Permit Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
Cityof Tigard II'II i 7 202� Received
P
;II • 131 SW Hall Blvd.,Tigard,OR 973A4 N 1 � ' • bc��� . s
Plan Review
Phone: 503.718.2439 Fax: 503.598. Other Permit No.:
Inspection Line: 503.639.4175 r17 Y Or TIGARD Date By:
T i G A R i) „.:r„ -,!V I I c I n tA) Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard-or.gov __ Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
lI r-and 2-family dwelling ❑Commercial/industrial SFR(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.ft.) Page 2
JOB SITE INFORMATION AND LOCATION r� Site utilities:
Job site address: l Z_5•• •7 'L,�.t ,i `� + Catch basin or area drain 18.76
r- Drywell,leach line,or trench drain 18.76
City/State/ZIP: V pic.-`-C J%cti.r% , c-z- et 1 2 Z"-J Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: \-I-L R
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
CI Rain drain connector 18.76
1 '�- Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: 1....e.A...w�p... -.. (fie_+ �{ . Lot no.: g Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
` r Clothes washer 25.02
-°j-""S d-ya V\i..-s.ti ( t) L:a.-.y (a 1) S L-:"-1t Dishwasher 25.02
Po1--.JJ C%. w-r*.- ..t-i e.A cn- Drinking fountain 25.02
Ch/ ,. . acf- 7Sra,c 7 J/!' - 9 Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT RIPMExpansion tank 12.51
c _D Fixture/sewer cap 25.02
-
Name: S ��\e • . �.-, \ csrc.-2"1
Address: -\' 5j�a�1 S1.---) Z...i] j�.,-..L Garbage
drain/floor i so sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: -p.„21-vN....- e . - Otei 1 2_3 Hose bib 25.02
Phone:(rj..i"b) •3Z - \ L V C Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
r Water closet 25.02 et,..
ON �TRACTOR Water heater 1 I 1 37.52 l
Business name: ('t\ PL, yIv v, t w.-c.l L.L. C_ Water piping/DW V 56.29
Address: - ° S'.J L..5,\1.•W Cfs_.e_e.V.._ 12-. Other: 25.02
City/State/ZIP: l.¢A.)¢sz_i o s-s t PZ -t-1.p`1 L. Subtotal
Phone:(5 )) 9_0 3S i.4 Fax:( ) 7(c at) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: i 4 ', 5 to\V-]_? Plumbing Lic.no.: ?E, l 5 3 Cs
/. - State surcharge(12%of permit fee)
Authorized signature: 1!,/�I t f� - TOTAL PERMIT FEE
111 5 �Y f
Print name: �R\� . L�t3}a d - Date: `9 - i.J - 2- This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
• *Fee methodology set by Tri-County Building Industry Service Board.
I:1Building\Pennits'PLMU-PermitApp.doe 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 fast$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
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
Baptistry/Font ❑ Any new commercial building with water service 2"and
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-hem-i/Whirlpool engineer.
Car 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 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"
-3" Isometric or Riser Diagram
❑ 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 Comments regarding fixture work:
Ice Mach./Refrig.Drains g g
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/Bar 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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
6/17/2020• • Mail-STEPHEN PERRY-Outlook
p Search s SF'
New message 8 Send ® Attach v g Encrypt v is Discard ••• G'
0 v Favorites To JD Julie Drinkwater X Cc Bcc
9 Sent Items 1 • RECEIVED
Contractor change
617 Drafts 267 JUN 17 2020
Julie, CITY OF TIGARD
Add favorite As per our recent conversation,I would like to change BUILDING DIVISION
contractor information on permit number(PLM2020-00225).It is
v Folders request that Mr.Brian Wayne Hill will no longer be the contractor for this
project.The new contractor is:
MD Plumbing LLC
Inbox 37598 939 SW willow Creek Dr.
Beaverton,Oregon 97006
Q Junk Email 733 503-267-3914
Mark W.
