Permit (16) CITY OF TIGARD PLUMBING PERMIT
S. COMMUNITY DEVELOPMENT Permit#: PLM2021-00494
Date Issued: 12/9/2021
TI GA R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 565
Project: Update Managemenet Subdivision: ASHBROOK FARM Lot: 5
Project Description: Interior plumbing for TI: Relocating(1)breakroom sink, (1)hub drain, and(1)water heater.
Contractor: CASCADE PLUMBING SERVICES CO Owner: KING CAPITAL INVESTMENTS LLC
PO BOX 112 ATTN KING, THOM
WOODLAND,WA 98674 19250 NE PORTAL WAY
PORTLAND, OR 97230
PHONE: 503-544-7454 PHONE:
FAX: 503-283-9514
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 12/07/2021 $25.02
Specifics: 1 ea Sink 12/07/2021 $25.02
1 ea Water Heater 12/07/2021 $37.52
Type of Use: COM 1 12%State Surcharge- 12/07/2021 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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: Flo- . Va.v, De,Wege, Permittee Signature: Ow A
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 C•
(���� : pup �0 0O 6
Site Utilities
City of Tigard NOV 1 82021 Received
Date B2: 41/3/�j - I'ennit No.:A 41�y J•-a41-1y
r 13125 SW Hall Blvd.,Tigard,OR 972.3.1, Plan Review / "r 'v GA7
' II Phone: 503.718.2439 Fax: 503.59899W OF TIGARU ^/ - Other Perms No.: P )_ / 5
Inspection Line: so3.639'4175 BUILDING DIVISION I3at�Ry t it /t/ g �iJ
lifi,lKll a dNic y �fjer/ �r S See w e2for
Internet: wow tll!dr(i-OI�,[rt Nonfi�d M tho.l: tiui Irmentnl Info;m:uinn
TYPE OF WORN---__ - -- -�� -eNzA p FEE* SCHEDULE
❑New'construction ❑ Demolition I I or %/with!in/ornurrinn use checklist.
Description I Qty. I Ea. F total
Additionralteration/replacement 0 Other: 1 New 1-2-faintly dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
Q 1-and 2-familydw(Illnti Commercial industrial1 SFR(2)bath _ 437.78
- SFR(3)bath 500.32
❑Accessory building 0 Multi-family -
__-___ Each additionalhath'kitehcn 25.02
❑Master builder 0 Other: Fire.sprinkler( sq.li.) Page 2
,1t i1r 1 *-h'i $l JOO SITE INFORMATION AND LOCATION Site utilities: -
y z s..i'iiro- k�l {t"Tt.�. ,.�n ,/►�).. ,. . .. pia
V�L/
Job site address (3 � Catch basin or area drain 18.76
(� -' Urywell,leach line,or trench drain 18.76
CityiState/ZIP: I �Y d.j CV__ kA` 7 ' Footing drain(no.linear ft.:_1 Page 2 --
Suite/bldg./apt.no.: C- Project name: �r-�� M
��� �P / � Manufactured home utilities 50.03
Cross street/directions to job site: / Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:-__) Paget - -Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear IL:_) Page 2
Subdivision: I.ot no.: Fixture or item: __.
Tax map/parcel no.: - Backilow preventer 31.27 -
' ' ` 61 SdRIPT O.N OF WORK Backwater valve 12.51
Clothes washer 25.02
-
V__A L nn' �V� k- Y '.rS\r)k I Dishwasher 25.02
V \° cx- ,Af' 1 -- -f j ch V ( Drinking fountain 25.02 -�-
E,jcctorsisump 25.02
__._. ❑ PROPERTY OWNER 1 ❑ 'I'F:NAN I' J Expansion tank 12.51
N:une: Fixture/sewer cap 25.02
- Floor drain/floor sink/hub I 25.020�
Address:
_ Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:I 1 Fax:( ) Ice maker 12.51
0 APPLICANT 'gr.CONTACT PERSON Interceptor/grease trap 25.02
Business Hume: 0 ✓!/I �a � ex:), Mrimeredical gas(value.$ 1 l'age 2
l Q P 12.51
jj ,�� 1 {
Contact name: (J ----- --- ------- -
OVf��ry\o.1 Roof drain(commercial) 12.51
Address: \ \a.... J/ Sink/basin/►avatory _ I 25.02
CityiState/ZIP: 4 Solar units(potable water) 62.54
Phone:a3 ) 5.2,c1 _ , , Fax: :( ) Tub/shower/shower pan 12.51
�► Urinal 25.02
I:-mail: �,�, i/r yt
-
t��L.x(X �" l.t �4�0) 1�Y ii�(� '� C ri 'i�tl_ � ��1 �,�
-" - �^�� � Water closet 25.02
CONTRACTOR •,,) I
---�---- r - Water heater 4 37.52 32 y-
Business name. {t .-d ,} -AV, ( O Waterpiping/DWV F 56.29
r Address: .PO ,t')--' lJll�C�� -1F� Other: 25.02 I
City/State/ZIP r r} /L': ' �') 1 �� A! ) Subtotal �
Minimum permit fee: $72.50
Phone:( ,,,3("- 3'R(;. i Fax:(34) 1614 flan review (25°i°of permit fee)
-
C'CB Lie.: t'��/� yU( PI ibin(dLL.ie.no.: ee
State surcharge(I 2°,o of pemtil fee) `13,
Authorized signature: TOTAL PiiRMFI EEI'. iIt O /
This permit application expires if a permit is not obtained with 1 o daps
Print name: ate: I
, after it has been accepted as complete,
*Fee methodology set by Tri-County Building Industry Service Board.
I.'.BuildmeLPcmtxsiPLMU.t' miApp.dot I0u0409 4411-46161110i02((1AI'WI B)
411111.
Plumbint 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: W
Footing drain- I'' 100' 50.03 0 to 2.000 $12I.90
Footing drain-each additional 100' 37.52 2,00 1 to 3,bnn $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 mValuafiit)n' Permit Fee:
Storm&Rain Drain-1st 100' 62.54
$1.00 to 55.000.00 Minimum Ice S72.50
Storm&Rain(hair each additional I on' ;752 $5,001.00 to 510,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Ins ections or Fees • Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
l� 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 $742.t)0 for the first S50,000.00 and$I.20 for
(minimum charge-1/2 hour) each additional$I00.00 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 q
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 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 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain • 0 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.
Isometric or Riser Diagram
Car WashDrain ❑ Isometric or riser diagram is required for new buildings
Garbage -'Domestic-non-food
g � 9
'Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice MachiRefrig,Drains
Oil Separator(Cras Station) C ments regarding fixture work:
Rec.Vehicle Dump Station �C �r c1-4 (�''® `' (3( �i C,i
Shower -Gang "��--��+++�c�L_ " t \Uf
-Stall ' � vv'r
� l_�
Sink/Lav -Non-food related ' r k^ tAy?ak .)r
-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 closer-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: a_
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