Permit (10) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2023-00435
T EGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/30/2023
Parcel: 2S110DB01300
Jurisdiction: Tigard
Site address: 15298 SW ROYALTY PKWY
Project: EyeHealth Northwest Subdivision: 1996-010 PARTITION PLAT Lot: 2
Project Description: Interior fixtures for tenant improvement
Contractor: DP PLUMBING INC Owner: EYEHEALTH NORTHWEST
15825 NE SPRINGBROOK 11086 SE OAK ST
NEWBERG, OR 97132 MILWAUKIE, OR 97222
PHONE: 503-537-9492 PHONE:
FAX:
FEES
Quantity Description Date Amount
10 ea Sink 10/18/2023 $250.20
Specifics: 1 ea Water Closet 10/18/2023 $25.02
1 ea Water Heater 10/18/2023 $37.52
Type of Use: COM 1 12%State Surcharge- 10/18/2023 $37.53
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $350.27
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
C\
Issued By: ,.., Permittee Signature: PQA)il
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures CEIVE cult 4,r1 ,i , 1 til ,,.i ,
City of Tigard !CT 0 5 2023 Res i 0 M Permit ' /n 2D013- tom{;55
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598,t 9 Plan Review
Inspection Lane: 503.639,417s I Q F 1 i GAR D �`e`B • °n'�P 3-D S
` Date Ready/By: / brit: WI See Page 2 for
Internet: www.tigard-or.gov p3 U I DING DIVI I$ L o(1 a-3 J
i '�- �,��y�F ��� f Noufied/Method S create!Information
y,+ :Ise ,�s*r y t. ..;4.>.,v x rr! -i,a, !a'. j.C+' 5 '�J r1s,0i.? y riy.i 3 tN,:-..ki„' s t ty` ". y?+k k ,% #,it, 1 S q r c,
. . . ..4. f ;i.,6 ,';'w•1 ... y r'...' +'t , t& rE I S, .9.L4 V4 Y`3, i'a�4.3�;n..�
❑New construction .?, r,+<
0 Dem�lition For . '- i»ormpflon use checklist
CI Addition/alteration/replacement ❑Ot -1�� NewNeri lion a�� Total
I-Z-fatdi dwelUn.a(includes 100 ft.for each utili connection)
� ; sa%r1 " �f. SFR(t)batha'4 S S V 7 , r aae $,a ,„` ,o.Tk . -. ,,,o • 312.70
❑1-and 2-family dwelling Qg Com ial/industrial SFR(2)bath 437.78
❑Accessory building 0Mul family SFR(3)bath 50032
0 Master builder 0 0th I�_ Each additional bath/kitchen 25.02 MN
r t Fire sprinkler( sq.ft.) Page 2
fy�,, r• , '� p,�r s
:)' $ 7,'4 Y ' F.Y' ',4 ..:rwrs`', ar a i- },; Site utilities:
Job site address: 51 ctg ; - i` Catch basin or area drain 18.76
Ci /State/Z[P: ��■ Drywall,leach line,or trench drain 18.76
tY •
r IL I ♦ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:
L k:' M Manufactured home utilities 50.03 EMI
Cross street/directions to job site: I Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:__,) Page 2 r
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
"� ,4 ' r;,109 ,?1,\' kk ,i .q ++• as, `T / , fi Backwater valve 12.51
clothes washer 25.02
t , ` • ! I`i se t `' ' r I i 111 Dishwasher
25.02 Drinking fountain 25.02 Ejectors/sump 25.02
f r$ rtk7 y 12.51
4 +r~4•:.. . .6,2,1a'.-v. f _F .,r.. Y.": n Y'9 2' .:i• 77 kih'; + +' Y.a:: Expansion tank _
r
Name: 4- ' It
k , I Fixture/sewer cap 11111111 25.02 r
Address: ! it : r S , Floor drain/floor sink/hub 25.02
f A� Garbage disposal 25.02
City/State/ZIP: i t , v, t• i* ' _ 11111111•1_ Hose bib
Phone: 2
( ) Fax ( ) 12.51
Ice makenett 12.51
•
r,
'•�4x�-.,. i;:e?' vBPt .:\G ti ty13y �„' s'r tyrr.,r•,r. k. .`9 • � .,m� Yx4v ., Interceptor/grease 25.02
Business name: Medical gas(value:$ ) 117331
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address: ISink/basin/lavatory MI 25.02
