Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00348
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/7/2022
T IG,ill.RD Parcel: 1S135CA00800
Jurisdiction: Tigard
Site address: 11255 SW GREENBURG RD 1
Project: Tigardville Apartments Subdivision: None Lot: None
Project Description: Replacing 25 ft.of sanitary sewer.
Contractor: ALPHA ENVIRONMENTAL SERVICES INC Owner: TIGARDVILLE APARTMENTS LLC
11080 SW ALLEN BLVD, SUITE 100 1233 NW NORTHRUP ST STE 125
BEAVERTON, OR 97005 PORTLAND, OR 97209
PHONE: 503-292-5346 PHONE:
FAX:
FEES
Quantity Description Date Amount
25 If Sanitary Sewer 09/07/2022 $62.54
Specifics: 1 12%State Surcharge- 09/07/2022 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 09/07/2022 $9.96
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 cop of the rules
„........4;r :,
Issued By: ..---
Egrmittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available 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.
r . a ,
Plumbing Permit Application
Site Utilities
FOR OFFICE USE ONLY
City of Tigard Ri CEIVED Deceived
• 13125 S W Hall Blvd.,Tigard,O C Date By: f ;H- Permit
No.: _ _ fiy
' Phone: 503.718.2439 Fax: 503.598.1960Ill
Plan Review ('V
Inspection Line: 503.639.4175 SEP 7 2022 Date/By: Other Permit No.:
I I GA I�I) SEP Reayietho
Internet:
www.tigard-or.gov ,,1„ - ®' Sec Page 2 for
,. Notified/Method: t�..Y`(� Supplemental Information
TYPE OF WOKIfil OF 1R M Ld
IJI.AING`DIVISION FEE* SCHEDULE
❑New construction emolition For special information use checklist
0 Addition/alteration/replacement Description Qty_ Ea. Total
❑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 x❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11255 SW Greenhurg Rd Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Suite bld /a t.no.: Footing drain(no.linear ft.: ) Page 2
g P I Project name:22- it to 1� 1.2.A Manufactured home utilities 50.03
Cross street/directions to job site:SW Tiedeman Ave t/
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: 25 ) Page 2 $62.54
Storm sewer(no.linear ft.:_) Page 2
Subdivision: Water service(no.linear ft.: ) Page 2
Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.S1
Replacing 25 feet of sanitary sewer line using 6-inch 30/34 via trenching in the parking lot. Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I . ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
Phone:( ) Hose bib 25.02
Fax:( ) Ice maker
- - 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Alpha Environmental Services Medical gas(value:$__) Page 2
Contact name:Cory Tipton Primer 12.51
Address: 11080 SW Allen Blvd,Ste 100 Roof drain(commercial) 12.51
SinIc/basin/lavatory 25.02
City/State/ZIP:Beaverton,OR 97005
Solar units(potable water) 62.54
Phone:( 503 ) 292-5346 Fax::( ) Tub/shower/shower pan 12.51
E-mail: sewer-septic(a)alphaenvironmental.net Urinal 25.02
... CONTRACTOR Water closet 25.02
Business name:Alpha Environmental Services Water heater 37.52
Address: 11080 SW Allen Blvd,Ste 100 Water piping/DWV 56.29
Other: 25.02
City/State/ZIP: Beaverton,OR 97005
Subtotal $72.50
Phone:(503 ) 292-5346 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 152125 Pun ,ic.no.:PB1612 Plan review (25%of permit fee)
Authorized signature: State surcharge(12%of permit fee) $8.70
�/ TOTAL PERMIT FEE $81.20
Print name: '-J )j,1' Date: >/z a. I 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.
IABuildingiPennits\PLMU-PerrnitApp.doc 10/01/09
440-0616T(10/02/COM/W EH)
. . -.
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:
50 03 0 to 2,000 $121.90
Footing drain- 1"100' 2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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- Ist100' 62.54 Medical Gas Systems: I
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
each additional$100.00 or fraction thereof,to
Qty. Fee(ea) Total 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.
and
Additional plan review for revisions
90.00/hr $50,001.00 and up each for the first
s$0,000.00orian $1.20 for
(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*. lntnbin Installations
Quantity by Fixture Type Plan Review for.P g
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate Please check all that apply.
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath -Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Dr
ve ohm as defined in OAR918-780-0040.
Di Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher -Commercial
-Domestic 0 Any multipurpose fire sprinkler system.
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"
4„ Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food that meet the qualifications above.
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/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMU_PermitApp.doc 2
IIIIIIm Site Utilities — Plumbing Permit Application
T I c n It D Plan Submittal Requirements
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map& tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS - Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping,manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Permits\PLMF-PermitApp,doc 12/30/05