Permit C( s•-J 61t08720?
CITY OF TIGARD Ac4 PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM2022-00406
Date Issued: 10/31/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 210
Project: Peck Rubanoff&Hatfield, PC Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: Interior plumbing for TI:Adding(1)dishwasher and(1)sink; Installing(1)water heater.
Contractor: POWER PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES L P
PO BOX 19418 ATTN: N PIVEN
PORTLAND, OR 97280 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Dishwasher 10/06/2022 $25.02
Specifics: 1 ea Sink 10/06/2022 $25.02
1 ea Water Healer 10/06/2022 $37.52
Type of Use: COM 1 12%State Surcharge- 10/06/2022 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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:
/,�� —c_, 1.✓.�G-gyp /'+t'�^
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 Applicatio EC E IVE /!ii ; ///mil E
Building Fixtures FOR orricb: USE ONLY
City of Tigard AUGq�qq Received Z Q Pemlit No.: p
u I3125 SW Hall Blvd.,Tigard,OR 97223 G 1 1 202Z Dale/BY: / ?� err /Zn'' s.76 "'deyffes
1 i Phone: 503.718.2439 Fax: 503.598.1960 Dale/By:
/v OtherPemtitNo.449.0)9 0Ullir-
Inspection Line: 503 639.4175Date Ready/By: Je .. H Sec Page 2 tar
TiGAan CITY OF TIGARD o. ,` / g
Internet. wwW.tlgard•or.gov Notified/Method: �V j Sup}ilemcnlal informahon
1'1'1'E OF \YOI ILDING.`Dt'I ..ii...,`-y 1ri}'f7�,1'EEa:;SCHEDULE..
❑New construction ❑Demolition For 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(I)bath 312.70
❑ t-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
.lob site address: 12909 SW 68TH PKWY Catch basin or area drain 18.76
City/State/ZIP:TIGARD, OR 97223 Drywall,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt no.:210 I Project name:22-632 p_ � A -
f"�� /Ge+',7t{aff7 f Manufactured home utilities 50.03
Cross street/directions to job site: +'y j,1� 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.: C�'rO�) c Backtlow preventer 31.27
DESCRIPTION OF WORE_ Backwater valve 12.51
Clothes washer 25.02
PECK RUBANOFF & HATFIELD TENANT IMPROVEMENT Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0.TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/Stale/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
ID APPLICANT 0 CON1AC i PERSON Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO. Medical gas(value:$ ) Paget
Primer 12.51
Contact name: MIKE WARREN Roof drain(commercial) 12.51
Address: P.O. BOX 19418 Sink/basin/lavatory 1 25.02
City/State/ZIP: PORTLAND, OR 97280-9418 Solar units(potable water) 62.54
Phone:( 503-244-1900 Fax::( 5031.244-8825 Tub/shower/shower pan 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
-- r Water closet 25.02
CONTRACTOR Water heater 1 37.52
Business name:POWER PLUMBING CO. Waterpiping/DWV 56.29
Address:6611 SW MULTNOMAH BLVD Other: 25.02
City/State/ZIP:PORTLAND, OR 97223 Subtotal
Phone:( 503-244-1900 Fax:( 5031244-8825 _ Minimum permit fee: $72.50
CCB Lie.:52378 Plumbing Lic.no.: 34-150PB Plan review(25%ofpermit fee)
/ State surcharge(12%of permit fee)
„/Authorized signature: ,,ti j''7 t, ii "e-eL--tom,. TOTAL PERMIT FEE
Print name:KRISTIE BRAMWELL Date:8-11-2022 This permit application expires if permit is not obtained within 180 days
atter it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
I:1BuildingU'ermitstPW1U-Pern,iApp.doe 10/0I109 440.4616T(la/02/CONYWGB)
•
Plumbing Permit Application - City of Tigard
Page 2- Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Pee(ea) fetal Square Footage: Permit Fee:
Footing drain- I" 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to3,600 $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-Ist 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
pand 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 S50,000.00 $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/Irr 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$160.00 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
Qua r6ty 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
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Dr
Each allr as defined in OAR918-780.0040.
ivCuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system.
Domestic t 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„ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
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 PLEASE CALL MIKE WARREN WITH QUESTIONS 503-936-5929
Shower: -Gang
-Stall
Sink: -LavBar non-food related
-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 plumbing permit can be issued.
Water Closet-'Toilet p g
Urinal
Other Fixtures:
I:1Building\Permits\PLMF_PermitApp.doc 08/04/2011 2