Permit CITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit#: PLM2020-00102
Date Issued: 03/05/2020
T f.G AR C) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S136AD05901
Jurisdiction: Tigard
Site address: 11455 SW PACIFIC HWY
Project: Tigard Regency Inn Subdivision: None Lot: None
Project Description: Interior plumbing: Replacing(50)tubs and(50)lavatories.
Contractor: KELSO PLUMBING LLC Owner: GOPAL LLC
PO BOX 16584 11455 SW PACIFIC HWY
PORTLAND, OR 97292 TIGARD, OR 97223
PHONE:
PHONE: 503-913-7278
FAX:
FEES
Quantity Description Date Amount
50 ea Sink 03/05/2020 $1,251.00
Specifics: 50 ea Tub/Shower/Shower Pan 03/05/2020 $625.50
1 12%State Surcharge- 03/05/2020 $225.18
Type of Use: COM Plumbing
Class of Work: ALT 1 ea Investigation Fee 03/05/2020 $90.00
1 ea Investigation 12%State 03/05/2020 $10.80
Type of Const: Surcharge
Occupancy Grp:
Stories:
Total $2,202.48
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: ermittee Signature:
)1(.1(9-
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
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard
Received
y t3m 1ji*.® Permit No.:,P Z f_e�(o
1111 • 13125 SW Hall Blvd.,Tigard,OR 97221M A k $ 2020 Da n R f O/� �V P�
I_ Phone: 503.718.2439 Fax: 503.598.1960 Date/By:an Review Other Permit No.:
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: }ru�r-is.: ® See Page 2 far
Internet: www.tigard-or.gov 'JILDING DIVISION Notified/Method: /l-tj; Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑ 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
❑ 1-and 2-family dwelling 0 Comercial/industrial SFR(2)bath 437.78
m
SFR(3)bath 500.32
❑Accessory building T /Multi-family /t't a /
` Each additional bath/kitchen 25.02
❑Master builder Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
`� r c� O t cf- C ,J_[ ,til Catch basin or area drain 18.76
DrJob site address: / J J / f-Y l� ( it,C J
City/State/ZIP: 6! 6 it_ 11-2- Footing leach line,or trench drain 1 Page 2
Footing drain(no.linear ft.: ) 2
Suite/bldg./apt.no.: I Project name: 7776l h C y 1nbY 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
Water service(no.linear ft.:_) Page 2
Subdivision: .e I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
L.DESCRIPTION OF WORK Backwater valve 12.51
� L Clothes washer 25.02
g., vie ;,-- L 60.� y2.tlp I to G.� 5l)b l�)v.-Ye(` Dishwasher 25.02
(45 ® �1 G O-'✓ f Drinking fountain 25.02
() ' L-0Ua40 t^i--/. 11i'/c Ejectors/sump 25.02
Xf.sPROPERTY OWNER f ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:/r ,�}�/��/� r �/f/' �' '^,FFloor drain/floor sink/hub 25.02
( `�1�a 1/' fa t� 'O r '' . Garbage disposal 25.02
City/State/ZIP: ' ) Cp- P.--3 Hose bib 25.02
Phone:(jb3)S j.-i 6,s-2..2.._ Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name.: ti U J m /��r r L L
<t_ > Primer 12.51
Contact name: l 111 Roof drain(commercial) 12.51
Address: Sink/basin/lavatory �0 25.02 [t 2.57
City/State/ZIP: Solar units(potable water) 62.54
Phone:(5 09 G�/57 2...?g Fax::( ) Tub/shower/shower pan L� 12.51 S'I
E-mail: j, 1,e0/GrJvt7.b//7 i AnQ:, . 6/001 Urinal 25.02
Water closet 25.02
'- CONTRACTOR ,,`.` Water heater 37.52
Business name:l ( r�so 010 WIa 1 v� L L. V Water piping(DW 56.29
Y Address: ,0 r o r /4 5,g Other: 25.02
City/State/ZIP: •PQ l.(- (qM d Or (2 �12 Subtotal ii g7(o.�
o3) 5 7 Z .,/Z Minimum permit fee: $72.50 Phone: I 7J Fax:( )
CCB Lic.: I Q 3 Q- 1 5 ra24 Plumbing Lie,no.: i 0`�/ Plan review (25%of permit fee)
////'''' f f /1n State surcharge(12%of permit fee) . j V
Authorized signature: -\ �,�t lO �r t f/u TOTAL PERMIT FEE ,Z �V ,�y�
Print name: et 5(1.1 (� I .( . 1 S \\! Date:03/O / 0 This permit application expires if a permit is not obtained within(ao days
after it has been accepted as complete.
*Tee methodology set by Tri-County Building Industry Service Board.or
L�Buading'PermitsiPLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB) r yy-
ifl
L a2 �iA.6 .LAV
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-1"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
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
p 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:
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
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replacer Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower 5 6
-Jacuzzi/Whirlpool engineer.
ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Thinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
-4" ❑ 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
lee Maeh.rRefi;g.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related b 0
-Bradley
-Com/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 fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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