Permit (10) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00217
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/14/2021
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 450
Project: HighKey Subdivision: ASHBROOK FARM Lot: 5
Project Description: Interior plumbing for TI:Adding(1)dishwasher; (1)2"hub drain, and(3)sinks; Installing(1)primer.
Contractor: ST HELENS PLUMBING &CONSTRUCTION INC Owner: KING CAPITAL INVESTMENTS LLC
306 S 14TH ST ATTN KING, THOM
ST HELENS, OR 97051 19250 NE PORTAL WAY
PORTLAND, OR 97230
PHONE: 503-396-3548 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 06/10/2021 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 06/10/2021 $25.02
1 ea Primer 06/10/2021 $12.51
Type of Use: COM 3 ea Sink 06/10/2021 $75.06
Class of Work: ALT 1 12%State Surcharge- 06/10/2021 $16.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $154.12
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:
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 Applicati'RECEIVED /-, -s/aet/ i
-Sitrittilttles FOR OFFICE USE ONLY
Tigard
CI`, Of Z 1gd NAY 4 2021 Received /�/y
Date/By:: "7 ) Permit No.: 4 M. ),., ,.L,�i
13125 SW Hall Blvd.,Tigard,OR 972 Plan Review /'/ obi
Phone: 503.718.2439 Fax: 503.598. k�Y OF TIGARD Date/By: j/Jjf Other Permit No.:(340azgiVAD0
Inspection Line: 503.639.4175 Date Read /B / 1 ® See e 2 for-TIGARD UILQIAiG DIIJI�IOn� y y 7/ .. l
Internet. www.tigard-or.gov �- Notified/Method- �� �� � Supplemental Information
TYPE OF WORK ✓t,Y. FEE* SCHEDULE
1L�Jl�"'v.i
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
[A Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
t?? �1; tja ;,,,r tR t ha t" '' t ., illf SFR(1)bath 312.70
il1kf ti V . c) .1 if Eir4iT 16. _' , . i; ze ,' ifat ik 1 wi
0 1-and 2-family dwelling IK Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site Catch basin or area drain 18.76
address:9600 SW Oak St. Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bIdglapt.SUite 450 Project name: `/-i � `�j� " Manufactured home utilities 50.03
Cross street/directions to job site: J 7J Manholes 18.76
J 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: :'-/q�F/�' ii Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
( ) ,a-,.j k Lj /,,,,-e• 6,11;1 i7,,,, Clothes washer 25.02
A Addinginks, 1 dishwasher 1 hub drain, 1 primer Dishwasher 1 25.02 ;5:0,...
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT ,o, Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub I 25.02 025-.4)
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: St. Helens Plumbingand Construction Medical gas(value:$ ) Page 2
Contact name:
Charlie Hall Primer 1 12.51 �� f
Roof drain(commercial) 12.51
Address: 306 S 14th St.
Sink/basin/lavatory y4V 25.02 ' VL0
City/State/ZIP: St. Helens, OR 97.0551 Solar units(potable water) 62.54
Phone:(503}3963548 ( Fax: :( ) Tub/shower/shower pan 12.51
E-mail_ brooklynsthelens@gmail.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: St. Helen's plumbing and Construction Water piping/DWV 56.29
Address: 306 S 14th St. Other: 25.02
City/State/ZIP:St. Helens, OR 97051 Subtotal /3 7 &)
Phone:5035284231 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie..22911 2 Plumbing Lie.no.:
PB2317 State surcharge(12%of permit fee),/, l(p-�J
Authorized signature: TOTAL PERMIT FE9/5/1 ,i
Print name: Charlie Hall Date:j/2/2021 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) *° S i--O"-i :}vice 0.4 C.
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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 1 ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
3„
Isometric or Riser Diagram
Car Wash Drain Garbage -Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station ✓t jt fli y4 ./Wit C i/. 4/4ii}i 8
Shower -Gang
-Stall
Sink/Lay -Non-food related 3
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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