Permit (202) 71 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
Permit#: PLM2019-00211
1 WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/21/2019
ilvomParcel: 2S 101 AD02400
wirsio v%1- J- Jurisdiction: Tigard
Site address: 12753 SW 68TH AVE
Project: George Fox University Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Interior plumbing for TI:Adding(1)sink and(1)water closet.7/15/19: REPRINTED permit to include(1)
ejectors/sump and (1)sink.
Contractor: K&C PLUMBING INC Owner: GEORGE FOX UNIVERSITY
PO BOX 2124 ATTN: FINANCIAL AFFAIRS
OREGON CITY, OR 97045 414 N MERIDIAN
NEWBERG, OR 97132
PHONE: 503-518-0234 PHONE:
FAX: 503-518-1100
FEES
Quantity Description Date Amount
1 ea Ejectors/Sump 07/16/2019 $25.02
Specifics: 2 ea Sink 07/16/2019 $50.04
1 ea Water Closet 05/17/2019 $25.02
Type of Use: COM 1 12%State Surcharge- 07/16/2019 $12.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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: < 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
Building Fixtures 3.3'..133.3,0,8.,44
t:*". '-' FOR I/1410E USE
City of.r igtird •-kr ..,„,
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/
_47,— . Perrot Nt, ..2ei
* i 3.1275 SW 11411 Bird„Tigard,Oti. 94S..2.3 ., - ,
! .3 pttoit,-,,,- 1113,7 11.2339 I-UV 1iO3 591i 19f111 \.)\--'
IIINI ,i-rt Plan itr*-11r1.
.'''INii"\-`-*--:lLjdittiv i itlier Pc7bil No _ ,
4...ig Iit....-.1400 '' —.AI 0
AD i 1_, itt:NNiliOn I itte; .1)3 nisi 4371 f,,,,c.... .,'.1-.,,,,.A...;,..,,,-",,,,,,,,-,151,,,.Re,4:44-4-,),
11 t;'s't'' IllieMet. ki,Piv ittiariSiii gill, - i 1-. . \11' s•-tirissiveil9;3 t„,a-t RI See Pate 2 tot
_ siiiiiiiiiinienta intitentatilie
TYPE OF Ili '''. FEE* S4111Etit1LE
Fn special infarrtaation use checklist, .>
0 NRP ivitstruction 0 tAidnitittion
idescri tinit '; Iite 1,4 total
„
It:0 AddiltORallertition repaccn-44:01 0 i)tiwr• • •• . A N V Vir I-lila:nil;iiviellin'IN 1111411113311.'S 100 it tor c,ich utiltis conneetiont
cATEE.,,(4148, OE („0,4,,,s,,inues,,,,i(,)8 ligviir, . mfmraircs, impl.__ st.„R t 1,..)btith fill!
,.., 141•14 i 21 Kith allillEill=
u 1r and 2-itinii0; disk(tiling Nr:41419irtRZci 11111ff
1 , ,
si,R(3)b,,tb
- ,
0 rti141;dit4,24-1 bi.11Willt: '1-'4 ''11.11-14111t':‘• 1*itch additional nitintAnciail 2502
0 Masai build0 Olno/, ' 1 •1,,i , it) ts4se-, 1MB
JOB SITE INEOIENIATION AND LOCATION Site utilities:
Joh 1 2-7 5
ein*It basin or titel drain 1 iti 7ti i
I sii4:iikidecs -,? S(....) 6 a
.,..,„C11,1444441013 line,or trench drain MI I)1.7o
,
t/tis State'ZIP, „ , eec ..,-,,,, lz g z 22,a _. It3ititig diain(Ito 11113;tar ti.: 4 toage 2
„ .
— ,
Suite-bldgno. 'ruteei name: ieh,„,--le f.,-),t 1i,A,,d,preyed-, 1,,,,, siatti-3eiiired bona;utilities — 10,03
-
Ciotti streettdirections to jtili site' Manhole; 1S 70
„
itain drain connector 18„70
, -- --1
Sanitary;ewer no.lisistar It:, ; Page 2
.... storm censer(no linear it',- ; Page 2
_
.....
Net iRR i no l
inear it.._I Pe 2 .
