Permit CITY OF TIGARD PLUMBING PERMIT
■., COMMUNITY DEVELOPMENT Permit#: PLM2022-00491
T i G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/6/2022
Parcel: 1 S134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 200
Project: Dr.Saum Hadi Veterinary Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: Interior plumbing for TI:Adding(2)2"floor drains/sinks, (3)sinks,and(1)clothes washer; Installing(1)backflow
preventer,(1)hose bib,and(1)water heater.
Contractor: QUALITY WEST PLUMBING LLC Owner: ROBINSON,JERRY CHRISTOPHER TRUST
23050 SE FULQUARTZ LANDING DIETRICH, NANCY BISHOP
DUNDEE, OR 97115 9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: 503-289-7095 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/06/2022 $31.27
Specifics: 1 ea Clothes Washer 12/06/2022 $25.02
2 ea Floor Drain/Floor Sink/Hub 12/06/2022 $50.04
Type of Use: COM 1 ea Hose Bib 12/06/2022 $25.02
Class of Work: ALT 3 ea Sink 12/06/2022 $75.06
Type of Const: 1 ea Water Heater 12/06/2022 $37.52
Occupancy Grp: 1 12%State Surcharge- 12/06/2022 $29.27
Stories: Plumbing
Total $273.20
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 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.
Plumbiniz Permit Application 7
- Building Fixtures REy��, „7 IN '-t-
City of Tigard "" Received 1 pe mit No.:
: ■ 13125 SW Hall Blvd.,Tigard,OR 97223 y Date/By: /1/,f�l�'y l�r}T- PLfI')2j -}-(,�('()
g �ty'j�i Plan Review I
Phone: 503.718.2439 Fax: 503.598.1960 C r'l ` Date/By: Other Permit No.:�un y ) �eb1v
Inspection Line: 503.639.4175 rr��yy,, Date Read B luris: /for ►�V
TIGARD Internet: www.tigard-or.gov �TItrOL y y' S See age2 for
® Notified/Method: Supplemental Information
TYPE OF W
0 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 SFR(1)bath 312.70
❑ 1-and 2-family dwelling ommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
�INFORMATI r '..° °^•LOCATN Site utilities:
Job site address: t bk15 S tV,`,M�� ,�` Catch basin or arcs drain 18.76_
Drywell,leach line,or trench drain 18.76
City/State/ZIP: '��(5/L CY t C) 9C ,
1 ,J 2.2.3 Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: apt) I Project name:� SILL 4tet CU, 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:
wp Backfloreventer , 3 31.27 / Ti
Tax map/parcel no.: / i
Backwater valve 12.51
Clothes washer I. 25.02 ,Oa-
Roo k. \Y\ 0-3(‘t^, ��- i ..-� Dishwasher 25.02
VW1✓ LpCA c-. Nk Uc $ Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub Z. 25.02 AI Li
Address:
Garbage disposal 25.02
City/State/ZIP: _ Hose bib ` 25.02 ).S 0.3_
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: U.N2 to (0,0m1:4 fir Medical gas(value:$_) Page 2
1lJ J\ Primer 12.51
Contact name
Roof drain(commercial) 12.51
25.0
Address:Z�� ., r ' ..4, La i n Sink/basin/lavatory _ 25.02 '7S d(-,
City/State/ZIP: nalek, y " CntIS Solar units(potable water) t 62.54
Phone:4565 ?j�a.1-7CS Fax::( ) Tub/shower/shower pan 12.51
UrE-mail:�/1( � 1 1, ,PR-
) + C „-\n/'� Water - 25.02
v^ w `�C� \ * Water closet 25.02
CONTRACTOR
Water heater t 37.52 3'7.')-
Business name: l ,�'�yn- Water piping/DWV 56.29
Address: C\/� 191\11 v_ �-. Other: 25.02 oal
City/State/ZIP: I V� ryY�'�' Subtotal e`J C}'1
Phone:( ) C. V_ Fax:( ) Minimum permit fcc: $72.50 J.
1
n Plan review (25%of permit fee)
CCB Lic.: ��� /, Plumbing Lie.no. 1Gj g State surcharge(12%of permit fee) �'�,)-7
Authorized signal c: TOTAL PERMIT FEE a7 3-
7,17
Print name: Date: I L, ZZ 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:\BuildingTermits\PLMU-PermitApp.doc 10/01/09 4404616T(10/D2/COMM1VEB)
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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 F
Footing drain-1"100' 50.03 0 to 2,000 S121.90
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
Storm&Rain Drain-1st 100' 62.54 aluation: Permit F`
$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 90.00Au 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 fast$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 Plumbing Insstallations
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
ptistryiFont El Any new commercial building with water service 2"and
Ba Tub shower greater,except systems designed and stamped by licensed
Bath:pti
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure
Drive tallThr as defined in OAR918-780-0040.
:ICuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 0 Any multipurpose fire sprinkler system.
Domestic 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"
r
3" Isometric or Riser Diagram
4" 0 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
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 ,i 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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