Permit • CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00144
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/06/2020
TIGARDParcel: 2S103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: Fowler Middle School Subdivision: None Lot: None
Project Description: Interior plumbing: Replacing (1)dishwasher in kitchen.
Contractor: OWNER Owner: TIGARD-TUALATIN SCHOOL DISTRICT
TIGARD-TUALATIN SCHOOL DISTRICT 23J BY MAPLETHORPE, BONITA
LARRY HIBBARD ADMINISTRATION CENTER 6960 SW SANDBURG ST
6960 SW SANDBURG ST TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-431-4017 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 04/06/2020 $25.02
Specifics: 1 12%State Surcharge- 04/06/2020 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 04/06/2020 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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.
Plumbing Permit ApplicD E I vE D
Building Fixtures APR FOR OFFICE USE ONLY
Cityof Tigard 2 2020 Received
'� g Permit No.:
II 13125 sw Hall Blvd.,Tigard,o1CMpx�,�OF TIGARD Date/By:
Review y (O /� 'j S ���y�
• Phone: 503.718.2439 Fax: EMCT/7 Date/By: " 1 Other Permit No.:
Inspection Line: 503.639.4175 DIVISION
T I t Alit) Date Ready/By: ,A/ b �luris: PI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: _l„'p�/, J <,.' Supplemental Information
TYPE OF WORK ( }E.ar/r.(4�s•4, JEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description Qty. Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
El1-and 2-family dwelling lil Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
AO SGtJ {414G-i( 0- Catch basin or area drain 18.76
Job site address:/Qt >
Drywell,leach line,or trench drain 18.76
City/State/ZIP:776,44p R dpti. 9 7 -- Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: reWf r1'4 5 7r UV. .�
/" ea+ .(-Manufactured home utilities 50.03
Cross street/directions to job site: j f c�N 4j� 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/J Clothes washer 25.02
/e- G sacra- air EJelPrA,t, />641141.4st:i_ IN,'i't!f`sw+ Dishwasher 25.02 ..,?S•O.4
Aullr S• ,eco.vF/Gu1..t-t-r,"-i o., 2210 7-Ati-S Drinking fountain 25.02
Ejectors/sump 25.02
k.PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
• Name:77 p(jJ -A 7NL`Lircrii7,S /< Fixture sewer capr
25.02
p'_,r, Floor drain/floor sink/hub 25.02
Address: 7V00 Q�,l` S -
Garbage disposal 25.02
� t !��'Qi� r lY� ���zt 7 T
Hose bib 25.02
-City/State/ZIP:
Phone:(9)3) 44, //t)(7 Fax:(5jzy)tf - 4 ZO Ice maker
12.51
APPLICANT CONTACT PERSON Interceptor/grease imp 25.02
v. Business name: %T'S�j Medical gas(value:$_) Page 2
,/ Primer 12.51
ntactname: �/t0t/J XONP7«eZlrE -t�-pt-tdCATfif5 AA.riN4bfCA.-
Roof drain(commercial) 12.51
Address: (p 7t4d �µ j SRO !f' Sink/basin/lavatory 25.02
City/State/ZIP:7'74,440 cal ff/ zz3 Solar units(potable water) 62.54
3 Phone:($.s.91) Itp/ 7 a f 7 Fax: :(SVI) !rzf rp zo Tub/shower/shower pan 12.51
t� oNrli9/�ect-C'.TT56. Urinal25.02
E-mail:
�f2*O�. f(S Water closet 25.02
CONTRACTOR
•
Water heater 37.52
Business nam . rc ;› Shy Waterpiping/DWV 56.29
Address: Other. 25.02
�
/,} \.. City/State/ZIP: Subtotal ,,(,
•'%Phone:( ) Fax:( ) Minimum permit fee: 572.50 ��. [1
Plan review (25%of permit fee)
CCB Lie.:
j bing Lie,no.: State surcharge(12%of permit fee) S , 7
Authorized signature: ' TOTAL PERMIT FEE �/,r1.0
Print name:� i Dare./ ift
/Z1 q� This permit application expires if a permit is not obtained wi hin 180 days
t/ LS/ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Bui dineermhs/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:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-I'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 S10,001.00 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 sew_gr1ees*. Plan Review for Plumbing Installations
Quantity by Fixta Plan review is required for any of the following.
Fixture Type for L rip Please check all that apply.
Work Performed: Capped Added Relocate
❑ 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
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
CIMedical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: -Commercial ❑ 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"
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
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -IavBar 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 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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