Drafts 267 Also,would you please add a Water heater fee on permit
PLM2020-00225
9 Sent Items 1
Best regards
> Deleted Items 2 Steve Perry
503-407-1115
Archive
10 Notes 4 AA A' B I U D A _ «= y er M. _ - C x'
Conversation History Send Discard 1 0 Draft saved at 1:01 PM
Notes 0
vanguard
save msg 634
New folder
v Groups
New group
Contractor change X
'Contractor change
https://outlook.live.com/mail/O/sentitems/id/AQM kADAwATczZmYBLTgxYjAtN m100C0wMAItM DAKAEYAAAOpeHjOpRuhCI4v%2FhS 1 dxXzYB W BRP6... 1/1
CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT 1, Permit#: PLM2020-00225
Date Issued: 06/08/2020
T f Q A g 1-) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 '1 ', '
l Parcel: 1S126DC03002
Jurisdiction: Tigard
Site address: 9250 SW LEHMANN ST
Project: Perry Subdivision: LEHMANN ACRE TRACT Lot: 8
Project Description: Installing(1)lavatory,(1)tub,and(1)water closet. 8/22/20:REPRINT to change contractor and add(1)water
heater.
Contractor: MD PLUMBING LLC Owner: PERRY, STEPHEN W
939 SW WILLOW CREEK DR 9860 SW 92ND AVE
BEAVERTON, OR 97006 TIGARD, OR 97223
PHONE: 503-451-1115
PHONE: 503-267-3914
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 06/01/2020 $25.02
Specifics: 1 ea Tub/Shower/Shower Pan 06/01/2020 $12.51
1 ea Water Closet 06/01/2020 $25.02
Type of Use: SF 1 ea Water Heater 06/22/2020 $37.52
Class of Work: ALT 1 12%State Surcharge- 06/22/2020 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.08
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 952-001-0010through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC calling 503.23 987 or 1. .332.2344.
frr-
Issued By: 'Mee Signature: C:1
/
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.
CITY OF TIGARD PLUMBING PERMIT
I g -n COMMUNITY DEVELOPMENT Permit#: PLM2020-00225
I 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439Date Issued: 6/8/2020
TIGARDParcel: 1S126DC03002
ff-/1 .CfLc1
Jurisdiction: Tigard
Site address: 9250 SW LEHMANN ST
Project: Perry Subdivision: LEHMANN ACRE TRACT Lot: 8
Project Description: Installing(1)lavatory,(1)tub,and(1)water closet. 8/22/20:REPRINT to change contractor and add (1)water
heater. 7/17/2020: REPRINT permit to add 45 If of water service.
Contractor: MD PLUMBING LLC Owner: PERRY, STEPHEN W
939 SW WILLOW CREEK DR 9860 SW 92ND AVE
BEAVERTON, OR 97006 TIGARD, OR 97223
PHONE: 503-267-3914 PHONE: 503-451-1115
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 06/01/2020 $25.02
Specifics: 1 ea Tub/Shower/Shower Pan 06/01/2020 $12.51
1 ea Water Closet 06/01/2020 $25.02
Type of Use: SF 1 ea Water Heater 06/22/2020 $37.52
Class of Work: ALT 1 12%State Surcharge- 06/22/2020 $12.01
Type of Const: Plumbing
Occupancy Grp: 45 Misc Administration Fee 07/17/2020 $45.00
Stories: 45 If Water Service 07/17/2020 $62.54
0 12%State Surcharge- 07/17/2020 $7.50
Plumbing
Total $227.12
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: /t 4�4: } Permittee Signature: D� �Pueg�0v/
""JJ s�Calll 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
S'15 RE ;
City of Tigard JUL 8 ZE,,,: Rnoeceved �y
/7/l0 Permit Nor(, i 2,-AI06 Z2' s
te By: 0 �1k
It
M 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
v Phone: 503.718.2439 Fax: 503.598.196(C TY (.)r Dnte,!By; Other Permit No.:
7l G A R O Inspection Line: 503.639.4175 BU 1 LD i l`i G 1.,-. Date Ready/By. Jaris: lid See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE*'SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description I Qty. 1 Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: �' D.__S 1. St..7 Lp W.. rj Catch basin or area drain 18.76
C" _ Drywell,leach line,or trench drain 18.76
City/State/ZIP: ?i,r4.n t_S'a+ . CL-)1-71.73 .
