Permit (24) t CITY OF TIGARD PLUMBING PERMIT
I°'1 I COMMUNITY DEVELOPMENT Permit#: PLM2022-00055
Date Issued: 3/3/2022
T!GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1S1356D00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 525
Project: Edge One Media Subdivision: ASHBROOK FARM Lot: 5
Project Description: Interior plumbing for TI:ADDING(1)bread room sink,(2)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
ea Floor Drain/Floor Sink/Hub 03/01/2022 $25.02
Specifics: 1 ea Sink 03/01/2022 $25.02
1 ea Water Heater 03/01/2022 $37.52
Type of Use: COM 1 12%State Surcharge- 03/01/2022 $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.
nn 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: Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. C�
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 ApplicatRECEIVED -2-OQ - lb
Site Utilities q qq7 POR (,I F1(.F, LSI. OyLv
City of Tigard P., ZQLL Receivedor 111
-• 13125 SW Hall Blvd.,Tigard,OR 97�g�y De1eBy: /�� �I 1'' t / �
III Phone: 503.718.2439 Fax: 503.59KI§'6d OF TIGHttV Plan Review � /L 013
��
Inspection Line. 503.639.4175 3UILDING DIVISION' Date Ready/By. �7 t„,„
Date/By. r
11C;A RO In tern et www.tigard-or �_/ r� HI See Pageifor
tNoulicd!klethtkl W/(7 1 ei r'-• Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction j ❑Demolition y, I r apecial information use checklist
Description T Qty. 1 Eu. j Total'13.41,
ddition/alteration repiacemenI ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF-CONSTRUCTION SFR(I)bath 312,70
❑ I-and 2-family dwelling Nrg Commercial industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 5O0.32
---- Each additional bath/kitchen 25.02
❑Master builder 0 Other
F.
-- Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address. Catch basin or area drain 18.76
Drywall,leach line,or trench drain
City/State/ZIP: 18.76
r Footing drain(nu.linear ft.:_) Page 2
Suitelbldg./apt.no.: Project name: C n
5 C >�y.�. � ���0. Manufactured home utilities 50.03
Cross street/directions to job site: V Manholes 18.76
Rain drain connector 18.76
-
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear B.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.:
Fixture or item:
Tax map/parcel no: Backflow preventer 31.27
•
DESCRIPTION OF' WORK. - Backwater valve 12.51
QVIj r� (� (�' y�yyv� Clothes washer 25.02
1(>i- y4r\17`S\-) i- • f act`� 1` � 1 Dishwasher 25.02
r UL V V llt�, I `�.A�I 14
Drinking fountain 25.02
4 � Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: -_-_ _-._-------------_- ----_ - --- Floor drain/floor sinl� I 25.02
--- ------ -- - Garbage disposal 25.02
City/State/ZIP:
---- - -- Hose bib 25.02
Phone.( I 1 I'uc:1 1 lee maker 12.51
APPLICANT CONTACT PERSON Interceptor/grease trap 25.02
Business name: ` (,��'�ry pi,,,,,,, / <„p y1 n� Medical gas(value:$ ) Page 2
lJ:1S V V..1 V t •
g
Contact name: •xn-• �+• ry in///��� ma Primer 12.51
�O B^, t 4� ��"\\ Roof dmin(commercial) 12.51
Address: `.v�
Sink/basin/lavatory 25.02
City/State/ZIP: r�6(4 (j (AA aC//'�'/l Solar units(potable water) 62.54
Phone:r)53cp� gI l Fax:l(( �) �q, Tub/shower/shower pan 12.51
E-mail: CIA_�A 0 u 6katC_n,/t/'(-n t/t/1 my Urinal 25.02
�• CURTOR�� V V { t t Water closet 25.02
V
�.1 - , Water heater 37.52
Business name: /t II
711 `� C� Waterpiping/DWV J OASL
56.29
Address: ) I I Other: 25.02
City/State/ZIP: 111) `�DVV1���CV 1 u)AA 02-6-' 1 Subtotal
Phone:(G{j� Jy L} Fax:( ) Minimum permit fee: S72.50
CCB Lie.: ' 8° Plumbing Lie.no.: 3y_q raNK Plan review (25°ia of permit fee)
11�� State surcharge(12%of permit fee)
Authorized signature: _ A • ,
,L� _ TOTAL PERMIT FEE
Print name: _'a, i favismo rya e, IT This permit application expires If a permit is not obtained within ISO days
-••■l Y. after It has been accepted as complete.
( we
•fcc methodology set by Tri-County Building Indugry Service Hoard.
LBtitdig;Permas,PLMti-Pets nApp.doe 10i01.09 sa0-4616Tt 10,02CUMW[BI
Plumbing Permit Application-- City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Sup t ression Systems:
Site Utilities Qty, Fee(Ca) Total Square Footage: Permit F
Footing drain-I' 100' s0.i1; 0 to 2,000 $121.90
--' 2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52
3,601 to 7,200 $233.20
Sewer-1st 100' 62 54
Sewer-each additional 100' 7,201 and greater $327.54
37.52
Water Service-In 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-Ixt 100' 62.54 SI 00 to$5.000.00 Minimum fee$7250
Storm&Rain Drain-each additional 100' 3752 $5,001.00 to$10.000.00 $72.50 for the first$5,000.00 and$1.52 for
Fer(Ca} Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty
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 90.00rhr each additional S100.00 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 S379.50 for the first S25,000.00 and$1.45 for
hours(minimum charge--2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00thr 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/ -
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Oaptistn:mont 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 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-78(1-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4 Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required fin new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related --- - ----'
-Industrial-food related
Ice Mach./Rerig.Drains
Oil Separator(Gas Station) CoTents regardingfixture work:
Rec.Vehicle Dump Station C n ,.,n A
Shower -Gang J✓��J�[�
-Stall
Sink/lay -Non-food related '
-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:
I:\Building'J'ennits PLMU_PermitApp.doc 2