Permit (2) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00006
T I t;;1 R q 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/13/2020
Parcel: 2S101AC01300
Jurisdiction: Tigard
Site address: 7105 SW HAMPTON ST
Project: Kaiser Dental Subdivision: BEVELAND NO.2 Lot: 18-19,P
Project Description: Interior plumbing:Adding(2)sinks and capping(1)sink.
Contractor: TOTAL MECHANICAL Owner: KAISER FOUNDATION HEALTH
PO BOX 15099 PLAN OF THE NORTHWEST#838
PORTLAND, OR 97215 ATTN PROPERTY ACCOUNTING
500 NE MULTNOMAH ST
PORTLAND, OR 97232
PHONE: 239-8121 PHONE: 503-348-6291
FAX:
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 01/13/2020 $25.02
Specifics: 2 ea Sink 01/13/2020 $50.04
1 12%State Surcharge- 01/13/2020 $9.01
Type of Use: COM Plumbing
Class of Work: ALT
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 mor the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules ar 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. 2.1987 or 0.332. 44.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspecti(T3 )(ed3V
daThis permit card shall be kept in a conspicuous place on the job site until coetict.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application ," _A - _
Building Fixtures RECEIVED I ur. 0.-„.„ (;.a: (1\I.r
6J 1 Received Pnmit No. /
City of Tigard mwB : l 1 ieo. v_ it _/'
- •- 13125 SW Hall Blvd.,Tigard.OR 97223 plan Review
Phone: 503.118.2439 Fax:.503.598.19 N 2 2020 lametgy, - Other Permit No.:je /91„ )-f,.4 jr.).,
Inspection Line: 503 639.4175 Date Ready/ily, tons: ® See Page 2 for
I]v'11.0 GI
-I FY OF TI ARD Supplemental Information
Internet: www.ngard-or.gov � vy{� 1!*V�/r'�Fyt�l�-c�a /�A�JNotAiedlMelhod: r PP
. TYPE OF `Ir943RL�INGDWlSION - r . .. FEE.' SCHEDULE
For special information use checklist
❑New construction .0 Demolition
Description I Qty I Ea. I Total
XAddition/alteration/replacement 0 Other: New]-2-family dwellings(includes 10(1 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling 54 Commercial/industrialSFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.it.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:1105W r►`S n •~ I� 5T 'T Catch basin or area drain 18.76
Y � Drywall,leach line,or trench drain 18.76
�p City/State/ZIP: QR T / 7 J f.JG. Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: P!Project name: 6 •- r D ' Manufactured home utilities 50.03
Cross street/directions to job site: fC9I'llte Ir•'vl)f0261 Manholes 18.76
eW 7tr•I"9 JL tr 4 S IA j (+Aim prop.
C112C r Rain drain connector 18.76
V 04 l-},Llt� t t n f e t t ll/�"' 1..) �1 Sanitary sewer(no linear ft.:_) Page 2
ys' -Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft: ) Page 2
`
Subdivision: �t ? Lot no.: Fixture or item: -
r�J 4-G0
Tax map/parcel no.. 1G 1 /;.361': Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.SI
�1 ��+ 1���/ ►•��,t • �f 1-1 L ' Clothes washer 25.02
\S l l'' e-1 PVr ®D S-U 1 CJfC t.rS l t S4i^a Dishwasher 25.02
V 1!2 All b 1. Woe-lc 1A • ___ Drinking fountain 25.02
s.. Ejectors/sump 25.02
PROPERTY OWNER } sz TENANT ! Expansion tank 12.51
4. Name: Its R- P inf-u _ Fixture/sewercap /. 25.02
het
y-��� �•. Flora drain/floor sink/hub 2502
Address: 1p . I e° J L. I r4v rJ 1 Garbage disposal 25.02
~• City/State/ZIP: po ItcL. -tt Ore, ct 1 2.5a Hose bib 25.02
Phone:Et/'.2 4.8 - (0?.9 I Fax:( ) lee maker 12.51
tI ag, APPLICANT gCONTACT PERSON Interceptor/grease trap 25.02 r
' Business name: fli.}.4 eJdtc,tDpc1.3gects 1G Medical gas(value:$_) Page 2
, . rrPrimer 12.51
.• ,• Contact name: ') �Y2_,1YY1 N,,, Roof drain(commercial) 12.51
Address: 11- ?0 rj� •)ry ko.E, •S j , nc) Sink/basin lavatory �, 25 02
City/State/ZIP: A�.,.p t C5 cf'� `-L Solar units(potable water) 62.54
Phone:( 0 P•i•`��3�7 t I Fax::( ` ) RoofTub/shower/sh
rpan 12.51
r,_ f'� i. 1R.�1_ ii{e.,J...t? ! Urinal 25.02
E-mail: �� �'a II�QJ G.LiWFCiTl (,�1-a cool
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: •-‘1JJp .__.TOTAL MECet. N1 L. Water piping/DWV 5629
Address: 4B5' No LSE ›, suae Sop Other: ' _ 25.02
City/State/ZIP: eXh...'AS t Wl:j eVi>1001 Subtotal
Phone:(3,/Q riSq(.0 • 3 Fax:( ) 6 () v Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB LicLie.: 3a• "6 '-'1 Plumbing Lic no.: $(p• 23•�P13
permit(� State surcharge(12%of fee)
Authorized sig TOTAL PERMIT FEE
Print nam c Date: a I This permit appltcadon expires If a permit is not obtained within]8n days
after it has been accepted as complete.
•Fee methodology set by Tri-County Sallding Industry Service Board.
I:Vluddingll'amiGNLMU-Pcmti:Appdoc 10l01439 44U-4616T(10t02/COMIWEB)
a
Plumbing Permit:Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(es) Total Square Footage: Permit Fee:
'• footing drain-1" 100' 50.03 0 to 2.000 512 L90
Footing drain-each additional 100' 37.52 2,001 to 7.200 $169.69
3,601 to .200 S2 33.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-tat 100' 6254 Medical Gas Systems:
Water Service-each additional 100' 37 52 - .
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62 54 S 1.00 to$5,000.00 Minimum fee 372.50
Storm&Rain Drain-each additional 10(i' 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 eluding$10l 00,00 or fraction thereof,to
SP and including$10.000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first SI0,000.00 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 S50,000.00 $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 90.00/1u $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge—I/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*. Plan Review for Plumbing Installations
Quanti by Fixture Type- Plan review is required for any of the following.
Fixture Type for Replaeet Please check all that apply.
Work Performed: Capped Addeo Relocate ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-JacuuiN✓hirlpool
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 ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
i" Isometric or Riser Diagram
4 CI 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./RefriR.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related i 2.-
-Bradley
Cor /Serv/Util food related
service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of.sewer EDUs,a sewer permit will be issued and
Washer-Clothes
Water Fz actor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing-permit can be issued.
Urinal
Other Fixtures:
I:1Building\Pennits\PLMF_PennitApp.doe 08/042011 2