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: •\{,pae...� Manufactured home utilities 50.03
Cross street/directions to job site: 1 Manholes 18.76
C 0.t-_ Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: 45) Page 2 G'Z,54
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
7ttlt-sue++ Zaa..t-..A- PLC -DESCRIPTION
- 001-7-j Clothes washer 25.02
Dishwasher 25.02
ft-fdJ 1►+SS►l.LtY1.Ji-I t S V'fi.J.'1 'm4-'rtm- ''11 1'1-4-1^y' • Drinking fountain 25.02
40 ws ak 'i 4-e6 sMt y t. A a.L S % Ejectors/sump 25.02
ROPERTY OWNER [ ❑ TENANT Expansion tank 12.51
Name: SA-u1.�- \ e n.Tt. Fixture/sewerordrain/floor
cap 25.02
Address: et $f.ye..) Cv�N„) e� „l ,{�„�-� Floor ge disposal
sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: �(L{_,/+e.w_Id, C] t, Q1.2Z.33
Hose bib 25.02
Phone:(5a-9 .4 J . t \s Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
VS l f L L Water heater 37.52
Business name: `I J V..1"'t vW C-- Water piping/DWV 56.29
Address: 916% 51..-.1 ka,,j,`L���„J CalttL, L. Other: 25.02
City/State/ZIP: V5tA.0 i_ra_NJ{�] 0 r?.,.. �10(N fp Subtotal
Phone:(St13) 2-(•-1 g`Z 1 4 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: c t's.. ,'I$5 Plumbing Lic.no.: P ‘,S I cz.
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: !V1 `_ L-,a-r2.wca/ TOTAL PERMIT FEE
Print name: ,'\ Z U.b 6 Zia C Date: O •ZAN 1.34 This permit application expires if a permit is not obtained within Isn days
after it has been accepted as complete.
*Fee methodology set by TO-County Building Industry Service Board.
]:lnwlding1Permils\PI.MU-PvmitApp.doc 10/01/09 440-0510T(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) TOd1l 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 G, Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm r&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 • Fee(ea) Total each additional$100.00 or fraction thereof,to
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 S 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added RelocatePlan review is required for any of the following.
Baptistry/FontPlease check all that apply.
Bath Tub/Shower ElAny new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thm ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
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 -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming 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:
I:\Building\Permits\PLMU_PermitApp.doc 2
CITY OF TIGARD PLUMBING PERMIT
11111
• ' COMMUNITY DEVELOPMENT Permit#: PLM2020-00225
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/08/2020
TIc;;1I p 9 Parcel: 1S126DC03002
Jurisdiction: Tigard
Site address: 9250 SW LEHMANN ST
Project: Perry Subdivision: LEHMANN ACRE TRACT Lot: 8
Project Description: Installing(1)lavatory,(1)tub,and(1)water closet.
Contractor: BRIAN WAYNE HILL Owner: PERRY, STEPHEN W
17548 SW ROBERT LN 9860 SW 92ND AVE
BEAVERTON, OR 97007 TIGARD, OR 97223
PHONE: 971-246-3682 PHONE: 503-451-1115
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 06/01/2020 $25.02
Specifics: 1 ea Tub/Shower/Shower Pan 06/01/2020 $12.51
1 ea Water Closet 06/01/2020 $25.02
Type of Use: SF 1 12%State Surcharge- 06/01/2020 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment- 06/01/2020 $9.95
Occupancy Grp: Plumbing
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 s forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC b calling
503.232.1 7 or 1. 0.332.2344. /+
Issued By: - -�- 'pe7rTdttee Signature: c�'�'.
f
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
` Biiixtt g Fixtures K)I ()Fri( t I Sl: ()NI.)
City of Tigard RECEIVE ved Gi/�� t , -co s
NI • 13125 SW Hall Blvd.,Tigard,OR 97223 Date By.