Subdt;ision Lot no.. • fixture or
— - * —
Fax map/pace)no _ Itackilow pnventcrI 11.27
i — ilackst mei valve
DESCRIFIION OF WORK . _ 12.51
I •-• r- / Ckithes
her
1 125:02 77.5-.0,
., .25.02
*
1
0 0, 7,... G v ttA P mtr'v Lou ''' 'in t
, 1,1isheia‘iter -3. 2
Z0 I - — ,40, Print ing fe;uritiiiii 25,02
Ejectors stimr;
0 PROPERI'A' OWNER 0 TENANT Fspansion tank ' 12 31
, -
1.1xtuteet4er cap 25,02
IltlOt iitifittliPer)« tv hub 25,02
, Address:
25,02
t'ity•Statc i,W 11ko,e bib 25 01
Phoite,i F'ax.1 ) Ice niter 12,51
0 ,APPLICANT 0 ,, ,,‘ A , * ic2i$1.04- iasepti,i-gicase tiap 25 02
,
Sled#Cal Ra,4)..tttle.S ) Page*2
Business novae' s
,— I
12 51
((; ii tiarriti ,
17 51
Addre3s Sink itatin-ItivainK 21(i2 ;457,42.
----
C'tt„s-St-tic/IP SOI/tr tiiiiiS(pt./1;31'4c\satin, 1 62,53
' ----*** i riititt1:5122
I'-ittail- *
Water closvi 25,02
CONTRACTOR -'
_ .
________ — ;Eater iteaci 37.52
lncs;name- 4).0. P1 I;;;) C ..,. Water piping 1-)1A V 4 .56,20
„.„
A414.1Tc4..s / ,0 .4 .9 it.i ..e c.,14.4,141.3 ' raillIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMMIIIII
—
, ,,,,,,...4„ _ .,....-4
4
C4t, Slate_IIP?)• *.40, .el A b.,-;„ -/ 0 i _ Suissotal o• 0
—
Platoa,ts-c))) 7 8 — 2 vya Fas( 1 IL‘./.1,4 ...,,,Iimullttal ptrrnit e4v: $72.54) 72,5-0
--
- Plan ieviest (25.16 :Si
mit feel
ce13 in:.:i(ip&4,1,f ,
--1---
1 Plumbing L .no., f_13,, 6.- t -
State isincharge(121';isf per:nit Ice;
AilibiiIrieil A igl) 6101,71111PIP*”" 101 Al.PERMIT FEE' 41./_.o 1
, . Ibis perinii siiplitation expires ire permit is piii obiairisiti*iiIii*I$O sitir+s
iltini mime' t<.t/t..S'S (.„,t I). 1)41C:7—?---/I after it has beim accepted*$complete.
'fee methadniery-;e1 by lintateits Buildinc Illy Soviet Dodd,
1 leen:bre Perstill X1I-Perrs:Arr ex Is iq 0 44' 1'
Plumbing Permit Application - City of Tigard
..,
• Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems: •
Site Utilities Qt, Fee(-tt Total i
-eh dd
routing drain-r 10C*
rooing dram acaitional 100'
37,52 -
Scott.
It 100' 50.03
62,54 Square Footage: Permit Fee:
0 to,2„1100
2 out m 3 tort
3nt t
'
... .loo 7`,200
7 201 and crater 8i21 on
t
$169.69
522o
S.417.54 „
sewer,4.301 AddItianal I OW .r)'32
\N'ater Set%ice.1st 101Y 62 54 Medical Gas Systems:
,..v41,1 ss..1-,h;c.each additiannt
IOU $7,52
Valuation. I Permit Fee:
storm&Ram I trata. Isi I Ole 62,54
1,00 to S5„.014 00 Mosmitost too S72$t)
Swint& Rain Drain-ciu,It additional 16,0 37 132 $$,4101,00 10$10,000,00 *7.2 50 for the fihr S5,00rt 00 and SI 52 for
T ette
Other Ins i eetions or Fees QtY.. rte(ea) , 1
I eAeb.shtmn„Is)00 00 or fraction thereof to
.,ind ineladow Si),00,tat
itro$poctioo ol cmstrte oloinhingor tot '
510 001(10 10$2500000 ' $148, t1 for the first$10.0a0.00 and S4 for
ks filch no fee is specitical4a inkhcated 1111 no oilhr
" eaett additional S100 00 or fraction thereof,to
*intim:nom costae 7 14 how) and including 823.0110.00.
