Permit (162) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00129
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/02/2019
T f c g Parcel: 2S113AB01201
Jurisdiction: Tigard
Site address: 16525 SW 72ND AVE
Project: Routeware Subdivision: None Lot: None
Project Description: Install(1)break room sink,(1)garbage disposal,(1)ice maker and(1)dishwasher for new tenant.
Contractor: ALWAYS FAITHFUL PLUMBING LLC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 757 ATTN: N PIVEN
WILSONVILLE,OR 97070 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-780-9486 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 04/02/2019 $25.02
Specifics: 1 ea Garbage Disposal 04/02/2019 $25.02
1 ea Ice Maker 04/02/2019 $12.51
Type of Use: COM 1 ea Sink 04/02/2019 $25.02
Class of Work: ALT 1 12%State Surcharge- 04/02/2019 $10.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $98.08
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.
Issued By: t Permittee Signature:
(MY-1-C— CA/ �/��'i r�et7 77 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 RECEIVED FOR OFFICE l,SE O\l.l
City of Tigard Received / Permit No --de.)M `/
13125 SW Hall Blvd.,Tigard,OR 97223 PR 1. 2019 Date/By: f No/1
Plan Review
Phone: 503.718.2439 Fax: 503. y 0 Date/By: Other Permit1,. ...52•11/2,20,1-410.41-2.
Inspection Line: 503.639.4175 )t T �� nDate Ready/By: 5,��g Juris: H See Page 2 for
1 1l;AlZD g g BUILDING DIVISION /• / Supplemental Internet: www.ti and-or. ov Notified/Method: Su lemage 2 nformation
TYPE OF WORK g17/9,11._: 2-( FiEE*SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description dwellings(includesI Qty. Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family 100 ft.for each utility connection)
�r CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling (Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
!. JOB SITE INFORMATION AND LOCATION `,.r Site utilities:
Job site address: `�S g, , c )� a N Q Catch basin or area drain 18.76
City/State/ZIP: T k b fv 6 C1-9-c Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: fq_oof 1 Project name: ROS N{� 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.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
s a i 1 Backwater valve 12.51
Clothes washer 25.02
1. IJ5-rF}L1-• lq-1, 'b \/-S' v -A- L Cit. Dishwasher ! 25.02
rA-A4--zr bDk 1 O b,i-i (Z-(s3'kER_ 1- CARS3AG Drinking fountain 25.02
9(VC6A-L--- Ejectors/sump 25.02
1 "' Expansion
tank 12.51
:7"114i';'-%Z'' ....0 PROPERTY OWNER- .'''.1z 'C� � a,• `_ P
e.-.%,Y7::'6°'
:�� rte.. �,
Name: ("ac tr-kc_, a_k Cry Fixture/sewercap 25.02
/ Floor drain/floor sink/hub 25.02
Address: 1
Garbage disposal [ 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker it 12.51
0 APPLICANT 0 CONTACT PERSON 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 I 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: O-t,(��14 S FA 11-1--\ V I 'J ' \/411-1, U
Urinal 25.02
{. �'1M Bi
cos cop\Water closet 25.02
CONTRACTOR '
Water heater 37.52
Business name: 11.1...1,3(k. Scc.,,, Fu.,•+v f ILA.,ev4,6 1n3(� Waterpiping/DWV 56.29
Address: *k710 £jc)(6 74S-1- Other: 25.02
City/State/ZIP: ‘i\ ‘‘,...,661\30 l LL. 00 j' ..4) Subtotal
Phone:(505 )1. q4,,g�..0 Fax:( ) �1 Minimum permit fee: $72.50
CCB Lic.: 01-4 g154, Plumbing Lic.no.: 'ciy Plan review (25%of permit fee)
1State surcharge(12%of permit fee)
Authorized signature: ��� c ° TOTAL PERMIT FEE
Print name: (Deft( Datea� I I This permit application expires if a permit is not obtained within 180 days
CDe. Cr-{,�}(1 I2(1iS( after it has been accepted as complete.
l *Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PennitApp.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-l'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: Permittee: µ..
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 Fres Qtr tee 010 T ;.
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*. an Review for Plumbing. s:ti Ration§
Quapti by Fixture ,y_.
h' Type Plan review is required for any of the following.
Fixture Type for Rice/ Please check all that apply.
Work Performed: Capped Added Relocate. 0 Any new commercialpbuilding with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
hm
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
-Domestic 1 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„
1s4netile Or Wiser�lagram
4
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain q g
Garbage -Domestic non-food ; 4-4,- that meet the qualifications above.
Disposal: -Domestic food related L.1//13.�- ='7"_,
-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 r
-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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16525 SW 72ND AVE, TIGARD, OR, 97224 May 20, 2019 at 11 :45:29 AM
Record Type: Record ID:
Commercial - Plumbing PLM2019-00129
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor