Permit (6) CITY OF TIGARD PLUMBING PERMIT
!Pqi COMMUNITY DEVELOPMENT Permit#: PLM2021-00022
13125 SW Hall Blvd.,Ti Date Issued: 1/25/2021
TIGrlRD and OR 97223 503.718.2439 9
Parcel: 2S101 BB01500
Jurisdiction: Tigard
Site address: 12236 SW GARDEN PL
Project: BKM Bldg 1 Subdivision: CROW PARK 217 Lot: 3
Project Description: Replace(1)WC and (1)lay
Contractor: PMSI LLC Owner: BKM PARK BC 252 LLC
8295 NW EVERGREEN PKWY#204 1701 QUAIL ST STE 100
HILLSBORO, OR 97124 NEWPORT BEACH, CA 92660
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Quantity Description Date Amount
1 ea Lavatories 01/14/2021 $25.02
Specifics: 1 ea Water Closet 01/14/2021 $25.02
1 12%State Surcharge- 01/14/2021 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 01/14/2021 $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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4{ `- „.� Permittee Signature:
1tJ��TlrMr►�lB_ � c� AWl�cGtlu^
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.
t
Plumbing Permit Application
Building Fixtures II
City of Tigard F�ECE11/E n;` ed �11%41z,Ox\ PermitNo.Pd-r12CZ/ - OODZZ.
IIIIIMEETIEIIIIIIIIIIII
• 13125 SW Hall Blvd.,Tigard,OR 97223 pan Review
yt/ ' Phone: 503.718.2439 Fax: 503.598.1960 II Lq q Date/By: Othe Permit No.:
Inspection Line: 503.639.4175 JA8 021 Date Ready/By: 1 t N. F.tvauk0 Jmis: ® See Page 2 For
"f1GARU Internet: www.tigard-or.gov Notified/Method: 11N `Y�1 Amy+6',., Supplemental Cnforum non
I 'I'YPE OF WORK�jCj'�j�' OF tT&J J FEET SCHEDULE.
❑New construction ❑�e II tb 443 F8 tl For special information use checklist
Description I Qty. I Ea. I Total
..n addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 fl.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ommercialiindustrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
O Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION- Site utilities:
Catch basin or area drain 18.76
Job site address: 12.23-u, s(k j (21a.)...r '� Drywell,leach line,or trench drain 18.76
City/State/ZIP: -^1`s t 1 r-e).3 Ca tt, C7r 2.'Z'? Footing drain(no.linear ft.:_J Page 2
Suite/bldg./apt.no.: Project name: 'S .A 4_ Manufactured home utilities 50.03
Cross street/directions to job site: - Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:,_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK 25.02
� Clothes washer
(l2st fy24w;t, (._) tv C 4- (\ i °L..oR') Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
.PROPERTY OWNER 0 TENANT Expansion tank 12.51
p pFixture/sewer cap 25.02
Name: `B\f\ \ jY�f-. - cc, 251-I --1--C Floor drain/floor sink/hub 25.02
Address: I ZZ3(., SCR c,%v, 'zA-a.P7 { tCa.,:, Garbage disposal 25.02
City/State/ZIP:-'(; -y- c-t , b�C__ OV"1 2-- Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: Ipp,A. 0 1 L)_ . Primer 12.51
Contact name:Ay.novel( 1 f=a Roof drain(commercial) 12.51
Address: 2Sta' k..)6 g1/P(vrL to 2 ,eskC 2-014 Sink/basin/lavatory 25.02 I l trt,
City/State/LUP: YI'1\L S�Cp. p i ).0,_ CA-1\-,t-1 Solar units(potable water) 62.54
Phone:( ) Fax::(C ) L Tub/shower/shower pan 12.51
5(33 t(aC,- L2z L3 rtac� -22\\
Urinal 25.02
E-mail: Qtt„.1e's YYIS, "Sv Sir Cvv'‘S'(OT\ Water closet
25.02 'LS•0
CONTRACTOR Water heater 37.52
Business nnaame: .2�s-s_ 1 L..-1.-.� Water piping/DWV 56.29
Address: 11Z06- A)e 6,"csrtrc x:n (' �k ,Vs-G �� Other: f 25.02
City/State/ZIP: CDs_ 0:1 11Z41� Subtotal ,0�
l�'bt7 n
Minimum permit fee: $72.50
Phone:(5D-5 )i 0,'Z222, Fax:(503)L1(tdo-2....-L\\
Plan review (25%of permit fee)
CCB Lie.: 1 5R-2+gco Plumbing Lic.no.: 34-41t-lpI State surcharge(12%of permit fee)
Authorized signature: A N. ��-. �'-�_ , „�) TOTAL PERMIT FEE
.1QNonrn. "'"`t '�" Date: j This Permit application expires it a permit is not obtained within 180 days
Print name: x,,...44 , .r,� 1CA7�']„(;f'�\ after it has bees accepted as complete.
W *Fee methodology set by Tri-County Building Industry Service Hoard.
i\nuilding\Permits\PLMIJ-PermitApp.doe 10/01/09 440-4616T(10/021COM/wE13)
I
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
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' 37.52 Valuation: Permit Fee:
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
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
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 charge-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 charge-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 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 Rene Please check all that apply.
Work Performed: Capped Added Relocate
❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thnt
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial l ❑ Any multipurpose fire sprinkler system.
ElAny 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"
-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 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 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:
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