Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00160
T i C A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2020
Parcel: 2S 113AA00500
Jurisdiction: Tigard
Site address: 16100 SW 72ND AVE B18
Project: Mode Health Subdivision: ROSEWOOD ACRE TRACTS Lot: PTA&F
Project Description: Relocate(3)sinks.
Contractor: WESTERN PLUMBING Owner: PACIFIC REALTY ASSOCIATES
9460 SW TIGARD AVE SUITE 101 ATTN: N PIVEN
TIGARD, OR 97223 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
3 ea Sink 04/20/2020 $75.06
Specifics: 1 12%State Surcharge- 04/20/2020 $9.01
Plumbing
Type of Use: COM
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 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: vAi/ n � /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. / N
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 ' CEI V E
City ofSW
Received v /7/,� /�U73U24 DO/('te
p Re Date/By: Permit N ..
II • 13125 SW I 131vd.. figard,OR 97223 APR Q 8 202�
I Phone: 503.718.2439 Fax: 503.598.196 0511Plan Review Other Perim ..:I9I
Inspection Line: 503.639.4175 (.1 i Y OF T ( AHD
pale Re �Yl1no�Oor (/vO��
T I G A R U gate Ready'/By: inns. ® See Page 2 for
Internet: www.tigardaxgov '�I !( rrhI/_' ni‘�(.(+11'y'Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
XAddition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling X Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
• 0 Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Vi` �.1� s7(�piw Catch basin or area drain 18.76
Job site address: X
Drywell,leach line,or trench drain 18.76
City/State/ZIP: \O Xd (��� (�
-(S - Footing drain(no.linear ft.: I Page 2
SeriteIhldg./apt.&:\% Project name:tm C•td,(1.„Sy n -s- Manufactured home utilities 50.03
Cross street/directions to job site: t" 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
^ ,, ,�' Clothes washer 25.02
1^l '\e \oY Mcr sd Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
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
'V APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:)t!\t\ ,C� ' .�� i\�'(V Medical gas(value:$_) Page 2
vu�-� Primer 12.51
Contact name: joix,...N.Aain
Roof drain(commercial) 12.51
Address:(� cc��� �^_ 0 c ,r11
`1 D� ,1w J,`�D7r t SLU.'K �U Sink/basin/lavatory ?J 25.02 .�s�
City/Stale/ZIP Solar units(potable water) 62.54
Phone:Ma)I kii Fax::1 1 Tub/showerfshower pan 12.51
F-mail:dQ _ CC: tax- �JC'c\ 0 AA K'(\Y1 \O "(\ v COIN\ Urinal 25.02
(\�' Water closet 25.02
CONTRACTOR
, Water heater 37.52
Business name:/Vs x t 1Qs � PLJJ_A'Y).. Iric r Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal O16,
Phone:I 1 Fax:( ) Minimum permit fee: $72,50
r� //�/; 'Ts- Plan review (25%of permit fee)
CCB Lic.:09(P / Plumbing Lic.no.:
State surcharge(12%of permit fee) �,6 I
Authorized signature: � A• `a A52K. i.) TOTAL PERMIT FEE WA ea
Print namery; /��`1 l 1 Date:4 g'20 This permit application expires if a permit is not obtained within ISO days
fir' after it has been accepted as complete.
'bee methodology set by Tri-County Building Indusliy Service Board.
I.,Hoildinu.PermimAPLM110-PermiiApp doe 10/01/Oo 440.4616T(10102/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 Oto 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-I st 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:
Stour,&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Stone&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 Ins ections'or Fees Qty. Fee tea) 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 Replace Please check all that apply.
Work Performed: Capped Added Relocate
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuai/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
C'uspidorlWaterpspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial
al ❑ Any multipurpose fire sprinkler system.
Commer El Any complex structure as defined in OAR918-780-0040.
-DoDrinking 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 regardingfixturew'ork:
' Oil Separator(Gas Station) r+ . GI F'f K, e.�/C.3
Rec.Vehicle Dump Station /eZ(" -Y�"" >`, 1
Shower: -Gang ...I //
-Stall n. '7 ...af -J..-/./.
Sink: -I.av/Bar non-food related '
-Bradley
-Com/Serv/Util food related
-Service de/ r 1 *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 iar'"
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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