Permit (33) i� CITY OF TIGARD PLUMBING PERMIT
Hi a., COMMUNITY DEVELOPMENT Permit#: PLM2017-00265
Tt GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/05/2017
Parcel: 2S 110AD08700
Jurisdiction: Tigard
Site address: 10695 SW MURDOCK LN
Project: Pacific Crest Apartments Subdivision: None Lot: None
Project Description: Building D-Directional drill 199'of sanitary sewer lateral for Building D,cap off existing line.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: AUK-REDWOOD PC SPE LLC
267 NE 34TH PLACE 10695 SW MURDOCK ST
HILLSBORO, OR 97124 TIGARD, OR 97224
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
199 If Sanitary Sewer 07/05/2017 $100.06
Specifics: 1 12%State Surcharge- 07/05/2017 $12.01
Plumbing
Type of Use: ME
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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 •-y obtain a copy of thp)rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: I, A s /'/, ��& Permittee Signature: 5010."
�
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 ECEIVL PFOR OFFICE USE ONLY
City of Tigard Received
Date/By: Permit No.: it t- �±/7-66!1 5-
- . 13125 SW Hall Blvd.,Tigard,�1t1197223S 2017 5" �7 .,..2,./ '(d ti J�
Phone: 503.718.2439 Fax: 8.19 0 Plan Review
Date/By: Other Permit No.:
Ti G A R D Inspection Line: 503.639.4175 Q�LL T 1/ Date Read/B
Internet: www.tigard-or.go i� V l' l 111 Ready/By: Jugs: !a See Page 2 for
DIVISION Notified/Method: Supplemental Information
TYP � 11 ` lii FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description 1 Qty. Ea. [ 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
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accesso buildin SFR(3)bath 500.32
rY g ❑Multi-family
0 Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ` 193(p S sk.33 muratk,k c Catch basin or area drain
18.76
City/State/ZIP: ` cNCN r t)(1." Dtywell,leach line,or trench drain 18.76
` �� Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: PA r" 1 f'i e_ t---►Q¢5'i
4p7-..; Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:1C11) ' Page 2 1 '0gji
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.: Backflow preventer 31.27
" 4„ ,,,A e= ION OF "k , ."; Backwater valve
12.51
Clothes washer 25.02
0,Y'�L�,,�Va o\ do,\\ G"N^A,s1 SCt v 4' Si (I Q Vt�� Dishwasher
t 25.02
Co(' b �W-%1�c\ ( C.4.1� O t' S�,t r`3 1\nt ,
ck`J Drinking fountain 25.02
Ejectors/sump 25.02
..sI°' PRO ER; Y R ti TENANT^- Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
,*''.,,,ti- APPLIC' i k w r Ifn CONTAE SO Interceptor/grease; Interc tor/grease trap 25.02
'
Business name: k o d a,( ( '�._(\ cC cc 4 LI.. Medical gas(value:$ ) Page 2
Contact name: V � 1A A _ `f\�Yy I Primer12.51
`)��'L' Zt Roof drain(commercial) 12.51
Address: ��o/ NC ' t4 k\ `
Sink/basin/lavatoty 25.02
City/State/ZIP: a*".\\\�`,�„ O Qt-1 p.(A Solar units(potable water) 62.54
Phone:(Co,) 11\11 ,YG`k3`v _ Fax::_(` 1)_ ` Tub/shower/shower pan 12.51
E-mail: 1 J �� Urinal 25.02
r h o c,�& \a.c,A- e o C,ktwAT_Cocov`� , r,o
� e �'�,,. I�C T'UR e` �' 4 e* Water closet 25.02
� Water heater 37.52
Business name:
vwct___
Water piping/DWV 56.29
Address:
Other: 25.02
City/State/ZIP: Subtotal /eo.c`
Minimum permit fee: $72.50 -
Phone:( ) Fax:( )
CCB Lic.: ,CNC.. \\C: \
Pl � `(,
umb' g Lic.no.: YkCj� Plan review (25%of permit fee)
i�/� State surcharge(12%of permit fee) /AA)/Authorized signature: S/ TOTAL PERMIT FEE
11A.o7
Print name: O,/�w \n n l Qj.. Date: 1\t)\141 This permit application expires if a permit is not obtained within 180 days
`�- 1 V 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-151 100' 50.03 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 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
Qty. Fee(ea) " Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*.
Ina*Rvlew foruPlumbing Ilstallations Al •
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 ❑ 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial ❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" _ =
3" Some rll or $ei�i gra
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
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