Permit (75) iii CITY OF TIGARD PLUMBING PERMIT
P . .- COMMUNITY DEVELOPMENT Permit#: PLM2018 00157
Tigard OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 04/11/2018
T4f�.'Lft.I) 9
Parcel: 2S104AB04700
Jurisdiction: Tigard
Site address: 13401 SW BENISH ST
. Project: Our Redeemer Lutheran Church Subdivision: None Lot: None
Project Description: 1,792 sq.ft.modular classroom. Permit created to assess sanitary sewer SDCs only-all work and inspections
performed under plumbing site utilities permit PLM2018-00147.
Contractor: MODERN BUILDING SYSTEMS INC Owner: OUR REDEEMER LUTHERAN CHURCH
PO BOX 110 13401 SW BENISH ST
AUMSVILLE, OR 97325 TIGARD, OR 97223
PHONE: 503-749-4949 PHONE:
FAX: 503-749-4950
FEES
Quantity Description Date Amount
Specifics:
Type of Use: COM
Class of Work: NEW
Type of Const:
Occupancy Grp:
Stories:
Total $0.00
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.
1
Issued By: Permittee Signature:
Ler-err—
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.
Plumbin. Permit A 1 .lication .....
Buildini Fixtures {,G4 ` ', ` FOR OFFICE. t SE oNL\
-,c'_._ Received ��)
Permit No.: 0 W�
City of Tigard Date/By: /� I,
IA ■ 13125 SW Hall Blvd.,Tigard,OR 97223 }0 I Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 A Other Permit No.:L 5 �(.ca r
Date/By: v 1
Inspection Line: 503.639.4175 to Ready/By: Juris: fa See Page 2 for
T I G A RD Internet: www.tigard-or.gov t, g_.._4.,i`l�l,T'{.� : A%i A tified/Method: '7(, Supplemental Information
,, __.;TYPE OF'WORKttU1 I111 (J, D SIO
FEE* SCHEDULE , " ^„,
0' For special information use checklist.
0 New construction ❑Demolition
Description I Qty. Ea. I Total
re-Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
M. ' ry` CATEGORY' OF CQNSi1tUCTIOiV � ;�
SFR(2)bath 437.78
❑ 1-and 2-family dwelling [vJCommercial/industrial 500.32
SFR(3)bath
❑Accessory building 0 Multi-family Each additional bath/lcitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
- JOB,:SITE INFORMATION AND LOCATION ,,: Site utilities:
. r
to , . S Catch basin or area drain
18.76
Job site address: � ( � S W � � Drywell,leach line,or trench drain 18.76
City/State/ZIP: - ( V7I C}`�-- l-2:7_---3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:6.144,£/ ty\*.- ltv, Manufactured home utilities 50.03
Cross street/directions to job site: (,/44,14,-4,,, Manholes 18.76
>r1 .yam 00;� 00 y\ Rain drain connector 18.76
ii N. ` V r � Sanitary sewer(no.linear ft.:_) Page 2
. : }�� J W YC ( y L T _ Storm sewer(no.linear ft.:_) Page 2
C` �E12,"-h/ •7 -b-6j 2- /Ai(� Water service(no.linear ft.:_) Page 2
z /SS (,L E Lot no.: Fixture r item: 31 27
Subdivision:���L✓ 2., ��,�(..�$�' � �
��� Backflow preventer _
�"'Tax map/parcel no /ep.../f/. "�/1 O ffctSFr e..77c7NS 12.51
. , ackwater valve
> # I0E CR P7"i<O$V or,*0 �l T. 25.02
', '' ''' / ' .; ,�, % ?7 f/V�y Gd/ .7 _"es washer _
N - c7i � 7 1e.3-\ c)i l.,(k--z }-., .,z).--i,<. ` - Dishwasher 25.02
''''C'I Lam\ 1 5 S C�.) -t7).3;1--- --Z> ?(f.., Drinking fountain 25.02
7 r '‘.. r. 5 .. ) fir' i ( r,P.1
Ejectors/sump 25.02
L';. 'R P RTY.OWNER ;4,: { ' ', t] 'l'EiiiAT`T t. Expansion tank 12.51
� � Fixture/sewer cap 25.02
Name: OO -
Floor drain/floor sink/hub 25.02
Address: \->-)t.4 O\.. ,%...4.) r.."6:10-- -A..1/4 c"T- Garbage disposal 25.02
City/State/ZIP: - f per-A--)l -r1:2_3 Hose bib 25.02
Phone:5i,) 31L _-�oLlp Fax ( )
Ice maker 12.51
