Permit CITY OF TIGARD PLUMBING PERMIT
ri COMMUNITY DEVELOPMENT Permit#: PLM2017-00540
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/28/2017
Parcel: 2S102AB02300
Jurisdiction: Tigard
Site address: 12519 SW MAIN ST
Project: Tigard Cleaners Subdivision:ELECTRIC ADDITION TO TIGARDVILLE Lot: 15
Project Description: 40 ft.of water service.
Contractor: PIPELINE PLUMBING Owner: MAYBERRY, DARBIE A
333 S STATE ST SUITE V-108 DIGMAN, CAROL J
LAKE OSWEGO, OR 97034 7603 SW LOCUST ST
TIGARD, OR 97223
PHONE: 503-624-1906 PHONE:
FAX: 503-624-1926
FEES
Quantity Description Date Amount
40 If Water Service 12/28/2017 $62.54
Specifics: 1 12%State Surcharge- 12/28/2017 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 12/28/2017 $9.96
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
11)
Issued By: /0, Permittee Signature:
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
Site Utilities FOR OFFICE CSE O\L1
City of TigardRec Permit No.
114
■ 13125 SW Hall Blvd.,Tigard,OR 97223 1 ' 144,9_,3:
f?. t � apH � `j
3 t w
Phone: 503.718.2439 Fax: 503.598.1960 ,, d �� Date/By: Other Permit No0L4k13 7
T I G A R D Inspection Line: 503.639.4175 Date Read B Juris- ® See Page 2 for
Ready/By:
Internet: www.tigard-or.govfeed Method' Supplemental Information
TYPE OF WORK [] A, �L FEE* SCHEDULE
❑New construction ❑Demolition g i Ia `e''.--,-.74 g For special information use checklist.
' ,.)I!t _ . Description Qty. 1 Ea. Total
®Addition/alteration/replacement ❑Other: a ° ' z` yl�k
I`t1l,t ° TAN z s ew 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTIOl l� I. SFR(I)bath 312.70
❑ 1-and 2-family dwellin SFR(2)bath 437.78
g ®Commercial/industrial
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:12519 SW MAIN STREET Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: 77etevi (L.e_v'p.c ..i Manufactured home utilities 50.03
Cross street/directions to job site: J 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.: ) 1 Page 2 62.54
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
INSTALL NEW WATER SERVICE
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:TIGARD CLEANERS Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:12519 SW MAIN STREET
Garbage disposal 25.02
City/State/ZIP:TIGARD OR 97223 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
E APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:PIPELINE PLUMBING Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:SAMANTHA HILL
Roof drain(commercial) 12.51
Address:333 S STATE ST V-108 Sink/basin/lavatory 25.02
City/State/ZIP:LAKE OSWEGO OR 97034 Solar units(potable water) 62.54
Phone:(503)624-1906 Fax::(503)624-1926 Tub/shower/shower pan 12.51
E-mail:SAM@PIPELINEPLITMBING.NET Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:PIPELINE PLITMBING Water piping/DWV 56.29
Address:333 S STATE ST V-108 Other: 25.02
City/State/ZIP:LAKE OSWEGO OR 97034 Subtotal 62.54
Phone:(503)624-1906 Fax:(503)624-1926 Minimum permit fee: $72.50 72.50
Plan review (25%of permit fee)
CCB Lic.:158260 Plumbing Lic.no.:3-510PB
State surcharge(12%of permit fee) 8.70
Authorized signature: I TOTAL PERMIT FEE 81.20
Print name:SAMANT A ILL Date:12-28-2017 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:ABuilding\Permits\PLMO-PermitApp.doe 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
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 (c2,St} 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) Total each additional$100.00 or fraction thereof,to
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
(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' Plan review is required for anyof the following.
Work Performed: Capped Added Relocate q
Baptistry/Font 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 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ 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.
-3"
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -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:
C:\Users\Pipeline Plumbing\AppData\Local\Packages\Microsoft.MicrosoiEdge_8wekyb3d8bbwe\TempState\Downloads\PLMU PermitApp.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12519 SW MAIN ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00540
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Water service ok to cover.
2. Note: verify proper grounding of electrical system as per section 604.8 of OPSC.
Violation Summary:
Inspector Contractor