Permit (12) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2023-00173
Date Issued: 6/5/2023
T[GAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15975 SW 72ND AVE
Project: Gentle Care Massage Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Interior plumbing for TI:Adding(1)2"floor drain/sink,(3)sinks, (1)clothes washer,and(1)water closet; Installing
(1)water heater.
Contractor: FAR WEST PLUMBING Owner: PACIFIC REALTY ASSOCIATES
PO BOX 597 ATTN: N PIVEN
ESTACADA, OR 97023 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-318-5148 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 05/23/2023 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 05/23/2023 $25.02
3 ea Lavatories 05/23/2023 $75.06
Type of Use: COM 1 ea Water Closet 05/23/2023 $25.02
Class of Work: ALT 1 ea Water Heater 05/23/2023 $37.52
Type of Const: 1 12%State Surcharge- 05/23/2023 $22.52
Occupancy Grp: Plumbing
Stories:
Total $210.16
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: Pmmfttee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available' ectio 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.
toiler- NuiP).0. 3 ---610.0
Plumbing Permit Application ,„
Building Fixtures I , -0ma IIIIIIIIIESIIIIIIIMIIIIIIIIII
.) Received Permit No.: G 1 73
City of Tigard �G `7 ,y
u 13125 SW Hall Blvd.,Tigard,OR 97223 t plan Review Other Permit No.:` �
■ Phone: 503.718.2439 Fax: 503.598.1960� DateBy:
s": 1/, 1 � Date Ready/By: runs: la See Page 2 for
Inspection Line: 503-or g 175Supplemental Information
Tit n l ll Internet: www ttgatd or gov l e } , t /�°tNonSed/Metbod:
,''❑New construction 0 Demolition For special tuformation use checklist
Description I Qty. I Ea I Total
[ '�ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
,; c e(a_ •'' E cl i7 i i°.i;. - SFR(2)bath 437.78
❑1-and 2-family dwelling P. Immercial/industrial SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
i >i(";.ii ° E, :\ 1f3�G'4,rD) E't 1 Kra, 1Site utilities:
Catch basin or area drain 18.76
Job site address: /�7 9 ....0) o� nd a��L/ Drywell,leach line,or trench drain 18.76
City/State/ZIP: ON ! 4aa•LA / Footing drain(no.linear ft.: ) Page 2
g p Project name: t�t�le (�,t j"/ . Manufactured home utilities 50.03
Suite/bld ./a t.no.: J
�J /®f Manholes 18.76
Cross street/directions to job site: // k ` Rain drain connector 18.76
-7( (-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:
Backflow preventer 31.27
Tax map/parcel no.: / d Backwater valve 12.51
'` ic ?1 Sfc)� ��� ;Z __ Clothes washer 1 25.02
/- II?`•`.24 f/./941/ /- e r I lialAck 5.--t l Dishwasher 25.02
Drinking fountain 25.02
>��L:��rfJ F /-ZiJrA /z/t cZ / /,L- ! Ejectors/sump 25.02
Expansion tank 12.51
= � -._ - - • / Fixture/sewereap
Name: �(IJ Grr 'C a �� �S®� f�j�s Floor drain/floor sink/hub l 25.02
25.02
1t. Address: /' c34-V S 6 /-U� 1/"' • - 3°c) Garbage disposal 25.02
/ d , 1J, 4Q, 2 Z Hose bib 25.02
City/State/ZIP: /Gin DR, / 12.51
Ice maker
Phone:( ) Fax (41: 25.02
. : ��E v :•�-,. ;[•crt. 1a's1Xc�� Interceptor/grease trap
� r� �'I.f�F�,,,, . _ ,-. � Paget
Medical gas(value:$ )
Business name: '� � � ' �') Primer 12.51
Contact name: pat.,-' Roof drain(commercial) 12.51
25.02
� A�� t/��3� Sink/basin/lavatory 3
Address: 62.54
)C Solar units(potable water)City/State/ZIP^^� / fL �� Tub/shower/shower pan 12.51
Phone:(J')> bib 60 Fax ( ) 22.51
�" A Urinal
qti E-mail /a(,(�kith D di . ., Water closet I 25.02
051 02
�s
Y°` x"�..r 'S "C •_i11� ,; � ,c s.;: . ' _ N z ,� Water heater l 37.52
y Water piping/DWV 56.29
Business name: ��4 t!!�S r l��Us7.4.(�i,t ci 25.02
Other:
Address: Po 1-4, S`� Subtotal
City/State/ZIP: 7 D2
ty [.atice 0 it p Minimum permit fee: $72.50
Phone:(St°3)_3%8-�%9 ,- F' �-"-i' .0 V 6 ` 8 Plan review(25%of permit fee)
CCB Lic.: 7 Q .,s�T Plumbing Lic.no.:,j' l g ,- p State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signature: �7 ,I�/Jr
Print name:
// l Z I This permit application expires if a permit is not obtained within 180 days
LA-Lk I Date: �1after it has been accepted as complete.
p��fr *Fee methodology set by Tri-County Building Industry Service Board.
440.4616T(10/02/COMNVEB)
l:\Building�Permiis\PLMU•PermitApp.doc 10/01/09
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Su ression S stems:
(C S. � i?.~T� :41:1 z az!tt� �`.'"s-S � ✓� .. S'.t JSa
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
3,601
Sewer-1st 100' 62.54 and y $327.54
7,201eater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52o s T 1 r xti
Y.��'J ' Jl�` `' s' I<g
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
Y--- lit4 LK� ari,Y� T J.; �E `R �` each additional$100.00 or fraction thereof,to
t 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 char:e—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 char:e—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 first$50,000.00 and$1.20 for
minimum char:e—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* < ;4,•;`1;1j) "wk,ta
r ; F c"ii e l t3 b • "VW: Plan review is required for any of the following.
Fixture, v�pe40t 's � R p ,, f J te, Pn Please check all that apply.
�^- �-�• • ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Stall 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each
as defined in OAR918-780-0040.
-DriveStall
Cuspidor/Water Aspirator 0 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" /
' V 4" • Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the i ualifications above.
Garbage -Domestic non-food
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/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 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
Water Closet-Toilet / plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PennitApp.doc 08/04/2011 2