Permit (22) CITY OF TIGARD PLUMBING PERMIT
■ COMMUNITY DEVELOPMENT Permit#: PLM2021-00093
Date Issued: 3/30/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 •
Parcel: 2S 103 DD00400
Jurisdiction: Tigard
Site address: 13727 SW PACIFIC HVVY 150
Project: Slay Studios Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Capped(11)2"floor drains/sinks.
Contractor: AMERICAN BACKFLOW&PLUMBING SERVICES INC Owner: VPT LLC
5623 SE CENTER ST 610 SW ALDER ST STE 1221
PORTLAND, OR 97206 PORTLAND, OR 97205
PHONE: 877-950-2468 PHONE:
FAX:
FEES
Quantity Description Date Amount
11 ea Floor Drain/Floor Sink/Hub 03/30/2021 $275.22
Specifics: 1 12%State Surcharge- 03/30/2021 $33.03
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $308.25
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: Permittee Signature: Owl Ucati.0T1
�t vA.rt�a�w pp
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 R E C E I'v
City of Tigard y ? �� al Permit No.: g M 7, �/ �y yr
13125 SW Hall Blvd.,Tigard,OR 97223 V /'�'fCrL 4��Wt 3
• Phone: 503.7182439 Fax: 503.598.1960 ir)1� 4 2�2�, Plan Rew,ew Other Pamir No.:
Inspection Line: 503.639.4175 DatdBy: for - - � ��
Internet: www.ti -or. ov _ {-'l''Date Ready/By: lure: ®See age 2 for
8 CITY Or- TIUAfIt�Notified/MeUrod: -rF��'/I-'I Supplemental Information
TYPE OF WORK RIM DING DIVISION FEE* SCHEDULE
--
❑New construction 4Nikeetnolition For special information use checklist
Description ] Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling 'I Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 50032
❑Accessory building
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: + 3 7,,z'7 Sui pa(i/4 G U.t J y C) Catch basin or area drain 18.76
City/State/ZIP: 'Tir1 `!Y'1 G..x.- ti 1 7 3' / Dryw¢II,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_J Page 2
Suite/bldg./apt.no.: I Project name: 1 Sllf t . uv�f 1 i3S Manufactured home utilities 50.03
Cross street/directions to job site: f� Manholes 18.76
O, Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
r�
Storm sewer(no.linear ft.:_) Page 2
i2itt-.-� 1n) Qerrw Q` Lik?aO Lt) s a0aa. Water service(no.linear ft.: ) Page2
Subdivision: I Lot no.: Fixture or Item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
T'
L Clothes washer 25.02
We- �/++ Y✓to..,:-J I]( po,,A+c d/- Cc1,1+'t•�.L 1.' " Dishwasher 25.02
#JO 11X'4 u. S Gk'%^C CA Cl wp jr�t Y. -E Drinking fountain 25.02
/ Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap h ..25.02 71"..2 L
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
VI APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
,A__. p ICI l ilk
S it Medical gas(value:$_) Page 2
Business name: F-Cf �" D ( N /t y
Contact name: .---I-oti 273 L 3 , 1 Primer 12.51
1.,,, � Roof drain(commercial) 12.51
Address: 56 2 SE C.4+.i^, 0 . Sink/basin/lavatory 25.02
City/State/ZIP: ay,.F(�, .1 .' ei ' Z. I '7 Solar units(potable water) 62.54
Phone:(S 9 2 S 1- (l'f! a Fax::( ) Tub/shower/shower pan 12.51
E-mail: -'`--0-� r ec/ e4L j[ rO� Ft}S,irk t'1..- , G.J� Urinal 25.02
y C.
/ J CONTRA OR Water closet 25.02
p Water heater 37.52
Business name: ‘GCcl,.d1r� �.�l ,Ot..1 IS. 4 l4[Y t✓y) Water piping/DW V 56.29
Address: Other. 25.02
` City/State/ZIP: Subtotal 2.?5"01.2.
Phone:( ) Fax:( ) Minimum permit fee: $72.50
• Plan review (25%of permit fee)
CCB Lie.: -�t., qg q ;Odin,' Plumbing Lic.no.: '1•��ej�� �/ /�� State surcharge(12%of permit fee) 03
Authorized signature: tl. 11 t.r p-7l'�✓ -b //�O TOTAL PERMIT FEE a.2.5'
Print name: j . ,1 VA •`,-rt y%-,,_• Date: 3- s 2 / Thtr permit application expires If a permit Is not obtained M In 150 days
k y after it has been accepted as complete.
I 'Fee methodology set by Tri-County Building Industry Service Board,
I:1 Building\PermitshPLMU-PcmlApp.doc 10/01/09 440.4616T00/02/COM/WEB)
I
Plumbini Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ee) 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 S 169.fi9
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 S5,000.00 Minimum fcc$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 S25,000.00 $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—I/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 S25,000.00 and$1.45 for
hours(minimum charge—2 hours) each additional S 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—I/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 Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font 0 Any 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 as defined in OAR918-780-0040.
ElCuspidor/Water Aspirator 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" i
3" Isometric or Riser Diagram
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: -Lav/liar 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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