $37.52
1 Plan Review 08/25/2022 $181.39
1 12%State Surcharge- 08/25/2022 $87.07
Plumbing
Total $994.02
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 Ceeentterr.�/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: - / I(1� / / U /'� D Permittee Signature:
f lll W �1(X 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
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received,t • Date/By: ��M Permit No.: t l
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/mil 13125 SW Hall Blvd.,Tigard,OR 97223Pl
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Phone: 503.718.2439 Fax: 503.598.1960 Dan Review
Dan
8.i g.10at 0.4 Other Permit No.:
T I G A R U Inspection Line: 503.639.4175 Date Ready/By: 1aria
r.gov y o See Pent 2 fInformation
Internet: www.tigard-o
Notified,Method. Supplemental
TYPE OF WORK FEE* SCHEDULE
IN.New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling krCommercial/industrial SFR(2)bath 437.78
ElAccessory building ❑Multi-family SFR(3)bath 500.32
0 Master builder Each additional bath/Idtchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: C WOS . . ,1 Buy.n W s{ Catch basin or area drain 18.76
Ll Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name:
L.kV\t V P r SA' P I G Z-Cl Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76 311,52
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
I r.ktir;olr ?LI
Dishwasher 25.02
Drinking fountain / 25.02 ?5,0 2.
Ejectors/sump 25.02
❑ PROPERTY OWNER 0 TENANT Expansion tank / 12.51 /a ,51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 13 25.02 315,24
Garbage disposal 25.02
City/State/ZIP: Hose bib ( 25.02 ,25,oz
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap / 25.02 a r QZ
Business name: Medical gas(value:$_) Page 2
Contact name:
Primer 3 12'51 3?,51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory q 25.02 f00,08
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet y 25.02 /00.08
Business name: Water heater / 37.52 3r),5.2
Water piping/DW V 56.29
Address: Other:
25.02
City/State/ZIP: Subtotal ray,Se,
Minimum permit fee: $72.50
Phone:( ) Fax:( )
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) /81,3C
State surcharge(12%of permit fee) t,(J(
Authorized signature: v
TOTAL PERMIT FEE 9r7q�
t0I
This permit application expires if a permit is not obtained within 180 days
Print name: Date:
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Buildingdermas\PLMU-PeimitApp 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-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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to S25,000.00 $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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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
Quantity 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
0 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 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial ❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain I Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
l3 Isometric or Riser Diagram
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains 1
Oil Separator(Gas Station) Mott: I rid.:rtoC t.Jas'�+t. a I-3u Naar $i h k. r-
Rec.Vehicle Dump Station 3-Got,..p. s:`.k, and 1- 3" Ploov S;.,k joy
Shower: -Gang 4J6es- lipattY•
-Stall
Sink: -Lav/Bar non-food related I
-Bradley
-Com/Serv/Util food related a
-Service I *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 plumbing permit can be issued.
Water Closet-Toilet q
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
i ' Plumbing Permit Application
r0 pi RECE.@v
City of Tigard Received q
II 13125 SW Hall Blvd.,Tigard,OR 97223 AI 1 r 1 , ,,Data/By, iri /aD permit No.: _,-38
ew
1111 11 Phone: 503.718.2439 Fax: 503,598.1960
Plan te/BY: O.t/ t Other Permit No..
Inspection Line: 503.639.4175 CITY OI" I IGAR $'14'�
TIGARD Internet: www[i and-or.goy , �te Ready/By. ions El See Paget for
g g Bt ll, niNi nly191.;olblied/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
J2'New construction ['Demolition For special information use checklist.
Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION f SFR(1)bath 312.70
❑ 1-and 2-family dwelling ECommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other. Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 9100 SW Burnham St Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223 Footing drain(no.linear R: ) Page 2
Suite/bldg./apt.no.: Project name: Universal Plaza Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18 76
Located on SW Burnham in between SW Main St and SW Ash St Rain drain connector 18.76
Sanitary sewer(no.linear ft.: S) , Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) i Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
All interior plumbing piping, fixtures and equipment, excavation and Dishwasher 25.02
backfill, insulation, fires stopping, chlorination, and seismic Drinking fountain 25 02
Ejectors/sump 25.02
PROPERTY OWNER 1 ❑„TENANT Expansion tank 12.51
Name: City of Tigard
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 13 25.02
Address: 13125 SW Hall Blvd Garbage disposal 25.02
City/State/ZIP:Tigard, OR 97223 Hose bib 1 25.02
Phone:( 503)639-4171 Fax:( ) Ice maker 1251
.)/APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name: Harder Mechanical
Primer 12.51
Contact name: Isaac Vanderbosch
Roof drain(commercial) 12.51
Address: 2148 NE MLK Jr Blvd Sink/basin/lavatory 4 2502
City/State/ZIP: Portland, OR 97212 Solar units(potable water) 62 54
Phone:(503)269-0908 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: ivanderbosch@harder.com Urinal 2502
Water closet 2 25.02
CONTRACTOR
Water heater 37.52
Business name: Harder Mechanical
Water piping/DWV 56.29
Address: 2148 NE MLK Jr Blvd Other: 2502
City/State/ZIP: Portland, OR 97212 subtotal
fee: $72.50
Phone:( 503) 269-0908 Fax:( ) Minimum permit
Plan review (25%of pennit fee)
CCB Lic.: 74 ///� may Plumbing Lic.no.: 26_35PB I State surcharge(12%of permit fee)
Authorized signature%"ter ",/� _. ... ��tr TOTAL PERMIT FEE
Print name: I ..._1:? „t_t /,Z ( Date: �7 .}� zI This permit application expires if a permit is not obtained within 180 days
c-Ci`ti+� C 1j after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1.\Building1Permits\PLMU-PermitApp.doc 10/01/09 440-4616r(I0/02/COM/WEB)
t 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-t' 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' I 62.54
7,201 and greater $327.54 _
Sewer-each additional 100' 37.52
Water Service-1st 100' I 62.54 Medical Gas Systems:
Water Service-each additional 100' 3 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 90.00/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/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
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 Thru 0 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 I ❑ 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 Domestio-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 21
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractorincrease 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:
C\Building\Permits\PLMU_PermitApp.doc 2