Permit (18) II it
CITY OF TIGARD PLUMBING PERMIT
�1 COMMUNITY DEVELOPMENT Permit#: PLM2023-00277
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/5/2023
Parcel:
Jurisdiction:
Site address: 14385 SW 112TH AVE
Project: The Ridge Apartments Subdivision:
Lot:
Project Description: Stubbing water service from main to future backflow device location. Backflow permit to be pulled by landscaper.
Contractor: ANDERSEN MECHANICAL Owner: HOUSING AUTHORITY OF WASHINGTON COUN
16285 SW 85TH AVE#410 ATTN: HENRY ALVAREZ
TIGARD, OR 97224 111 NE LINCOLN STE#200L
HILLSBORO, OR 97124
PHONE: 503-992-6664 PHONE:
FAX:
FEES
Quantity Description Date Amount
10 If Water Service 07/05/2023 $62.54
Specifics: 1 12%State Surcharge- 07/05/2023 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 07/05/2023 $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 copy of the rules
1:,-
Issued By: '1 1 Permittee Signature:
Cj C`P
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Call 503.639.4175 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 Reeeiyed 7 yc ry C
11111 ■ 13125 S W Hall Blvd.,Tigard,OR 97223 PlateBy: /_ Permit No.: '1 �__ if/
>11 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review / Ir Or
Inspection Line: 503.639.4175 Date/By Other Permit No.:
Ti GARD Date Ready/By'7 / luny See Page 2 for
Internet. wlvw.tigard-or.govNo Date Read ethad./ ef�e .,-j›j
Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
®Addition/alteration/replacement ❑Other: Description Qty. Ea. , Total
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 IDCommercial/industrial SFR(2)bath 437.78
❑Accessory building ®Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Joh site address:14385 SW 112th Ave Catch basin or area drain 18.76
Drywell;leach line,or trench drain 1 g 76
City/State/ZIP:Tigard Oregon 97224
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:Bldg J I Project name:The Ridge Apartments
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes
18.76
Next to SW 112th Ave between SW Gaarde St&SW Pacific HWY Frontage Rd Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.._) Paget -Subdivision: I Lot no.:
Fixture or item:
Tax map/parcel no.:2S110AB00400 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 1251
Install 1 irrigation shut off T for landscaping Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:HAWC AHP4 Limited Fixture/sewer cap 25.02
Address:111 NE Lincolm Suite 200-L Floor drai floor sink/hub 25.02
City/State/ZIP:Hillsboro Oregon 97124 Garbage disposal 25 02
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker
12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Andersen Mechanical Medical gas(value:$_) Page 2
Contact name:Samuel Kinne Primer 12.51
Address:16285 SW 85th Ave Suite 410 Roof drain(commercial) 12 51
Sink/basin/lavatory 25.02
City/State/ZIP:Tigard Oregon 97224 Solar units(potable water) 62.54
Phone:(503 )504-4666 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:charlie@andersenmechanical.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Andersen Mechanical
Water piping/DWV 5629
Address:16285 SW 85th Ave Suite 410 Other:
25.02
City/State/ZIP:Tigard Oregon 97224 Subtotal
Phone:(503 )504-4666 Fax:( )
Minimum permit fee $72.50
Plumbing Lic.no.:PB 1978 Plan review (25%of permit fee)
CCB Lie.: 217392
fj4 � State surcharge(12%of permit fee)
Authorized signature: fl
TOTAL PERMIT FEE
Print name:Samuel Kinne I Date:07/05/2023 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.
I.\BuddmgPermits\PLMU-PermitApp.doe 10/0l/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- I"100' 50.03 0 to2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
Sewer-each additional 100' 7,201 and greater $327.54
37.52
Water Service-1st 100' 62.54
Water Service-each additional 100' 37.52 Medical Gas Systems:
Storm&Rain Drain-1st 100' 62 54 Valuation: Permit Fee:
Storm&Rain Drain-each additional 100' $1.00 to$5,000.00 Minimum fee$72.50
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
Inspection of existing plumbing or for and including e first$10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
(minimum charge—1/2 hour) each additional$100.00 or Erection thereof,to
Inspections outside of normal business 90.00/hr and including thefirst 0.00.
hours(minimum charge—2 hours) $25,001.00 to$50,000.00 each a 0 for first$25,000.00 and thereof,for
Reinspection Fees 90.00/hr each additional$10000 or fraction to
and including$50,000.00.
Additional plan review for revisions 90.00hr $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*. Plan Review for Plumbing Installations
Fixture Ty a for Quantity by Fixture Type Plan review is required for any of the following.
p Replace/ Please check all that apply.Work Performed: Capped Added Relocate pP X
Baptistry/Font 0 Any new commercial building with water service 2"and
Bah Tub/Shower greater,except systems designed and stamped by licensed
Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall El New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ElMedical 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"
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
IceMach/Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Sere/Util 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.
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