Permit CITY OF TIGARD PLUMBING PERMIT
,' COMMUNITY DEVELOPMENT Permit#: PLM2020-00163
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/22/2020
Parcel: 2S110DB01300
Jurisdiction: Tigard
Site address: 15294 SW ROYALTY PKWY
Project: Tigard Animal Hospital Subdivision: 1996-010 PARTITION PLAT Lot: 2
Project Description: Separate existing cold water supply and install (2)remote read water meters.
Contractor: PMSI LLC Owner: TIGARD INVESTMENT PROPERTIES LLC
8295 NW EVERGREEN PKWY#204 11086 SE OAK ST
HILLSBORO, OR 97124 MILWAUKIE, OR 97222
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Quantity Description Date Amount
50 Misc Other Fee 04/22/2020 $50.04
Specifics: 1 12%State Surcharge- 04/22/2020 $8.70
Plumbing
Type of Use: COM 22 ea Minimum Fee Adjustment- 04/22/2020 $22.46
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 Appiicatitm
EDEIVED
Site Utilities APR 15 2020
City of Tigard CITY OF TIGARD Rcccived
PlateBy:y i 7/zv 4 p Pcgmit N 0 y2aao °Doito3
Phone: 50 Hall.8.243 Fard,ORg p WING DIVISION Plan RevK;w
Phone: 503.71 R.2439 Fax: 503.59 46tf DatdAy: Other Permit Ne.:
1 Ie:a hi, Inspection Line: 503.639.4175 Darr Rradyt0y.
ntemet: www.ti gard-or.gov lure' ® Ste Page 2 for
Nonlimi,Method: Supplemental Inine ma rill II
TYPE OF WORK FEE* SCHEDULE
❑New construe(iou ❑Demolition For,special information use checklist
Description FT.r En. Total
4ddition/altcrattonhcplacemcnt ❑Other: New 1-.2-familydwellings(includes 100 ft.for eac312 7h 0 ity connection)
CATEGORY OF CONSTRUCTION ' SFR(I)bmh
❑ I-and 2-family dwelling tmereial/industrial SFR(2)bath 437.7R a.i.o m
0 Accessory building ❑Multi-family SFR(3)bath 500.32
--'-' Each additional bath/kitchen 25.02
❑ Master builder 0 Other:
Fire sprinkler( sq:ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
lob site address: ��24 Si ("2 rNA,ii j�kr -y . Catch basin eh area drain I R.76
City/StatcIZlP:"'�'}but IQ1i 1� 2Z7u O Drywel leachlo.linetrenchdrain IR.76.
I Footing drain(no.linear IL:_) Page 2
Suite/bldg./apt.no.: Project name:u ft`^r� pt„i 1 1.6 s j 4 I j� Manufactured home utilities 50.03
Cross street/directions to job site: G.?0e14.-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: Lot no.: Fixture or item:
Tax map/parcel no.: Ilackflow preventer 31,p
DESCRIPTION.OF WORK Backwater valve 12.5I
Clothes washer 25.02
Se .ro.k,- %-i-i ).7%CCU Sus)1..{ O:.t1A `H71s.e t r Dishwasher 25.02
anr4 ,n54.\k (2)v(8ArtOl'C 'C't�Ck (. 3 ea+r r Drinking fountain 25.02
m G k'e es. /�/2 /"het"// y%t l A it, Pe-n. ,6d9/Ejectors/sumP 25.02
❑ PROPERTY,OWNER I L7.tENANT -e, Expansion tank 12.51
Name:"'�'"� /� M 4/P/2e Fixture/sewer cap 25.02
xrtk l'�rkat,, 4{r-, t'}'r.. Floor drain/floor sin101iub
Address:E CILI S.,) YSt3�C.. Fix-(�:,L._seai 25.02
( Garbage disposal 25.02
City/State/ZIP: ' r c:t,,,, Cc` t o c,„\--122)`i
9 Hose bib
25.02
Phone,( ) Fax:( ) Ice maker 12.51
` .A-PPLICANT ❑ CONTACT FI 1014 Interceptor/grease trap 25.02
Business name: E �", LA_�? Medical.gas(value:$ Page 2
-)
p ('� Primer
Contact name: Fs�"'7.G�. l' 12.51
Ct. Roof drain(commercial) 12.51
Address:82A6 JY A tE &VC.(., r el "jack- i`Sic_ 4 Sink/basin/lavatory 25.02
City/State/ZIP: ^
mat O. ' r. M I Solar units(potable water) 62.54
Phone:(t ) Fax:: C 4 Tub/shower/shower pan 12.51
E-mail: CA es �d Urinal 25.02
Water claret
CONTRACTOR r ' Dili,,= 25.02
-- ---"` Water heater 37.52
Business name: Pry'(<} L- �
Water ptping/AW V 56.29
Address:RZSK' IUE F.ve rv�-ecn }Pku,.( , S 4-r.. 2-01 i other: 2 25.02
0,04
City/State/ZIP: 14-j l lsIc ,..,I c7 oil 1Z.1 Subtotal Gy ,C,,L\
Phone:(g C.3)W.P -_ZZZZ Fax:(r�,-p3 )1.1 `Z.Zt 1 Minimum permit fee: $72.50 7 2`So
CCB Lie,:kt-3' Plumbing Lie.no.: �y Plan rcvt w (25%of permit fee)
�r+�L"IZ.Ti , State surcharge(12%of permit fee) tt 7O
Authorized signature: �
c"'""`mi/l o 24,jF TOTAL PERMIT FEE 11,/, 2.0
Print name: ,t ii,ryd G fR„. e Date:3 �u This permit appikanurr expires its permit is not obtained within ISO days
' „r 1y` jGtl✓hth]+e. ) Q aner it has been etsepted as complete.
'Fee methodology set by Tri-Couttyy Building Industry Service Beard.
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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 S 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 Ci as_ stems:
WaterService-eachadditional 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 I(X)' 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$100.00or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for s 10.001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee in specifically indicated 90.00/hr each additional$t00.00 or fraction thereof,to
(minimum charge--1;2 hour) r 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 A5 for
hours(minimum charge—2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.001hr 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 thereat.
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*. _
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type far Replace/ Plan review is required for anyof the following.
Work performed: Capped Added Relocate q g
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 ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OA.R918-780-0040.
Dishwasher -Commercial 0 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 I sets of plans with any of the above.
-
4' Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-foci 0 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.IRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Clang
-Stall
Sink/Lay -Non-fond related
-Bradley
-Commercial-food related
-Service
Swimming l 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:
IrtBuilding\Pennits\PLMU_PermitApp.doc 2