Permit (24) CITY OF TIGARD PLUMBING PERMIT
3 ,� COMMUNITY DEVELOPMENT Permit#: PLM2023-00302
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued; 8/16/2023
Parcel: 2S 105 DB00400
Jurisdiction: Tigard
Site address: 13425 SW 154TH AVE
Project: City of Tigard-Pump Station 18 Subdivision: None Lot: None
Project Description: Interior plumbing:Adding(1)eye wash and(1)3"floor drain/sink; Installing(1)backflow preventer,(1)hose bib.
(1)water heater,and(1)trench drain.
Contractor: II S MECHANICAL INC Owner: TIGARD WATER DISTRICT
PO BOX 639 8777 SW BURNHAM ST
STAYTON, OR 97383 TIGARD, OR 97223
PHONE: 503-769-3738 PHONE:
FAX: 503-769-4374
FEES
Quantity Description Date Amount
1 ea Drywell,Leach Line or Trench 07/17/2023 $18.76
Specifics: Drain
1 ea Backflow Preventer 07/17/2023 $31.27
Type of Use: COM 2 ea Floor Drain/Floor Sink/Hub 07/17/2023 $50.04
Class of Work: ALT ea Hose Bib 07/17/2023 $25.02
Type of Const: 1 ea Water Heater 07/17/2023 $37.52
Occupancy Grp: 25 Misc Other Fee 07/17/2023 $25.02
Stories: 1 12%State Surcharge- 07/17/2023 $22.52
Plumbing
Total $210.15
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
a
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.
Si.
i '
Plumbing Permit AvplicatiRECEIVED
Building Fixtures FOR orris•p: tsi: oNLv
City of Tigard 16 Received r,
.111 • 13125 SW}Intl Blvd.,Tigard,OR 97223 Date/By: / 1-7 7-3 err Pemrit Ne.:�/,�yt �]�,�r�_ _t,�^'
Phone: 503.718.2439 Fax: 503.598.1 of TIGARDplan Review �/ �/ ' (�Q 3 (�J a Y'
Date/Dy: �1/� Other Per nut No: !/J` ]n')3-Oi/ 3
fIGARD Inspection Line: 503.639.4175 - /v /' sue/(- O�VF7 W4-/
Internet: www.tigard-or.gov BUILDING Date led 1,ho /�,� lurix: ® Sec ace 1 for
---- -- -- 4 No[ifedMelhod• �/�7/�3 ] - �I Supplemental Information
TYPE OF WORK -
��iw=rr� /`i;�f)s�t FEE* SCHEDULE
XNew construction ❑Demoll lion %fJ For special iupenaRnn use checklist
Description j Total
❑Addition/alteration/replacement ❑Other Cr.
New I-2-family dwellings(includes 100 ft.for each ulility.comsoctioq)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 I-and 2-family dwelling 2C1 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath kitchen
25.02
0 Master builder ❑Other. -
Fire sprinkler( -sq.ft.) Page 2
JOB STTE INFORMATION AND LOCATION Site utilities:
Job site address: /q2_s co 09,71) l k(en U:Z Catch basin or area drain 18.76
City/State/ZIP: �6 -a(--j 0 D (1, r1 1. Drywcll,leach lint,or trench drain 1 I8,76 !Y,-i ,
Suitelbld /a t.no.: 4� 1� j Footing drain(no.linear ft: ) Page 2
8 P Project name:CiArti 0 rj.9rit-l } -)evvi f (b' Manufactured home utilities
50.03
Cross street/directions to job site: k TO.res.p ' t ei"f.l+.,0 tl Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear R.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or Item:
Tax mop/parcel no.: 02'57tls De c�. Backtlow preventer ! 31.27 �1.2.1
,K c�0
DESCRIPTION OF WORK Backwater valve 12.51
',...IS"k ;�iCh.1 l., Clothes washer 25.02
i- F .l`Yl`IlQ• (--�g�f- c u`.h"v- ` 1 c,l Dishwasher
25.02
Drinking fountain 25.02
�ry Ejeotora/surtlp 25.02
u°1�'yPROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: 4_:1`i-l4 U - --- -k jar_,c.i Fixlurciscwcrcap 25.02
Address: Floordmin/floor sink/hub2$,p2 4-4,),D(.j
----- - - Garbage disposal 25.02
City/State/ZIP: t
-- --- Hose bib I 25.02 2.5.02,
Phone:( ) Fax:( ) Ice maker 12.51
YZJAPPLICANT 0 CONTACT PERSON Interceptor/grease trap. 25.02
Business name: �^ /I Medical gas value:$
---
Primer ilk char?) L� ..�,)�C. 8 ( -) Paget
Contact name: Ole/,'s5 e�`Ty) h�a0.S Primer 12.51
Roof drain(commercial) 12.51
Address: 22..9 tI -31_1,1 i a l.;Q..\4_ ••=,
sink/basin/lavatory 25.02
City/State/ZIP: 3,D;°' '.- ram O c'i'552 Solar units(potable water) 62.54
Phone:('-��')) •7 7 -37'3' ' Fax::( ( ) Tub/shower/shower pan 12.51
E-mai1:fl //s.5Y1 G ''.SI)')@Ci'ci1)l CC�4,QT77 Urinal 25.02
,,"CONTRACTOR .„,.. Water closet 25.02
Business name: (� `- • Water heater I 37.52 ')7,5:2,
Address; -...� 1'�'k \\ )( if- Walerpiping/DWV 56.29
other:Trenchh Df&lye - 25.02 . ,(f)-
City/State/ZIP: Ege.&j subtotal G 1/ 7.(v3
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 5941 . g Lie,no.:2y /S"5pB Plan review (25°/oermi
Stateee surcha2°h oermiAuthorized signatu t tJ/lurnbln
TOTAL PERMIT FEE fff
1✓ 24
Mo.) o. it
Print name: <• L}J Date: a,/5j,2,cs 2_3 This permit application I ha.be If a permit Is not oblate. wi s0 days
after II has been accepted as complete.
+Fee methodology set by Tri-County Building Industry Service Board.
titauildinaSPersoiOPLMU-PermiiApp.doe 10/01/09 440-4616T(Io/0220M/WEO)
37 EAU -4"t-cr-64-c
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
Sewer- lst 100' 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
Water Service-each additional 100' Medical Gas Systems:
37.52 Valuation: Permit F :
Storm Rain Drain-1st 100' 62.54 Fee:&
Stone&Rain Drain-each additional 100' $1.00 to$5.000.00 Minimum fee$72.50
37.52 55,001.00 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 the$10,000.00.
which no fee is specifically indicated 90.00/hr 310,001.00 to$25,000.00 each a 0 for tint$10,000.00orfraction
and$1.54 for
(minimum change-t/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business and including$25,000.00.
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
Rcinspcction Fccs 90.00/hr and including$50,000.00.
Additional plait review for revisions 90.00/hr $50,001.00 and up $742.00 for the first S50,000.00 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
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for 1 Replace/ Please check all that apply.
Work Performed: Capped Added Relcate
flsptisuy/Font - ElAny 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
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher. -Commensal ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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"
Isometric or Riser Diagram
Car Wash Drain 0 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: -Lay/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter
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: 5
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