Permit (165) CITY OF TIGARD PLUMBING PERMIT
.111 COMMUNITY DEVELOPMENT Permit*: PLM2019-00329
Date Issued: 08/15/2019
D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110AB00200
Jurisdiction: Tigard
Site address: 14305 SW PACIFIC HWY
Project: Canterbury Coin Laundry Subdivision: CANTERBURY PLACE,AMENDED Lot: PTS 1-4
Project Description: Replace existing washing machines and(3)drain troughs and add(3)primers.
Contractor: CAMPBELL'S PLUMBING INC Owner: BULL MOUNTAIN INVESTMENTS LLC
14755 SE 232ND DR. ATTN JERRY KOLVE
BORING, OR 97009 14389 SW PACIFIC HWY
TIGARD, OR 97224
PHONE: 503-314-8070 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Floor Drain/Floor Sink/Hub 08/15/2019 $75.06
Specifics: 3 ea Primer 08/15/2019 $37.53
75 Misc Other Fee 08/15/2019 $75.06
Type of Use: COM 1 12%State Surcharge- 08/15/2019 $22.52
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $210.17
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 no started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to low - r - a•opted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00.4. Yo i •,,ta' a copy of the rules
or direct questions to OU C by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
_4 111Call 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 p •
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
,4t y
t T ' r
Building Fixtures FOR OF I ICE I SI. 011.1
I 1 )1''' Received
City of Tigard G`,I ? Is
II IIII 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: f -- "Permit 1�C,lt-faCl�'�J-(9 GI jL�
C Phone: 503.718.2439 Fax: 503.598 e19 0' Date/By:
- an Review Other Permit No.:
D
Inspection Line: 503.639.4175 y y,
I I G A R I) Date Read /B Jur s: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
" CATEGORY OF O)NSTRVCTIOI4 SFR(1)bath 312.70
❑ 1-and 2-family dwelling LC SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
o Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
.t3 ,*M "° x#9111 I1 ICNFOitMATIONtLOCATION r Site utilities:
Job site address: e:"' t Catch basin or area drain 18.76
/�•�� Drywell,leach line,or trench drain18.76
City/State/ZIP: t t. Gh\Q if'h
�J Footing drain(no.linear ft.:_) ■ Page 2
Suite/bldg./apt.no.: Project name: 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
�'p1 LLQ Water service(no.linear ft.:_) Page 2
Subdivision: Q�.�y, rno I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer31.27
' rO ', Backwater valve 12.51
S� � +�l�l' IAT fi !V a. Clothes washer . i
rY r � Dishwasher25.02
Wj i?)c) 1.1 106 1e) - - 1 VG tin Drinking fountain 25.02
LiN) • ,114 A - 07-6-19-e. S E Ejectors/sump 1
Expansion tank 12.51
Name: a EY)Sm- ---- j ft:!^(�Fixture/sewer cap 25.02
Address: �
� ��� .i.. Floor drain/floor sink/hub
��
arbage disposal 3 25.02
25.02
City/State/ZIP: Hose bib
25.02
Phone:( ) Fax:( ) Ice maker 12.51
r Ir.
' x .��c ,._ ` -T 1» ACTe"
t I . Interceptor/grease trap Business name: Medical gas(value:$ ) Page 2
Primer : 1.Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory
City/State/ZIP: Solar units(potable water) 6234
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet i
:Ler:" i` CO CTO: . i".K�,. . <, Water heater 37.52
Business name: p f`tx ��Uf' ,tt)/, O.i I Waterp i m DWV f
Address: (`i /J ,c.1:: Z3Z � a 1, Other: 'IS pr-a "r12.-bkkC-A-$ 11=1 25.02
City/State/ZIP:ti'y:,,Cc.l t 5 C) qr7 f3, Subtotal f ,(o 4
Phone: 3)-3(([,..En 7 ii Fax: j)v S-f, r7 Minimum permit fee: $72.50
/ /� uu+ 3-l•S z�F Plan review (25%of permit fee)
CCB Lic.: I PlumbingLic.no.: L#
Authorized signature: I - State surcharge(12%of permit fee) �2-SI .;�'!, 1TOTALPERMITFEE „2,2_,20.
1/d
Print name r Date ^» j This permit application expires if a permit is not obtained within 180 days
,0,,,,6-
�% ` �/(t �0 SIL 1 l after it has been accepted as complete.
*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)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Qty: Fee Total ;-Square Footage . Pa
mit Utilities „011, �. Pt�rm><t fee: ..
Footing drain-1s1 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: 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$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Qty. Fee lea) Total" each additional$100.00 or fraction thereof,to
Other Inspections or Fees- 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
�w
accurately report fixtures could result in increased sewer fees*. 1AP1an a ew for Flpmb1ng r.
Qfty by;FixtureType Plan review is required for any of the following.
Fixture pe for Capgedt Added Please check all that apply.
Work Performed: 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water
irator 0 Any multipurpose fire sprinkler system.
-CommercialDomec 0 Any complex structure as defined in OAR918-780-0040.
-DDrinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
/ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-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
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDU5,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
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:
14305 SW PACIFIC HWY, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2019-00329
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor