Permit (4) CITY OF TIGARD PLUMBING PERMIT
44
COMMUNITY DEVELOPMENT • Permit#: PLM2019-00370
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/30/2019
Parcel: 2S 102AB05900
i Jurisdiction: Tigard
Site address: 9249 SW TIGARD ST
Project: City of Tigard Subdivision:>TREET HERRITAGE TRAIL PLAZA RE Lot: 2
Project Description: Site utilities for a new public restroom between the Chamber of Commerce building and parking lot near 12345 SW
Main St.
Contractor: LEE CONTRACTORS LLC Owner: CITY OF TIGARD
PO BOX 896 13125 SW HALL BLVD
BATTLEGROUND,WA 98604 TIGARD, OR 97223
PHONE: 360-852-2317 PHONE:
FAX:
FEES
Quantity Description Date Amount
31 If Sanitary Sewer 09/30/2019 $62.54
Specifics: 40 If Water Service 09/30/2019 $62.54
2 ea Backflow Preventer 09/30/2019 $62.54
Type of Use: COM 1 12%State Surcharge- 09/30/2019 $22.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $210.13
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.
CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit#: PLM2019-00370
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/30/2019
TIGARD. g Parcel: 2S102AB05800
Jurisdiction: Tigard
Site address: 12345 SW MAIN ST, STE#101
Project: City of Tigard Subdivision: 1996-026 PARTITION PLAT Lot: 1
Project Description: Site utilities for a new public restroom between the Chamber of Commerce building and parking lot near 12345 SW
Main St.
Contractor: LEE CONTRACTORS LLC Owner: TIGARD AREA CHAMBER OF COMMERCE
PO BOX 896 12345 SW MAIN ST
BATTLEGROUND,WA 98604 TIGARD, OR 97223
PHONE: 360-852-2317 PHONE:
FAX:
FEES
Quantity Description Date Amount
31 If Sanitary Sewer 09/30/2019 $62.54
Specifics: 40 If Water Service 09/30/2019 $62.54
2 ea Backflow Preventer 09/30/2019 $62.54
Type of Use: COM 1 12%State Surcharge- 09/30/2019 $22.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $210.13
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/13.232.1/;7 or 1.:10.332.2344.
Issued By: // / Permittee Signature: /+16"j�^
///4‘.
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
Site Utilities ?, IMIIIIIIMIIIIIIIIIIIII
Cl of Ti andill
� C 9 I Received �.
4 r ll 4� <.. Date/By: _ / �,,,_ Permit No.: /�
13125 SW Hall Blvd.,Tigard,OR 97223' .t x ��f`' �� '�1� ` � ���- �t 1
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 cc ec Date By: /cl Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 .)E P 1. 2 7°1:- Date Ready/By: /� Juris: EI See Page 2 for
Internet: www.tigard-or.gov Notified/Method:. ' /tet i ; ' Supplemental Information
TYPE OF WORK i-y q ' 1 3 r" , ,` 1...,n ,1.04. E*SCHEDULE
For special information use checklist
®New construction ❑Demolition Description I Qty. ( Ea. ( Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
SFR(2)bath 437.78
El 1-and 2-family dwelling ®Commercial/industrial -
SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:City-owned parking lot next to 12345 SW Main St Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:n/a Project name: tit ,d.f!.T' Manufactured home utilities 50.03
Cross street/directions to job site:Parking lot at NW Amer of Ti and St Manholes 1 18.76 18.76
and Main St intersection(next to Chamber of Commerce building/Symposium Coffee) Rain drain connector 18.76
Sanitary sewer(no.linear ft.:iv 1 Page 2 62.54
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:40) 1 Page 2 62.54
Subdivision:n/a Lot no.: Fixture or item:
Tax map/parcel no.:2S102AB05900 Backflow preventer 2 31.27 62.54
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Install sanitary sewer lateral and water service to city parking lot for a Dishwasher 25.02
future restroom. Drinking fountain 25.02
Ejectors/sump 25.02
17
PROPERTY OWNER III TENANT
Expansion tank 12.51
Name:City of Tigard Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:13125 SW Hall Blvd Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)718-2466 Fax:( ) Ice maker 12.51
® APPLICANT CONTACT PERSON Interceptor/grease trap 25.02
Business name:City of Tigard Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Jeff Peck
Roof drain(commercial) 12.51
Address: 13125 SW Hall Blvd Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)718-2466 Fax::( ) Tub/shower/shower pan 12.51
E-mail:jeffp@tigard-or.gov Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Lee Contractors,LLC Water piping/DWV 56.29
Address:20907 NE 72°°Avenue Other: 25.02
City/State/ZIP:Battle Ground,WA 98604 Subtotal 206.38
Phone:(360)723-5295 Fax:(360)263-6567 Minimum permit fee: $72.50
8833J p Plan review (25%of permit fee)
CCB Lic.: 196535 _ , Plumbin Lic.no.: I- State surcharge(12%of permit fee) 4/,)),3-/
Authorized sign �� I - '�� "'�� TOTAL PERMIT FEE 4,14", i
/ +--' Thispermit application expires if a permit is not obtained within 180 days
Print name: rrC1tC� Date: /) r'/% pP after it has been acepted as complete. Y
`� J *Fee methodology set by Tri-County Building Industry Service Board.
`i ''" FES
1:\Building Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application
Site Utilities �j FOR OFFICE USE ONLY (C/ y
City of Tigard RDateBy: -1``�(ict PLl�o�0!L 03 6
Permit No.: r
"I 13125 SW Hall Blvd.,Tigard,OR 97223 y
Plan Review q�y �j Other Permit No.:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 'T"�tf "l
T I GARD
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
%New construction 0 Demolition For special information use checklist
Description Qty. Ea. I Total
0 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
❑ 1-and 2-family dwelling kr-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 Site utilities:
1' Catch basin or area drain 18.76
Job site address:
t'a t k.ns E '.eY �. 3 S .�rcr i✓lt;. tr. 5 Drywell,leach line,or trench drain 18.76
City/State/ZIP: --r ,d: et+ (49 as Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Pro Project name: `�`
� l J Cet.1 p f- 1 j��,ir(� �,,�Yv'v�l Manufactured home utilities 50.03
Cross street/directions to job site: 0 Manholes 0 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:11 ) J Page 2 b gt 54
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:46) J Page 2 62,54
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer .2 31.27 g2,54
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
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
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) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal /97r 6
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: '1
State surcharge(12%of permit fee) PIS
Authorized signature: TOTAL PERMIT FEE / ,
This permit application expires if a permit is not obtained wi in 0 days
Date:
Print name: after it has been accepted as complete. Uv,11 ))
*Fee methodology set by Tri-County Building Industry Service o d.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
f
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-1n 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 0,54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 0.34 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
Other Inspections or Fees Qty. Fee(ea) Total 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: 115-06
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/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate q
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 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 ❑ 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.
-3"
4 Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ 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/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU_PermitApp.doc 2
I
Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map&tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS -Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Pennits\PLMF-PermitApp.doc 12/30/05