Permit (174) CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit#: PLM2018-00367
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/16/2018
T t C3 A t?T� g Parcel: 25101 DA02101
Jurisdiction: Tigard
Site address: 6958 SW VARNS ST
Project: CIC Portland Subdivision: VARNS ACRES Lot: 4
Project Description: Plumbing for tenant improvement: ADD(2)lays,(1)break room sink,(1)service sink and(1)water heater;
RELOCATE(2)lays,(1)break room sink and(2)water closets.
Contractor: JUDSONS INC Owner: AVANOA, LLC
1390 13TH ST SE 4904 S POWER RD STE 102-203
SALEM,OR 97301 MESA,AZ 85212
PHONE: 503-576-0936 PHONE:
FAX: 503-399-8760
FEES
Quantity Description Date Amount
3 ea Sink 07/26/2018 $75.06
Specifics: 4 ea Lavatories 07/26/2018 $100.08
2 ea Water Closet 07/26/2018 $50.04
Type of Use: COM 1 ea Water Heater 07/26/2018 $37.52
Class of Work: ALT 1 12%State Surcharge- 07/26/2018 $31.52
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $294.22
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 0 C by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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 Rz E -e r �' 2 --
Building Fixtures
City of Tigard2eived .
1111 a 13125 SW Hall Blvd..Tigard,OR 97223 (J JULL 01 DatdBy: ; /' Permit No/ � C//dam CJI:
ti Phone: 503.718.2439 Fax: 503.598.I } 8 Plan Review
g b� k `iGAR Date/B : Other Permit No. 1
Inspection Line: 503.639.4175 y �tL 'o /� /��
T t G,Ilt Ci Internetwww it ardor ov R has See Page 2 for
g g fW ,D Date
hod: nl ��
T Supplemental information
�1�1 I S or
,? �.:.:::, -....�e� -..,.gip .,,.
. . ..� C 01. aFt 'Kot Y r 1 to ., rs..,: li
-. ._. ._. . . ,.,: � : ...._... -. _.. � ��/ �..r..... �. "�L-;.ii�k ...r.. C.rp�„��.J.'�ii��1�J5!';�! �;xk`E a1L.
up
❑New construction 0 Demolition For speda!Information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other:
� T _ y 7- New 1-2-family dwellings(includes ft.for each utility connection)
it d nein s 100
. .: .... V'EGORY'OF:ts0)ISTRWIllo) ' r , '+-°� SFR(I)bath ' 312.70
❑ I-and 2-family dwelling ®Commercialfindustrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
❑Multi-family _
❑Master builderEach additional bath/kitchen 25.02
0 Other
.i.:::, ' 1J' a .iIRR o V i u()!R, PD1 o sr 1 o ! •% Site utilities:Fire sprinkler( sq.ft.) Page2
Job site address:6958 SW VARNS ST Catch basin or area drain 18.76
City/State/ZIP:TIGARD,OR 97223 el C s9tog�Nb Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:-___) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site:SW 72ND AV-OFF BEAV-TIGARD HWY 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 II.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
a iE' QT<'�FQl*: :i ". ,_'�= ` ;, :; Backwater valve 12.51
1 ,_ . y,r... '�.• Clothes washer 25.02
ALTER EXISTING PLUMBING ROUGH-INS,INSTALLING REPLACEMENT
L_ey-relilt'e Dishwasher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Ig PR(3P) 0 ;;Y .;i ''...:,_11-,- .7.Ht `_ ':f Expansion tank 12.51
Name:EMMETT PHAIR CONSTRUCTION Fixture/sewer cap 25.02
Address:6305 SW ROSEWOOD ST NE Floor drain/floor sinkfiub 25.02
Garbage disposal 25.02
City/State/ZIP:LAKE OSWEGO,OR 97035 Hose bib 25,02
Phone:(888)831-0566 Fax:( ) Ice maker 12.51
_ , ;. - ,ig car j (i.',PERSO ?` '�: Interceptor/grease trap 25.02
Business name:JUDSON'S INC. s - - ' Medical gas(value:S ) Page 2
Contact name:RICH ACKERMAN,FOREMAN Primer 12.51
Roof drain(commercial) 12.51
Address:PO BOX 12669 Sink/basin/lavatory 7 25.02
City/State/ZIP:SALEM,OR 97309 Solar units(potable water) 62.54
Phone:(503)363-4141 Fax::( ) Tub/shower/shower pan 12.51
E-mail:ttichnjudsons.com Urinal 25.02
? CD C!OR • -- .''; Water closet 2 25.02 Se :0
Business name:JUDSON'S ' --' Water heater 1 37.52 3 a/,_.C.;2._
Water piping/DWV 56.29
Address: PO BOX 12669 Other: 25.02
City/State/ZIP:SALEM,OR 97309 Subtotal 0.6,,,,/, 70
Phone:(503)363-4141 Fax:(503)399-8760 Minimum permit fee: $72.50
CCB Lic.:34604 Plum ing Lic.no.:24-22-PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) :_s)/. _5..0.1--
Authorized signature:
e......-
----.•'"
�� TOTAL PERMIT FEE ry, ..-2
,.2--
Print name:RICH ACKERMAN D '•••r-- 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.
I'Bu,Wmi'Pnmtq'•PLAni-PermitAppdoc 1001,09 IoT 0.o2/CONVWF.a)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
... _
•Si
te T-. tIlt00- ..::•:: .,r`.,:.- '. ..,.'..::.........:.-, ?.-7.,- _.:,.. ..M._..et}e-ap" ',.1Cn.,..d1;.. .. _ ` _ ,ieg'g !_y• _ ifnk" I:.-.Ni ..:...x>:.K
BnxIb-: :•..::
Footing drain-I"100' 50.03 0 to 2.000 S121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 5233.20
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 ,. :. -y.. �x.e..-..� ,;�;•�;,M:, .�,; ,..,... '�:. ,.�,<,:,.:..::��r:.� ,.r ., ,� .:::-r,.,,
�Y}"` 'ti "ik4�rg{1�r �,},�{�'�Q��}�;5�,'fr;I.��i�{,+'�!itr�ti��! .!!!€:,•:�_:: ::�cis,.
ll
Storm&Rain Drain-1st 100' 62.54 S 1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain,each additional 100' 37.52 55.001.00 to 510,000.00 $72.50 for the first$5,000.00 and$1.52 for
t %2t 89 �o, II each additional 100.00 or fraction thereof.
QCIf: ] g9' ': !..._�.: cP". c ��s . .. and including$10,000.00. to
Inspection of existing plumbing or for S10.001.00 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 525,000.00.
Inspections outside of normal business 90.00/hr 525,001.00 to 550,000.00 $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 550.000,00 and SI.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*.
Quitudy by Fixture Type ,� :��. .x ..p
...>._:....__ . g . �. �W � 3
_ ...
Fixture Type for Replace/
.Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
-lacuth/Whirlpool greater.except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive 7'hru 0 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 0 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" _
-4« is i.-..,-r:.'G'���ZMi°:r� :iS•.:.+:rr:T ?.,.r..'R•:�+'�.::: �...��I•._.y'.-.u,��":G�-!�.:::•-,,.-!rG`.:-.._....-:.
Car Wash Drain � _.
Garbage -Domestic-non-food 0 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/Lay -Non-food related 3 3
-Bradley
-Commercial-food related
-Service I
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Water xtrClothes
increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet 2 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\ckurth\Downloads PLMP_PermitApp(1).doc 2
C
Plumbing Permit Applicationicrir �. �. '•.
Building Fixtures roti OFFICE USE ONE
City of Tigard iIJI. ," 7_f11 Z�//� �y,,j Permit ri
01 13125 SW Hall Blvd..Tigard.OR 97223 Y• °�� v20/�dt� Gs
IN . Plan Review G ,
Phone: 503.718.2439 Fax: 503.598.1�6��'" ���� �°���� �) t>urrsy: Other Permit N.�LL�+��J �C16�
Inspection line: 503.639.4175
TIGARD T ate Ready/By: foris ®See Page 2 for
Internet: trww.tigard-or.gov BUILDING DiVIS1(I otified7Nethod: Supplemental Information
...r_ _ _
❑New construction 0 Demolition For spedalInformation use checkllst
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 R.for each utility connection)
' ; : ' ... k CATCORY'AF'G_ kopc[fioN! :.:. ..;... • ,...,..::...,:::.,;!!::!:!:1;.i.,, SFR(1)bath 312.70
❑ I-and 2-family dwelling ®Commercialrndustrial
SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
E
)ac additional bath/kitchen 25.02
taster builder 0 Other: Fire sprinkler( sq.ft.) Page 2
.
