Permit (45) CITY OF TIGARD PLUMBING PERMIT
71 '> COMMUNITY DEVELOPMENT Permit#: PLM2016 00400
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/01/2016
TIGARD g Parcel: 1 S 136CC00100
Jurisdiction: Tigard
Site address: 8200 SW PFAFFLE ST
Project: Westside Christian High School Subdivision: None Lot: None
Project Description: Replace 260'of storm sewer&(2)catch basins.
Contractor: GREGORY PACIFIC CORP Owner: WESTSIDE CHRISTIAN HIGH SCHOOL I
11650 SW 67TH AVE#130 BY DAVIS, DANIEL A, PRESIDENT
PORTLAND, OR 97223 8200 SW PFAFFLE ST
TIGARD, OR 97223
PHONE: 503-639-3887 PHONE: 503-697-4711
FAX:
FEES
Quantity Description Date Amount
2 ea Catch Basin or Area Drain 08/01/2016 $37.52
Specifics: 260 If Storm Sewer 08/01/2016 $137.58
1 12%State Surcharge- 08/01/2016 $21.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $196.11
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 di questions . *UNC b •. 'ng 503.232.1987 or 1.800.332.2344. /f
I ued By: V� �,
011 / Permittee Signature: C' /�
` 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 :f . .
City of Tigard Received `/ /
Date/By: 7j /�4 Permit No.: L.4}-067/ea OD
1111 111 13125 SW Hall Blvd.,Tigard,OR 9723 i
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.6 r�l& D lO
T I G A N D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov , ,; Notified/Method: Supplemental Information
TYPE'OF lf in
FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description Qty. Ea. l 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
El1-and 2-family dwelling 'a Commercial/industrial SFR(2)bath 437.78
1=1Accessory building 0 Multi-family SFR(3)bath 500.32
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: e�oo S i%) P ACI,L Catch basin or area drain Z 18.76 3 -SA,
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 77 a,✓o4 QR '7)2 2 3
/ Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: W PST7Tu�P CinYIr/iAn 115 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.:240 Page 2 13 7.51
Water service(no.linear ft.:_) Page 2
Subdivision: J Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
WO DESCRIPTION O 7,--'-',' Backwater valve 12.51
E
- ',,. x' x, Clothes washer 25.02
Replace 260 LF c,"( S)4r�I Setve,- / Z ea7/,C4 ,&as`Axs Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
a PROPERTY TOWNER I ❑ 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
Al(r LiCANT 0 CONTACT PE ire, Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet
25.02
Address:
/ ($t) sW767 OitveAsic
/3c, Water heater 37.52
Business name:c.ejd_ fes,�l,c Carp Water i inDWV 56.29
Other: 25.02
City/State/ZIP: p -f-/a / 012. .97 Z Z 3 Subtotal /75./0
Phone:(.5-6)) 793-364 f Fax:( ) Minimum permit fee: $72.50
�a y/6 4-( Plumbing 3g.y pg
Plan review (25%of permit fee)
CCB Lic.: /'/ /7 Lic.no.: /
State surcharge(12%ofpermit fee) /A."
Authorized signature: '� p/
r TOTAL PERMIT FEE /!tP.1,//
Print name: &t in W i se-WI aeh Date:8_/ -/ This permit application expires if a permits not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 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 Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1s`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
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 �' Fee(ea) Total and incadluding
$10,l$100.00. or fraction thereof,to
pand 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 how) 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
0 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
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
-Commercial
al 0 Any multipurpose fire sprinkler system.
Dishwasher:
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 lir Riser Diagram' ;
4"
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/Bar 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:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2