Plan RY iew J , i _G63��
S Phone: 503.718.2439 Fax: 503.598.1960 MAY 2 0 202C' Date B : ,J`TSlle� r(p�
T I G A R D Inspection Line: 503.639.4175 Date Ready./By: Smis: I ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplementallnformation
TYPE OF WORK e-!I( L gyp G i)1V1sILN FEE* SCHEDULE
O Newconstruction El Demolition For special information use checklist
Addition on/alteration/replacement ['Other: DescriptionI Qty. I Fa. I Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: �S k S� L , - rk j Catch basin or area drain 18.76
City/State/ZIP: ��)77' * 'L./jt'4 o Drywall,leach line,or trench drain 18.76
Footing dur (no linear ft.: ) Page5 . 2
Suite/bldg./apt.no.: I Project name: ` n�n_,_.` ;��� ' .;4�
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Q,`Za„Jt L„ Rain drain connector _ 18.76
A' 5-�4,"c- 5 p' 2/ A/Orur� Sanitary sewer(no.linear ft.: ) Page 2
/vL ,�/r� / Storm sewer(no.linear ft.: ) Page 2
k.L6 t V '' (/tom • 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
- ._I CD ligkV "") t '.-At._) 4"-3 Dishwasher 25.02
�� . . y (44+.t t, 4_ JL.s � � Lis- l Drinking fountain 25.02
\l Ejectors/sump 25.02
ROPERTY OWNER 1 � 0 TEN{T,, Expansion tank 12.51
�pe0�e `' Fixture sewer cap 25.02
Name: A
S � 9��\ Floor drain floor sink/hub 25.02
Address: q O`* `rf Garbage disposal 25.02
City/State/ZI t�` � t S 1 Z.et35 Hose bib 25.02
Phone:(5J) -\\ -S Fax: ,(�j';),245-Obfact Ice maker 12.51
PLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
`�� -j .. Primer 12.51
Contact name: �� 7
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory (1, ) 25.02 z.S`�✓
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan (1 ) 12.51 ( 7 St
Urinal 25.02
E-mail: . Water closet oZ
CONTRACTOR I , 25.02
• _ - , -�� Water heater _ 37.52 _
Business name:
_ Waterpiping/DWV 56.29
Address: f S4ES � k..-- 1 .-4..-1 Other: 25.02 1
City/State/ZIP: `' „ ��� on_ Arm ite) Subtotal
Phone:(91I) `�.LI�-'-S(5$� Fax:( ) / 7(c Minimum permit fee: $72.50
CCB Lic.: J/ 0/ Lf/I!/ Plumbing Lic.no.: r Plan review (25%of permit fee)(
State surcharge(12%of permit fee)
Authorized signat� . TOTAL PERMIT FEE
Print name: t Vate: C:5 ,1 This permit application expires if a permit is not obtained within 180 days
(� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
1:1BuildingPermitsPPLMU-PermitApp.doc 10/01/09 440.4616T(10/ OM/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-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 fast$5,000.00 and$1.52 for
Other ec Ins tions 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 Replace/ 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
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ID 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
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
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: -LavBar 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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Julie Drinkwater
From: STEPHEN PERRY <a737capt4aa@msn.com>
Sent: Friday, June 5, 2020 11:40 AM
To: Julie Drinkwater
Subject: Fw: water meter worksheet
Follow Up Flag: Follow up
Flag Status: Flagged
Caution! This message was sent from outside your organization. Allow sender I Block sender
Julie,
The enclosed e-mail is from Michelle Rosa a representative from Tualatin
Valley water district. As per her e-mail the home at 9250 SW Lehman has
an 5/8 meter and is sufficient for my new plumping fixtures. This should
satisfy requirements to issue my plumbing permit. Thank you again for your
help, please contact me with any questions.
Best regards
Steve Perry
503-407-1115
From: Michelle Rosa<Michelle.Rosa@tvwd.org>
Sent: Friday,June 5, 2020 11:17 AM
To:STEPHEN PERRY<a737capt4aa@msn.com>
Cc:Sarah Alton<sarah.alton@tvwd.org>
Subject: RE: water meter worksheet
Hi Stephen,
It was great talking to you. After reviewing the residential fixture worksheet you provided,your existing 5/8" meter will
be sufficient for the total amount of 23.5 fixture units(old & new fixtures). You do not need to upgrade your meter.
Should you have any questions, please feel free to contact me directly.
NOTICE: Due to the COVID-19 front office closure,all Development Services payments(Plan Reviews, Meter Sales,and
Fireflow testing payments)will be processed on Wednesdays. Payments may be mailed to our office,Attn: Meter
Sales for quickest processing. Credit card payments over the phone may also be made on Wednesdays.
Thanks,
Michelle Rosa
Engineering Administrative Assistant
1850 SW 170'h Ave,Beaverton,OR 97003
direct 503-848-3028//office 503-848-3000
michelle.rosa@tvwd.org
1
www.tvwd.org
Tualatin Valley Water District
Delivering the Best Water•Service•Value
From:STEPHEN PERRY<a737capt4aa@msn.com>
Sent:Thursday,June 4, 2020 11:27 AM
To: Michelle Rosa <Michelle.Rosa@tvwd.org>
Subject:water meter worksheet
CAUTION: This email originated from outside of the organization. Do not click links or open attachments
unless you recognize the sender and know the content is safe.
Good mourning Michelle,
I have attached my worksheet for 9250 SW lehman Portland,
Oregon 97223, thank you for your help and quick response
in this matter!
Best regards,
Steve Perry
2