Permit (2) CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit#: PLM2020-00111
Date Issued: 04/15/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S135BC00700
Jurisdiction: Tigard
Site address: 10795 SW CASCADE AVE
Project: Wiggle Land Subdivision: None Lot: None
Project Description: Interior plumbing for TI: Capping(3)sinks,Adding(1)dishwasher,(7)2"floor drains/sinks, (1)ice machine, (6)
sinks.(2)water closets;Relocating (1)urinal;Installing(1)expansion tank,(1)grease trap, (1)primer, (1)water
heater,and(1)wok.
Contractor: HILDEBRAND PLUMBING Owner: CASCADE FUTSAL LLC
4480 SW 96TH AVE UNIT#10 5010 NE OREGON ST
BEAVERTON, OR 97005 PORTLAND, OR 97213
PHONE: 503-686-0854 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 04/14/2020 $25.02
Specifics: 1 ea Expansion Tank 04/14/2020 $12.51
7 ea Floor Drain/Floor Sink/Hub 04/14/2020 $175.14
Type of Use: COM 1 ea Ice Maker 04/14/2020 $12.51
Class of Work: ALT 1 ea Interceptor/Grease Trap 04/14/2020 $25.02
Type of Const: 1 ea Primer 04/14/2020 $12.51
Occupancy Grp: 6 ea Sink 04/14/2020 $150.12
Stories: 1 ea Urinal 04/14/2020 $25.02
2 ea Water Closet 04/14/2020 $50.04
I ea Water Heater 04/14/2020 $37.52
25 Misc Other Fee 04/14/2020 $25.02
1 Plan Review 04/14/2020 $137.61
1 12%State Surcharge- 04/14/2020 $66.05
Plumbing
3 ea Fixture/Sewer Cap 04/14/2020 $75.06
0 Plan Review 04/14/2020 $18.76
Total $856.92
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. 2.1987 or 1.800.332.2344.
Issued By: . j 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 Application fc,ile, , . ,_
r
Building Fixtures FOR OFFICE USE ONLI
City of Tigard Received N �
g Date/By: 3 /d'� "! Permit No.: f r`l� r1/�'�/3 00111
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �-t t OC� V(/ l
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: _' _ao 1U p Other Permit No.: y, fJ`'3 1
Inspection Line: 503.639.4175 Date Ready/By: orris H See Pa e 2 fo u��
1 I G A I t U Internet: www.ti and-or. ov y o 3/.7/p - g
g g 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 l-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El 1-and 2-family dwelling ACommercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder El Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10 h ys s �;_ ('c`iLt7.0.2 A t Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -1 -;v 0.r i 0 ,R
4 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 7 i
(Ai y('lJt l C�ifk Manufactured home utilities 50.03
Cross street/directions to job site: Q 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 Ytiv2'r I ci. '.. t.i..lees.6;ny Dishwasher / 25.02 ,�',
O Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank / 12.51 /2,5
Name: Fixture/sewer cap 25.02
Floor drain floor sink/hub 11 25.02 1/75,/q-
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker / 12.51 /9,r 5 1
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap / 25.02 .15,O
Business name: Medical gas(value:$_) Page 2
Contact name: Primer 1 12.51 /0,,5 i
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory (j 25.02 /50, la
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) I Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 1 25.02 d 5 t O),
Water closet ,, 25.02 D,0Li
CONTRACTOR S
Water heater / 37.52 39,52
Business name: Water piping/DWV 56.29
Address: Other: t.,J Old_ 1 1 25.02 0)5,c
City/State/ZIP: Subtotal 556,yJ
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) /3 /, 6 i
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) b 6,0
Authorized signature: TOTAL PERMIT FEE 954,45Cj
Print name: Date: Thin 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:\BuddingTermits YLMU-PermitApp.doc 10r01/09 440-4616T(10/02/COWWEB)
ts,rA.s '- z
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-I st 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 fast$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
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
' ❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
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 C nts regarding fixture work:
Oil Separator(Gas Station) 3) Q fr y'1`'l et J w.K tiiy'S-
Rec.Vehicle Dump Station , ,-4, A.Y IGI_~'/ IgGe. yl(�V/*
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related 3
-Service I *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.
'a.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doe 08/04/2011 2
PIumbing 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 S121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
S . 3,601 to 7,200 $233.20
Sewer-1st]00' 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 - -
Storm&Rain Drain-1st 100' 62.54 -
Valuation: Permit Fee:
$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$5,000.60 and$1.52 for
Other Inspections or Fees 'Qt3'• Fee(ea) Total each additional 00.0 or fraction thereof,to
and including S10,000.00.
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: FIECEiNiL.t.
04PR 9 202.0
Commercial Fixture Work: CITY OF (r(a>�VS1A
`-'/'
Are you capping,adding or replacing fixtures? If"yes �L. 4NG oVe
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees* 1 ; ,° an Review for Plumbing Installations
Quantity b Fixture , _1 v;' . is required for any of the following.
Qu ty y Type a
Fixture Type for Replace! .a6- k all that apply.
Work performed: Capped Added Ratocate .? Y� y new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuz2i/Whirlpool engineer'.
Each Stall ❑ New exterior plumbing site utilities for any complex structure
Car wash:
Drive tall as defined in OAR918-780-0040.
DICuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher -Commercial i ❑ Any multipurpose fire sprinkler system.
Domestic CI 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" r]
-3" _ Isometric or Riser Diagram
0 Isometric or riser diagram is required for new buildings
-Car wash]rain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Maeb./Refrig.Drains s 1 Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang _
-Stall
Sink: -Isv/13ar non-food related . ,..,
-Bradley
-Corn/Serv/Util food related 3
-Service I *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
-t plumbing permit can be issued.
Water Closet-Toilet a P g
Urinal I
Other Fixtures:
I:1Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
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Branden Taggart
From: Branden Taggart
Sent: Monday,April 13, 2020 12:39 PM
To: PKNW Construction
Cc: #Building Permit Technicians
Subject: RE: Wiggle Land: PLM2020-00111 &SWR2020-00063 - 10795 SW Cascade Ave.
Attachments: Branden Taggart.vcf
Alex,
Thanks. I will work on revising the permit fees.
Thank you,
Branden Taggart
Senior Permit Technician
City of Tigard
(503) 718-2449
TigardBuildingPermits@tigard-orgov
Original Message
From: PKNW Construction <pknwconstruction@gmail.com>
Sent: Monday, April 13, 2020 12:17 PM
To: Branden Taggart<brandent@tigard-or.gov>
Subject: Re: Wiggle Land: PLM2020-00111 &SWR2020-00063- 10795 SW Cascade Ave.
Hello Branden
The 3 sinks are Lav/bar non food related.
We're only installing one ice maker.
Thank You,
Alex Mendez
PKNW Construction LLC
503.530.6428
Sent from my iPhone
> On Apr 13, 2020, at 9:02 AM, Bra nden Taggart <brandent@tigard-or.gov>wrote:
> Hi Alex,
> I apologize for the delay. We have been really busy. I can revise the plumbing and sewer fees, but I will need to know
the types of sinks for the SDC fees,whether they are "Lav/Bar non-food related" sinks, "Com/Serv/Util food related"
sinks, or service sinks. Please see the second page of the Plumbing Permit Application attached above, and enter the
capped fixtures on the form. Once I receive it back from you, I will revise the permit.
1