.
ItINPtIS tEithidC Or normal hrivines. 90.ou.nt S25,001 0010$,..70,000 330 $370 50 tor the Wit S.254100 00 and S 45 tor
hours 4tionattont charne-2 hour.t each ad1olort415100 00 or fraction thereof to
Rein yeetion 1-.N.,‘ 90 00,to and metadine S50.001100,
90 inni550,001anS7
.00 d up 42 00 tor the furA$5(1.040 00 and St 20 Cm
Additional plan rek teks for revisions r
, i minimum eharge-V2 nano I . 1 each a‘tditiortnt iloubn or fraction therm'
---
Suhrotat:
... '
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:
Work Performed: Capped Added Relocate Pk irt re'ieo is required for an or the Cliouins.
Please check ail that apply,
Rapti qr.,ront
Rath -Tut,Shower0 Any neer commercial building viith outer seri,ice 2-and
-factail,Whirtpoot greater.vskvirt systvms designed and stamped hy !fecund
- CiVo'iriccr,
Cat 4.‘ash -Each Stall 0
.Dri4e chru 0 Nco exterior plumbing site utilities lot an." compl‘.8 suOtittile
C usgulor Water Af,pauto: as defined in 0AR9 I 8-780=0040.
.Dishoosher -Commerctal 1:3 Medical gas and vactio systems for health care facilities,
-flonicslic 0 An4 multipurpose tire sprinkler s!..stem.
thinking I ountani0 Ans comples strueture as defined in OAR9 IS-780-0040,
ray_Wash -
Floinl7ram'sink Submit 2 sets of plans ssdh ani of the above.
- ' isometric or Riser Diagram
I.at Wash DidiU
-1 iacsos-oan.i,s.d.
0 Isometric or riser diagram 6 required for new buildings
il,siimge so
i)i,p,A41 .1$000;,Ntik,-114.4 icLud that meet the qualifications abOVC.
-corornereial food rented ''''' , •.,
- -41niumilli-ttiotti'retated '' 4- .:.• - -- -------- - -'
lee Mach-Reim'thams
,...
On set...drat:0 (...14-.Station t Comments regarding fixture work:
kee.Vehicle-1)=p station
S Ito%%et .4 Lang, .,
-Stall ...
Stahl as -Non-food related .
..
-titadle;
-Commercial-food 0.1.31z4
-Sees lee
5,$)unnun4 Pool 11114,1 , *Note: If the fixture work under this permit results in an
Washer-Clothes
Fstraetor increase of sewer Entls,a sewer permit will be issued and
wuci „.„
at.titer Chisel- relief fees assessed for the sewer increase must be paid before the
rural plumbing permit can he issued.
.---
timr I ismies.
,
I
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CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2019-00211
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/21/2019
ftR Parcel: 2S101AD02400
Jurisdiction: Tigard
Site address: 12753 SW 68TH AVE
Project: George Fox University Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Interior plumbing for TI:Adding(1)sink and(1)water closet.
Contractor: K&C PLUMBING INC Owner: GEORGE FOX UNIVERSITY
PO BOX 2124 ATTN: FINANCIAL AFFAIRS
OREGON CITY, OR 97045 414 N MERIDIAN
NEWBERG, OR 97132
PHONE: 503-518-0234 PHONE:
FAX: 503-518-1100
FEES
Quantity Description Date Amount
1 ea Sink 05/17/2019 $25.02
Specifics: 1 ea Water Closet 05/17/2019 $25.02
1 12%State Surcharge- 05/17/2019 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 05/17/2019 $22.46
Plumbing
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.