•JOE„SITE:tFQ t111A�11,IONi ND L11C tt,ON;:•:;.. :.i Site utilities:
Job site address:6958 SW VARNS ST Catch basin or drain 18.76 i'S\
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD,OR 97223 016 At rie3 Footing drain(no.linear ft.:___) Page 2
Suite/bldg./apt.no.: I Project name. , Manufactured home utilities 50.03
Cross street/directions to job site:SW 72ND AV-OFF BEAV-TICARD IIWY 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.: Backflow preventer 31.27
:, .. : �- �;°.,:•:"� :; ---=-.....--....,.,�•: -- • ;r`,;;=; •:>¢i;``: !:::; y valve
A� Q Backwater12.51
: . :-.;>z._W . . Clothes washer 25.02
ALTER EXISTING PLUMBING ROUGH-INS,INSTALLING REPLACEMENT
r"'''s"s''` Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROP Expansion° .Z��rOWi.Ng1�. :.;.`:. _ .''-'Q.?,USh1�V tank 12.51
Name:EMMETT PIIAIR C_ONSTRUCf1ON Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:6305 SW ROSEWOOD ST NE
Garbage disposal 25.02
City/State/ZIP: LAKE OSWEGO.OR 97035 Hose bib 25.02
Phone:(888)831-0566 Fax:( ) Ice maker 12.51
®.APPLICANT . . . .} l CNma� �PERSON ;:: Interceptor/grease trap 25.02
Business name:JUDSON'S INC Medical gas(value:S ) Page 2
Contact name:RICH ACKERMAN.FOREMAN Primer 12.51
Roof drain(commercial) 12.51
Address:PO BOX 12669 Sink/basin/lavatory 7 25.02 /7S:/7'
City/State/ZIP:SALEM,OR 97309 Solar units(potable water) 62.54
Phone:(503)363-4141 Fax::( ) Tub/shower/shower pan 12.51
E-mail:rich@'udsans.com -- A_scws Urinal 25.02
cm
_ ... • .,..:._..
. .....-,._ .. .�_.�.__. _,_�......�:-----. .... �. . :
...:.
arc closet
� Lif
. •:...:..:.. •iCOVIK .OIC . ..�:. • . .: .. ,:._. ]
Water heater 1 37.52 3 7 s
Business name:JUDSON'S Water piping/DWV 56.29 i
Address: PO BOX 126691
Other: f 25.02
City/Stater/IP:SALEM,OR 97309 Subtotal 407. 7I
Phone:(503)363-4141 ! Fax:(k03)399-8760 Minimum permit fee: S72.50
CCB Lie.:34604 /(//(r,//c7 Plumbing Lic.no.:24-22-PB .78;x') Plan review (25%of permit fee)
l /// / State surcharge(12%of permit fee) 3/..-5,g
Authorized signature: TOTAI.PERMIT FEE 99,a,•
rPrint name:RI('li ACKERMAN Date: This permit application expires ifs permit is not obtained within 180 days
after i1 has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
I'-Binding,.Permits',PLMU•PamilAppdoe 10401.09 440-461bTiln:'UV•COMVWEa)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Ski.Vtiliwp :.: '..-..L1..`:;.:::::':.:_, ::-.1..:::.:.!
...:1.'.!.1: ._.. .r..'.)_.'..:`:: i i .Q. .Y•,' 1! \ y .S.:,ToHRYdf
_: :'.;lrn �.adifi`t � �►�lr yg a+Y��7Y^ti .
i,
Footing drain-I"100'
50.03 0to2,000 $121.90
Footing drain-each additional 100' 37.52 2.001 to 1600 5169.69
3,601 to 7,200 5233.20
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 ��
;�,�, :•.�iu�' :e u-- 'ly:._yl:t,�,;l:FrN:����-.:'�i"::"�:.§^gip .�..rl�,.'!r
Storm&Rain Drain-I st 100' 62.54 S1.00 to 55,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 S5.001.00 to 510,000.00 572.50 for the first$5,000.00 and S1.52 for
U>�her _ �. .. i qty_"' �iR�ie'(ea}`-; Tott11 each additional 5100.00 or fraction thereof,to
Bf3QIli$0� eCB i . and including$10.000.00.
Inspection of existing plumbing or for S10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and S1.54 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 S50.000.00.
Additional plan review for revisions 90.00/hr 550.001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
•
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Queatiy by Fixture Type :ildiS I.. Q _ _, 1 ...$ :':'"' '4!:
Fixture Type for Replace/ Plan review is required for any of the following.
.Work Performed: Capped Added Relocate
Baptistry/Font 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 0 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 0 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 ofthe above.
3"
Car Wash Drain t d s Kc w ...:a. 1 2.
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 MachiRefrig.Drains
Oil Separator(Gas Station) ,omments regarding fixture work:
Rec.Vehicle Dump Station 7i/ /l &i1CZieiN CCteEz It x y-Zr.4C3 f'&-7 . /7.1-77"3
"3
Shower -Gang Erlegr L ; r .
-Solt 3 ,Z.4.4J -CO - f- ' oc -
Sink/t av -Non-food related 9'� 3 3 ICDA 7- - j. / > _ /� H
-Bradley
-Commercial-food related /
-Service I
Swimming Pool Filter *Note: lithe fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet 2 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:tUserstckurth\Downloads\PLMF_PennitApp(I).doc 2