Permit (13) CITY OF TIGARD PLUMBING PERMIT
• - COMMUNITY DEVELOPMENT Permit#: PLM2022-00097
Date issued: 4/4/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S126CC00200
Jurisdiction: Tigard
Site address: 10065 SW CASCADE AVE
Project: Tesla Subdivision: None Lot: None
Project Description: Landlord interior plumbing work prior to TI: Replacing(4)sinks,(5)water closets,(2)urinals,and(1)water
heater.
Contractor: R A WARNER PLUMBING Owner: 10065 SWC LLC
PO BOX 820785 BY ALSTON& BIRD LLP
VANCOUVER,WA 98682 BANK OF AMERICA PLAZA
101 SOUTH TRYON ST STE 4000
CHARLOTTE, NC 28280
PHONE: 360-772-2490 PHONE:
FAX: 360-263-5354
FEES
Quantity Description Date Amount
4 ea Sink 03/21/2022 $100.08
Specifics: 2 ea Urinal 03/21/2022 $50.04
5 ea Water Closet 03/21/2022 $125.10
Type of Use: COM 1 ea Water Heater 03/21/2022 $37.52
Class of Work: ALT 1 12%State Surcharge- 03/21/2022 $37.53
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $350.27
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
�-- .--y_
Issued By: - Permittee Signature: Q%\7- -L"'
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 Applicatin
ECEIVEEl
Building Fixtures MAR 8 2022 FOR OFFICE USE ONLY'
Received
. City of Tigard CITY OF 1 IGARU DateBy: 3/
/ rW 4? - PermitNo.: tivi . j't9 7
a 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review / r./ ` OZ;d7� V
Phone: 503.718.2439 Fax: 503.59i 4DING DIVISION DateBBy: N other Permit No.:e!-Dys?.. 5
T I G A R D- Inspection Line: 503.639.4175 Date Ready/By: J orris 65 See Page
2 for
Internet: www.tigard-or.gov Notified/Method: 3O/Li S"/try- r - -net, Supplements l Inform a tin n
TYPE OF WORK Fit,---,1-4 N" FEE* SCHEDULE
❑New construction I ❑Demolition For special information use checklist
Description I Qty. I Ea. Total
I 1 Additiordalteration/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 ®Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingMulti-family SFR(3)bath 500.32
0
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: 10065 SW Cascade Ave.
City/State/ZIP: Tigard,OR 97223 Drywall,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Tesla-LL Work 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflowpreventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Plumbing scope for landlord work prior to tenant improvement. Dishwasher 25.02
Reference building permit#BUP2022-00005 Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNERlir
I ti TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
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
Dit APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: RA Warner Plumbing Co. Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Jerime Maloney Roof drain(commercial) 12.51
Address: PO Box 493 Sink/basin/lavatory 4 25.02 100.08
City/State/ZIP:Camas,WA 98607 Solar units(potable water) 62.54
Phone:(360 ) 772-2490 Fax: :( 360)210-4739 Tub/shower/shower pan 12.51
E-mail: rawamerplumbing@gmail.com Urinal 2 25.02 50.04
�•_. Water closet 5 25.02 125.10
CONTRACTOR
Water heater 1 37.52 37.52
Business name: RA Warner Plumbing Co. Water piping/DWV 56.29
Address: PO Box 493 Other: 25.02
City/State/ZIP:Camas,WA 98607 Subtotal 312.74
Phone:( 360)772-2490 Fax:(360 )210-4739 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 151329 Plumbing Lic.no.: 37-521PB State surcharge(12%of permit fee) 37.53
Rhonda Boehm KK -.°- -..Authorized signature: ..,I os w""" TOTAL PERMIT FEE
$350.27
Print name:Rhonda Boehm Date:3/8/2022 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.
1:113addinglPermils1PLM11-PermilApp.dos 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Defies Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-I"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 3,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-let 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) Todd each additional$100.00 or fraction thereof,to
Pectl 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 S25,001.00 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 Replan/ 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: -Faeh Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator CIMedical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ 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"
3" Isometric or Riser Diagram
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station) Installing fixtures on existing rough
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related 4
-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 5 plumbing permit can be issued.
Urinal 2
Other Fixtures: 1
1:\BuildinglPermits\PLMF_PermitApp.doc 08/04/2011 2