Permit CITY OF TIGARD PLUMBING PERMIT
� COMMUNITY DEVELOPMENT Permit#: PLM2019-00189
T- [) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2019
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Project: Clean Water Services Subdivision: None Lot: None
Project Description: Site utilities for TPS building landscape and irrigation improvements.
Contractor: OWNER Owner: CLEAN WATER SERVICES
CLEAN WATER SERVICES 2550 SW HILLSBORO HWY
16060 SW 85TH AVE HILLSBORO, OR 97123
TIGARD, OR 97224
PHONE: 503-547-8152 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 05/16/2019 $18.76
Specifics: 1 If Storm Sewer 05/16/2019 $62.54
1 Plan Review 05/16/2019 $20.33
Type of Use: COM 1 12%State Surcharge- 05/16/2019 $9.76
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $111.39
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 50 .232.1987 or 1.800.332.2344.
Issued By: / Permittee Signature:
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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.
Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLY
- City of Tigard etved
111 ii g Permit No.:
13125 S W Hall Blvd.,Tigard,OR 97223 E C E'V By: � � i g[ �
Phone: 503.718.2439 Fax: 503.598.1960 an Review
Date/By: f l 474 Other Permit No.:
TIGARD Inspection Line: 503 639.4175 APR 2 9 2019 Date Read B
Internet www.tigard-or.gov y y 7uris ® See Page 2 for
Notified/Method: 4151/II r 1, Supplemental Information
TYPE OF WORK t'�OF T1.`' ,
E*, STD�iL `` `'
0 New construction 0 Demolition For special information use checklist
Description Qty. I Ea. Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
1:1 Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:16060 SW 85th Ave Catch basin or area drain 1 18.76 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:TPS Bldg Landscape&Irr
Manufactured home utilities 50.03
Cross street/directions to job site: Improvements Manholes 18.76
Durham Rd and SW 85th Ave Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:55) I Page 2 62.54
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Demolition of existing concrete sidewalk,construction of a new rain garden, Clothes washer 25.02
Dishwasher 25.02
installation of new storm drain piping,landscaping,and irrigation piping.
Drinking fountain 25.02
Ejectors/sump 25.02
` ® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Clean Water Services Fixture/sewer cap 25.02
Address: 16060 SW 85th Ave Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224
Hose bib 25.02
Phone:(503)547-8043 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Clean Water Services Medical gas(value:$ ) Page 2
Contact name:Michael Idehara Primer 12.51
Roof drain(commercial) 12.51
Address:16060 SW 85th Ave
Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97224 Solar units(potable water) 62.54
Phone:(503)547-8152 Fax::( ) Tub/shower/shower pan 12.51
E-mail:ideharam@cleanwaterservices.org Urinal 25.02
CONTRACTOR' Water closet 25.02
Water heater 37.52
Business name:By Owner-Clean Water Services
Water piping/DWV 56.29
Address:2550 SW Hillsboro Hwy Other: 25.02
City/State/ZIP:97123 Subtotal 81.38
Phone:(503)681-3600 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) 20.33
CCB Lic.: Plumbing Lic.no.:
Authorized signature: __
State surcharge(12%of permit fee) 9.76
/` t-
c TOTAL PERMIT FEE 111.3
This permit application expires if a permit is not obtained within 180 days
Print name: � V����ff/gt=C �f y�Cl Date: /c; after it has been accepted as complate. 11/.37
*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)