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Permit (3) CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2021-00394 T I t;A 1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/22/2021 Parcel: 2S101 BB01500 Jurisdiction: Tigard Site address: 12236 SW GARDEN PL Project: Chimcare Subdivision: CROW PARK 217 Lot: 3 Project Description: ADD(1)lay and(1)water closet. Contractor: K&C PLUMBING INC Owner: BKM PARK BC 252 LLC PO BOX 2124 BY SLK GLOBAL SOLUTIONS AMERICA OREGON CITY,OR 97045 2727 LBJ FREEWAY STE 806 DALLAS,TX 75234 PHONE: 503-518-0234 PHONE: FAX: 503-518-1100 FEES Quantity Description Date Amount 1 ea Lavatories 09/17/2021 $25.02 Specifics: 1 ea Water Closet 09/17/2021 $25.02 1 12%State Surcharge- 09/17/2021 $8.70 Type of Use: COM Plumbing Class of Work: ALT 22 ea Minimum Fee Adjustment- 09/17/2021 $22.46 Type of Const: Plumbing Occupancy Grp: Stories: Total $81.20 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules Issued By: )..jay Vo,ir,p -W"e, Permittee Signature: QwAr LtooFiova Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application RECEIVED Building Fixtures SEP 13 2021 City of Tigard Recer 0 t q 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGARDr13, 7/!&/� V Paoan 1�LM 20 21�1 D `l`7' _►{ s Phone: 503.7)g.2439 paw. 503.sa$.I6gUILD1NGDIVISIO ''ic'k Tither Ponta NosidAzc j�to2.52 inspected Law 503.fi39.3175 1!C;A I:U Date Ready By- 9 'i' 1' .1 "Le la see Neel'for Internet: mkw.li ix_ uY V edi lerhld:'� � Supplemental Information TYPE OF WORK t:-7't4-1- Acs 5 FEE* SCREDULE ❑New ematrucion ❑Demolition l'orspecial inforntrrtion MVO checklist Deacriplice I Qh:. 1 Fs. I Taal gAdditionkaltcratialJroplacement 0 Other: Ncsr 1-2-family&waling&(includes 100 ft.ror each utility connection) CATEGORY OF CONSTRUCTION SFR(Obeli 312.70 , ❑ I.-and 2-family dwelling 'ofirCodunerciallindustrial SFR(2)bath 437.78 SFR(3)bath 50032 ❑Acectisory building 0 Multi-family Ea+.in additional bath4:ilthcal 25.02 ❑Maraer builder ❑idler fire sprint:lut /41 11.) Vrive2 JOB SITE INFORMATION AND LOCATION Site u1UIlks: Job silt address: ( Z.Z. 34, c 4, ag.f ,(40, 1 I Catch basin a ores drain 13.76 Dronll.leach lire:.or trlmoh drain 13.76 Cis.Stoic'%I]': �(9ot r pt () Totting drain(no.linear ft.:i) Page 2 Sttitcbldglapt.no.: f Project name: cH I r"t('}ri2__E \tanulheturcd!nanc utilities 50.03 Cross atreete'diratiata to job site: \lambed.s i t).7fi Rain drain connector 11.76 Sanitary scum.(no.linear ii:_) Pogo 2 Storm wear(no.linear 11.: ) Page 2 Water aerwice(nts.linear ft.:_1 Page 2 Subdivision: Lot no.: Fixture or Hum Tax map(are a no- Rackllow prevemer 31.27 Backvailier valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 n P 1 Ile 4- a_ei cl / .S) n k_ Disbeastax 25.02 Drinking liwmain 25.02 Ejectua's nip 25.02 0 PROPERTY OWNER 0 TENANT Epansimtank 12.51 Name: Ftaturu''stuer cap 25.02 Flax drain1lna smk!huh 25.02 Address: Crarbage disposal 25.02 CitpStatcZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ire maker 12-51 0 APPI.IC_ANT 0 CONTACT PERSON anlcraptagrcase trap 25.02 Business name: Medical gas(value:5 I Page.2 Primer 12.51 Contact names Ronfdrain(cornmacial) 12.51 Address: Sink basiNlavnttm• 1 25.02 lc,o L . City/State+7.11': Solar units(pulable water) 62.54 Phone:( ) Fas.:( ) TiWshossox'sarusva pan 12.51 f 1 Urinal 25.02 L rJ j E-mail: 1 I� � rr` et.,LL t 1 co 11� Walla(closet j 25.02 Z S.o L kill CIY)R Ware heater 37.52 Business name: K4-)e P 1 II J yyt bl? r I. c water pipingDWV 56.29 Address: i 4.