City/State/ZIP: Solar units(potable water) 111111 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
'' ' >* 4. fit, s 3 k r, ;^k d` ry:r r v .. f ?^ ?1w v r-. Water closet 25.02
+� �,r. '� � ....�%� "' r "'�`� Water heater
Business name: k ` °• D - .1 37.52
Water piping/DWV 56.29
Address:
i ♦ ..•l4 •ii A,i. Other: 25.02
k�.:T'�'- ..' ! Subtotal
Phone:(Se ) 141 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: , 9 Lic.no.: • ; Plan review (25%of permit fee)State surcharge(12%of permit fee)
Authorized signature: 11 c i-,L TOTAL PERMIT FEE
Print name: , p Date: f p This permit application expires If a permit le net obtained militia 180 days
after it bas been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:MusidinePormits1PLMU-PcrmitApp.d°c 1O/i* 440-4616T(10/07/COM/WEa)
Plumbing Permit Application - C ty of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
X. .. $Y,o 4 d''''w L+S..1. .. yY ".e..b,. - �•. ..h.a.: ''7 d,;s a i,..a,,,,,yam r3 fi k,�,., .
Footing drain-1 100' 5C.03 O to 2,000 $121.90
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' 3';52 "7 ' Y Co``4 R'': ' ""` °" 4V0.r
Storm&Rain Drain-1st 100' 62.54 S1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001,00 to S 10,000.00 $72.50 for the first$5,000.00 and S 1.52 for
r,,,t •; r}tea -;,vr s. 1 ar �t)tkjy 2 r each additional$100.00 or fraction thereof,to
n .,s.."; , ,< '. and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first S10,000.00 and$1.54 for
which no fee is specifically indicated 90.10/hr each additional$100.00 or fraction thereof,to
(minimum charge—1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.110/hr S25,001.00 to S50,000.00 $379,50 for the first S25,000.00 and$1.45 for
hours(minimum charge—2 hours) each additional$100.00 or fraction thereof to
Reinspection Fees 90.00/hr and including S50,000.00.
Additional plan review for revisions 90.30/hr $50,001.00 and up S742.00 for the first$50,000.00 and$1.20 for
(minimum charge—I/2 hour) each additional S 100.00 or fraction thereof.Subtotal:
Commercial Fixture Work: 11'
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
„' 1} k • ,y,,, , -.., :.,F�,. 'fi t .�,
accurately report fixtures could result in incr• sed sewer fees* 5-1 ,'` , ,,S ,
Q an b ,o' r Plan review is required for any of the following.
'l` ►,agaur , Please check all that apply.
e10d1u 0 Any new commercial building with water service 2"and
Baptistiy/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower I engineer.
-Jacuzzi/Whir l
Car Wash: Each Stall 1 0 New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780.0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial - 0 Any multipurpose fire sprinkler system.
11 CI Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" , } x ti wr,
f in Isometric or riser diagram is required for new buildings
-Car Wash Drain 1 that meet the qualifications above.
Garbage -Domestic non-food l'
Disposal: -Domestic food related
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice MachJRefrig.Drains 1
Oil Separator(Gas Station) f
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related A
-Bradley
-Com/Serv/Util food related 1
-Service r *Note: If the fixture work under this permit results in an
Swimming Pool Filter I 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 I j plumbing permit can be issued.
Urinal 1
Other Fixtures: i
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