Issued By: Permittee Signature:
��yC� �.r:nr✓ .e •
/ -
>
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shalt,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 AnnIRECI E1VED _, ,ea )
Building Fixtures u()It. ()IFicr. u SI. ()N1,1
MAY 1 3 2019
City of Tigard Received
Date/By: °: /i./Vi,PO_Letf -6,t)
1 , 4 13125 SW Hall Blvd.,Tigard,GITY7E;F TIGARD Plait Rm.iew Ni'zti4
' II Phone: 503.718.2439 Fa
_ iit
By lefifilt6b1VISION Datear , other Permit No../3t1/9,-;24)/eisat)47Y
Inspection 1,inc: 503.639A ... Date Readyilly: Suits Fa See Page 2 for
1 it,Attsti
Internet: w‘vsv.tigard-or.gov Notifiedilviethed: ici.....(,_ Supplemental Information
1 TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description 1 Qt . I Fa. I Total
kf A d d i t i o n i a 1 t c ra t i o t ii re p I ac e in e n t 0 Other: New 1-2-family dwellings(includes 100 IA.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ID 1-and 2-family dwelling biCommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
.Each additional bath/khchcn 25.02
0 Master builder 0 Other: Fire sprinkler( sq.IL) Page 2
JOB SITE INFORMATION AND LOCATION . Site utilities:
Catch basin or area drain 18.76
Job site address. I e2 7 6 .• s'LA? 6.,,e -t:1, c--).-
Drywell.leach line,or trench drain 18.76
City/State/ZIP: -7-1 1 a_.‘,....el 0 r..._. 97 3 i Footing drain(no.linear ft.:___,) Page 2
t
Suite/bldg./apt.no.: V I Project name: eteelc ,,,c. w,() e' :17.1..- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear 11.: ) Page 2
Storm sewer tio.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Back/low preventer 31.27
Tax map/parcel no.: („2,.s-i j i,4_00d...14G0
- 1 - Backwater 8 alve 12.51
DESCRIPTION OF WORK ' '
Clothes washer 25.02
1 nc.4--ix...tg ine,c..t, -t-e3114e i W440 Dishwasher 25.02
I Drinking fountain 25.02
Ejectors/sump 25.02
Q PROPERTY OWNER El TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/StatelZIP: Hose bib 25.02
Phone:( ) Fax:( 1 lee maker 12,51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name:
Roof drain(commercial i 12.51
Address: Sink/basin/lavator) i 25.02 25..o.Z
Cil,v/StatC/Z1P: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet / ,. 25.02
CONTIZACTOR heater
P Water e 37.52
Business name: 1)e ,,,,,,,t,,,A 4 .....11___ ,, c Water piping/DWV 56.29
Address: I , 5 g-o- - t.-- ., , Other: 25.02
City/State/ZIP:Or, tv.i i; fi 1..
/ p• dir .0 ti subtot.i 60,e if
t-i
Phone:$73 I ..2 ) __2,4 z..... Fax:( ) it-'1,,,A. ____, Minimum permit fee: $72.50 72,s-e5
Plan review (25%of permit fee)
CCB l.ie.: /(,k e,„ fr 1,)1711 1 Plumbing I.ic.no.: i',"5
State surcharge(12%of permit fee) 13, 10
Authorized signatu,_ ' -aro' TOTAL PERMIT FEE 51,00
Print name'. t,t,..s-C i‘it Date:5--.7-1 f This permit application expires if a permit is not obtained within 1110 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
1.14eiiiiiiitPeret-t -Poir.i.4.pg 4''..11141200 440-44161(168021C01881W40!
Plumbine Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities (t3r- Fee tee) Total ' 'sivAtejootage: -Permit Fee:
Footing drain-1'100' 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 5233.20
Sewer-tat IOU' 62.54 7.201 and greater 5327.54
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 510.000.00 $72.50 for the first$5.000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
Other Inspections or Fees QtY. Fee(ea) Total
, , and including$10,000 00.
Inspection of'existing plumbing or for $10,001.00 to$25.000.00 $145.50 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 90.00ihr 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*.
Quantiy by Fixture Type Plan Review for Plumbing Installations
Fixture Type for RePlavd Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Please check all that apply.
Baptistry/Font . 0 Any new commercial building with water service 2"and
Bath -Tub/Shower
-Jacuzzi/Whirlpool greater. sy
except stems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities tbr 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.
- -11: Isometric-or Riser Diagram - ...
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/La -Non-food related i
-Bradley
-Commercial-fond related
-Service i
,..
Swimming Pool Filter .
*Note: If the 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 i . fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
Macintosh IID:Users:blkemb2:Downloads:PI.MF_PermitApp.doe 2