Permit (57) CITY OF TIGARD PLUMBING PERMIT
F1 COMMUNITY DEVELOPMENT Permit#: PLM2019-00313
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2019
(G4,‘, O 9 Parcel: 1 S 134AA02100
Jurisdiction: Tigard
Site address: 10300 SW NIMBUS AVE PB
Project: Saibri Cooper Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: 3
Project Description: Add(1)lay and(1)dishwasher;reinstall(1)existing breakroom sink.
Contractor: WESTERN PLUMBING Owner: DIETRICH, NANCY BISHOP
9460 SW TIGARD AVE SUITE 101 ROBINSON, JERRY CHRISTOPHER TRUST
TIGARD, OR 97223 ROBINSON, LYNN ET AL
9701 SE MCLOUGHLIN BLVD
MILWAUKIE,OR 97222
PHONE: 503-245-7100
503-639-5296
FAX: 503-684-9015
FEES
Quantity Description Date Amount
1 ea Dishwasher 08/05/2019 $25.02
Specifics: 1 ea Sink 08/05/2019 $25.02
1 ea Lavatories 08/05/2019 $25.02
Type of Use: COM 1 12%State Surcharge- 08/05/2019 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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: j 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 Applicata , , .0
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Building Fixtures , 1,(< "II 1' 1 1 "" ,
City of'['igstrd12O!u oat CFAC if 4 v PermitNett/.2C/4-do3/3
• 13125 SW Hall Bivd..Tigard OR 9722 Plan Review k ,/5
Phone: 503.718.2439 Fax 503.1%1,9r a Bine/By Other Permit ] -,00.2y17
Inspection Line: 503.639.4175 1 ° Date Ready/By: f ," ,) :oris St See Page 2 for
Intern �... ,... I
� www,tigardax.gpv ���,)I�.�P,4;- ,a t` �'' ' `"'s NaifiadliMeKhod: /`r/ Supplemental Information
Demolition Far special information use checklist
0 New construction Description. i Qty. I Ea. I Total
IV Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
iCATEGORY OFSFRO:401 '\' SFR(i)bath 312.70
I 0 1-and 2-family dwelling SFR(2)bath 437.78
Commercial/industrial 500.3237
SFR(3)bath
0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other Fire sprinkler( sq.ft.) Page 2
JOS SITE%i�fRM1!TI N�4kIU LOCATIONSite utilities:
Catch basin or area drain 18.76 I
Job site address: W` '`� ` ) t%)isc{\ $ Nam"
i\1A1 Drywell,leach line,of trench drain 18.76
City/State/ZlP: ,n� J
OC\ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: D, Project name:NikOctil eirscurManufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76 a
Sanitary sewer(no.linear ft.:___) Page 2
Storm sewer(no.linear ft.: . ) Page 2
Water service(no.linear ft.: -,-,_) Page 2
Subdivision: 11.ot no.: Fixture or item,
Backflow preventer 31.27
Tax map/parcel no.: 12.51
Backwater valve
Wt4 C►v Clothes washer 25,02
nuz � /..4-dAs I t�i1011� Dishwasher 1 25.02 aro,0`;.
gQ \'n . _3n k • Drinking fountain 25.02
�•icEjectors/sump 25.02
-Expansion tank 12.51
0 PROPERTY OWNER-in`'ii'LrPf CNN
Fixture/sewer cap 25.02
Name: Floor drain/floor sink/hub 25.02
Address: .
Garbage disposal 25.02
City/State/ZIP: Hose bib • 25.02
Phone:( ) Fax ( )
ice maker 12.51
It APPLICANT bNTA
.( CT PV interceptor/grease trap 25.02
Medical gas(value: ) Page 2
Business name:��� 111 Primer 12,51
Contact name:C .100_,5\ortse y t. Roof drain(commercial) 12.51
Address: t� S) "\Or S*('oQQ„'t 1 SLu t +0\ Sink/basin/lavatory 25.02 ,n�
City/State/ZIP \ 4 C` 2d 0) Solar units(potable water) 62.54
Fax::( ) Tub/shower/shower pan 12.51
IIrinai "
E-mail:dLQ tA/+( 1b
yiY�(��' <<'�-r 1 Water closet 25.02
£ CTOR , Water heater 37.52
Business name:Western Plumbing,Inc. Water piping/DWV 56.29
Address:9460 SW Tigard Street,Suite 101 Other 25.02
Subtotal -Ac'j,(11.,
City/State/ZIP:Tigard,OR 97223
Minimum permit fee: $72.50
Phone:(503)639-52% Fax:( )
Plan review (25%of permit fee)
CCB Lie.:2439 Plumbing Lie.no.:3429PB State surcharge(12%of permit fee) 4,iJ 1
Authorized signature: �J� /I/ /It 0 - TOTAL PERMIT FEE It4,Q'.
This permit application aspires if a permit is not obtained within 181)days
Print name: • / 1�� Date:2,;,,tI after it has been accepted as complete.
0. *Fee methodology set by Tri-County Building Industry Service Board.
I.1BuildinsTermits\PLMU-PermitApp.doc 10/01/09 440-4616T(!MI/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
,
Site Ut#litied ,. r- h.`t � Tat �? F 1 Piismdml t' .e-,_
Footing drain-I"100' 50.03 oto 2,000 $121.90
hooting drain-each additional 100' 37.52 2,001 to 3,600 , $169.69
Sewer-1st 100' 62.54 - -3.601 to 7,200 $233.20
7.201 and greater $327.54 1
Sewer-each additional 100' 37.52
Water Service•1st 100' 62.54 Medical Gas Systems:
Water Service•each additional 100' 37.52 « -
V
Storm&Rain Drain•1st 100' 62.54 ��
th �
$1.00 to$5,000.00 Minimum fee$72.50
Storni&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 I • ,,,e.,41,° , or F ' ,:' Theach additional$100.00 or fraction thereof,to
A and including$10,000.00.
Inspection of existing plumbing or for 510.001,00 to 525.000.00 S148.50 for the first$10.000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr Ieach additional$100.00 or fraction thereof:to
(minimaeLeharpe-i/Z hour) and including$25,000.00.
inspections outside of normal business 90.00/hr 525,001.00 to 550.000.00 5379.50 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-172 hour) a each additional$100.00 gr 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*.
Fixture Type NrArrded ueitkeel
detooaar Plan review is required for any of the following.
Work Performed: C+ Please check all that apply.
Baptistry/Font .,
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 tire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
, 1ycWegh . .
Floor Drain/sink •2" �. Submit a sets of plans with any of the above.
C `D�m
car Wash Drain ,
Garbage -Domestic-non-food 0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related r that meet the qualifications above.
-Commercial-food related _
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Kies Station) Comments regarding fixture work:
1 Rec.Vehicle Dump Station._ ,
Shower dung ,
-Stall
•Sink/l.av -Non-food related 1 , 1
-Bradley
-Commercial-food related _ _
-Service
-
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 fees assessed for the sewer increase must be paid before the
urinal plumbing permit can be issued.
Other Fixtures:
http://www.tigard-or.govldocument_center/Bu ild i ng/PLM F_PermitApp.dT