APPICANT � eCON`1<'A"(T PERSON 4'
Interceptor/grease trap 25.02
�w r Medical gas(value:$ ) Page 2
Business name: s-x13 ` 6q Lit- 47 Primer. 12.51
Contact name: Aj 14 c6 t k.) Roof drain(co�ercial) 12.51
Address: Jg-reP---- 1veD Sink/basin/lavaRGry 4( 14 25.02
City/State/ZIP: t`,,S�AL-- OSZ - -Z23 Solar units(potable water) 62.54
�
1
Phone:( 3) I t ye-v,kek Fax::( ) Tub/shower/shower pan 12.5125.02
Urinal
E-mail: L O�v.) C. f1G7 .715�5 'A Water closet 25.02
CQNTRACTOii ' t t 37.52
" Water heater
Business name: "- Er Water piping/DWV 56.29
Other: 25.02
Address: Subtotal
City/State/ZIP:
Minimum permit fee: $72.50
Phone:( ) Fax:( ) Plan review (25%of permit fee)
CCB Lic.: ./14k4j2j-7 Plumb g Lic.no.: 'ZIA.2ij State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: F\LAO L5 Date: Z L' This permit application expires if a permit is not obtained with n 11 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: Resi tial Fire Suppression Systems:
e'Utilities Nv ' Qty. Feeteai lath Square Fo age:u. ,,Pernik Fec: ,
Foot drain-1 100' ( 50.03 50„(.1 0 to 2,000 $121.90
Footing in-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 00' 62.54 3,601 to 7,200 $233.20
7,201 and greater 7.54
Sewer-each adds' nal 100' 37.52
Water Service-1st 1 0.' 1 6 ;. co.Z��y
T� Me • 1 Gas Systems:
Water Service-each addit`lopal 100' 37.52
V 1uatio
Storm&Rain Drain-1st 100' �2
62.54 C1_ 4 in F
$1.00 to$5,000.01 Minimum fee$72.50
Storm&Rain Drain-each additioil'ay 00> 37.52 $5,001.00 to$10,000.1, $72.50 for the first$5,000.00 and$1.52 for
ether Inspections; r eS� (ea) , Total -ach additional$100.00 or fraction thereof,to
an; including$10,000.00.
Inspection of existing plumbing or for \ $10,001.00 to$25,000.00 $148. 1 for the first$10,000.00 and$1.54 for
which no fee is speci y indicated �� 90.00/hr
ado,'charge /2 hour) each ad� ',nal$100.00 or fraction thereof,to
Inspections o ide of normal business and includin_ 5,000.00.
00/hr $25,001.00 to$50,000.00 $379.50 for the i $25,000.00 and$1.45 for
hours(minimum charge 2 hours) `' each additional$100.11 o..fraction thereof,to
Reinspection Fees 90.00/hrs, and including$50,000.0,
Additional plan review for revisions 90.00/hr `,,, $50,001.00 and up $742.00 for the first$50,001.!1 and$1.20 for
(minimum charge 1/2 hour) �� each additional$100.00 or fract.s.thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
�b
accurately report fixtures could result in increased sewer fees*. v.Plan Review for PlumbingJnstallations ;
Quantity by Fixture Type
Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that a 1
Work Performed: , Capped Added Relocate pP Y•
Baptistry/For 0 Any new commercial building with water service 2"and
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
-Drive Thiu as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 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"
- ="Isometric or l serbiagr m
4
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain g q
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)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related '4 eZ) 4-4 C/
-C/S C 2-) 1+.11- lit;f} -t't. -S'1 iVI KS
-Bradley S i 1� la..: [/t.Oeor-C S
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractorfees assessed for the sewer increase must be paid before the
Water Closet-Toilet .Z, plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doe 08/04/2011 2