-a S R F1 ,. f-i,2e4,7 Other: J 2502 City!State'T.1P: 10 r aq, ©p L ,04 9 7Q f/f-` Minimum ptamil fi¢Sb7 50 'f�,S'p Phone:(S 7z2 " .57 Y Fax:( ) it/ /.4 CC11 Lie,:14,4 G Plumbing Ix.no.: �'B Plan review(25°tofpalni!foe) Statemehane(12%ofpamitfa) S, 70 Authorized signutu / / TOTAL PERh1rr FEE is( r P fl i Prink name': C �z� Dale! F- 5-z/ TIIa�tMI V1I1 Nt�1dI4turit asb Irapctink Mnot pktr.J.,Inds dal J.p, �' t.['C />!f anrr is has bean aaeptarl as surnPkrr. *For tnrth:dnL.ay set Iu Tri.Cnumy Belidrnp Industry Service Marc! I:ffimldtidt'k1crofis'411.1U.Paarlt49.d4e 1701'7. a.W-01071ta.9=0141'EB) Plumbing Permit Application-City of Tiga rd Page 2- Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(c.l Total Square Footage: Permit Fee: Fuotingdrain-1'100' 50.03 0 to 2,000 S121.90 1 totting drain- additional IOC 37.52 2.001 10 3,600 $169.69 3.601 to 7.200 S23310 Selma'-1 ct WO' 62.54 7.201 and pinto S3t27.54 A;,-iux-each additional 100' 3732 - _Water tiervtus-lsr too' 62.54 ... Medical Gas Systems: Water Service-each additional 100' 3752 Valuation: Permit Fee: Stuns&Rain Drain- 100' 6254 $LOG to 55,000.00 Siinimwn fee$72.50 Storm&Rain Drain-tarh additional IOn' 3752 $5.001.00 to S10.000.00 S72 30}fir the first$5,000.00 and S1 S2 lir Other Inspections or Fees Oiy• tree(di 'fatal cacti additional SI00,00 or fraction bawl:to P and including$10,000.00. Inspection oCexisting plumbing or for St0.00t.011u$25,000.00 5146.56 for the first 510.000.00 and sl,54 roc ',Aid,no fox is specifically indicated 90.0)-hr comb addilirannt S100.00 sa Treaties d,eratf.to (minimum Marge,• 1,2 hour) and including S23.000.00. Inspections outside of nomtal nosiness 90.001r S25.001.00 to S50.000.00 S379.50 for the Irst$25,0)0,00 and Si.A5 for hours(minimum chino -2 hours) each additional$100.00 or fraction thereof,to Ri+nel.ct;nn VON 40(Whhr and inchtdint S50-000 An Additional plan review fir revisions 90.00.7rr ccn,aol.IX)and up S742.00 for the first$50.000.00 and SI.20 for (minimum charge- Ir2 hour) each additional St WOO or fraction Minor 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 incsrased sewer fees*. Plan Review for Plumbing Installations Quantity In nature Type Plan revicn-is requited for any of the following. Fixture Type for Replace/ Please check all that apply. 'York Performed: Caps Added xetoatr ❑ Any new commercial building with water service 2"and $nptistri,Futn greater,except systems designed and stamped by licensed Bath: -T1INSICPW Jacu2 Whirlpool exr. Car Wash: -Fach Stall ❑ NOVcH'exterior plumbing site utilities for any complex structure Each Thu as defined in OAR918-780-0040. -DriveQrspidtxrW'ater Aspirator ❑ Medical gas and vacuum systems for health care facilities, Dishwasher -Commercial ❑ Any multipurpose fire sprinkler system -Domestic ❑ Any complex structure as defined in OAR918.780-0040- Dri Was h[iruntnin Ewe Wash Submit 2 sets of plans with any of the above, Hoer Drain/sink: .2" -3" isometric or Riser Diagram 4.. 0 isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic Cued related -Commercial food related -Induairial food related Ice niach-Refrin.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shout': -clang -Stall Sink: -t.av,filar non-food rclat-i I -Bradley' -font:Servo ltil lured rchual -Service "Note: If the fixture work under this permit results in an swimming Pool Fitter increase of sewer EUUs,a sewer permit will be issued and Wailiur-Cloihos fees assessed for the sewer increase must he pair) before the Watts Extret- plumbing permit can he issued. WattsWattsClostK Closet Toilet lkimtl Other tlsturas! I\Boilding\Pennitslin,MF_PenuitApp,doc 081u4t201 1