Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00262
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/09/2020
T( " � Parcel: 2S101AB03100
Jurisdiction: Tigard
Site address: 12115 SW 70TH AVE 202
Project: Med RX Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: ADD(1)2"hub drain, (1)lay,(1)break room sink and(1)water closet.
Contractor: FIVE STAR PLUMBERS INC Owner: TIGARD TRIANGLE PARTNERS LLC
PO BOX 28 BY DEERING MANAGEMENT GROUP
BANKS, OR 97106 4800 SW MACADAM AVE STE 120
PORTLAND, OR 97239
PHONE: 503-324-0717 PHONE:
FAX: 503-324-0883
FEES
Quantity Description Date Amount
1 ea Expansion Tank 07/08/2020 $12.51
Specifics: 1 ea Floor Drain/Floor Sink/Hub 07/08/2020 $25.02
1 ea Sink 07/08/2020 $25.02
Type of Use: COM 1 ea Lavatories 07/08/2020 $25.02
Class of Work: ALT 1 ea Water Closet 07/08/2020 $25.02
Type of Const: 1 ea Water Heater 07/08/2020 $37.52
Occupancy Grp: 1 12%State Surcharge- 07/08/2020 $18.01
Stories: Plumbing
Total $168.12
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 toOUNC/ by ca//llin�gj5003.232.2.y1987 or 1.800.332.2344.
Issued By: !X% j / /1 / Permittee Signature: 0
✓ 6/4C. t 7-70 )
LL Call 503.639.4175 by 7:00 a.m.for the next available inspection date. °W
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 Appliea > � i� I �
Building Fixtures 2
Cityof Tigard SUN 1 ,� ZQZQ Received /7/ �//�/�
131 SW Hall Blvd„Tigard OR 47223 oal&RY, !! w[ `"D Pamir No�O2'11 .Zo-OD U
Plan Review
Phone: 503.718.2439 Fax. 50Ci> I7(60GFTIGARD Datu1., Other PerathNo-40/2k2.0.-Gagz8
I i . I,.a Inspection Line 503.639.4173 f f� f'� f t�t/�R i pate Reaay,r+". tau ® See Page 2 far
Internet: www.tigard-or.gov 'IL!)I7 Vla t_,7I'J l •) .,D9 d Noiifl d/M h d Supplemental information
TYPE OF WOIRT ... I FEE" SCHEDULE
❑New construction ❑Demolition • For special information use checklist
Description I Qty. I Ea. I Total
j Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 6,for each utility connection)
4
cA7` ; 3N61Pilv7-.404b> ",. .. , .,"fi"^ pii sFR(I)bath 312.700
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family - SFR(3)bath 500.32
Each additional bathkitehen 25.02
❑Master builder ❑Other:
Fire sprinkler(_._sq.ft.) Page 2
JOB SITE 1N1:ORM.tF1O 1ND LOL'AT1Qg-. 7'fit"''^'J'a Sileutilities:
*,tx,s. ww°v
Job site address: G- „Lk) si` ' Catch basin or area drain r 18.76
12-1 t . . 7 1t H \,(�
City/Siete/ZIP: `�( 'ru 1 ,-, Drywall,leach line,or trench drain 18.76
Footing drain(no linear ft.: ) Page 2
Suite/bldg./apt.no.: '"7yO2 Project name: tj 06 Manufactured home utilities SO.U3
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.. ) Page 2
Stonn sewer(no linear ft.: Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item
Tax map/parcel no.. Backflow preventer 31.27
`_ Backwater valve 12,51
`�� DESCRIPTEON OF WORK
Clothes washer 25.02-y
it 'r t ..rvt pro tjg1 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
' PROPEHT'1" OWNER, I 0 TF,N r4 -, ".ice Expansion tank - , 12.51
Name. 1-I�f71�L�t Y CA 1 r(a r'et' Pa r f rh c r s t J + Fixture/sewer cap 25 02
Address: L t b.Po C> Ai rifi o f (}(JO-Ill
r Aloe ir"x'I. () Floor ge dispoaa sink/hub ,/ I 25.02 I
/tnt.�Ltd v V Garbagedispo:al 25.02
CitylState/ZIP: P�vc�r-f-}la.vt c9 , O (II Hose bib 25,02 i
Phan; I ;dc3 Z1 C.' t •1(.. 7 3_ Fax:( ) -'' 1 Ice maker 12.51
0 APPLICANT i .'0 CON r irr PERSON Interceptodgrease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Roof dram(commercial) 12.51 i
Address: Sink/basin/lavatory 1.,- 25.02 ..
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12,51
i
E-mail: Urinal 25.02
CONTRACTOR ✓ 25.02 1
-_-- +.a w m 43,, Water heater 37.52
Business name # ,r ,>r , ✓ I
Et� `s ; Uft'� 3Y1G WaterpipinglDWV 5629
-Address: 17 '2,4i� _ Other: 25.02
City/State/ZIP: s V i. "f it t (I Subtotal /50 t/i,
Phone:(C 0} }( ( Pax:( j2 Minimum permit fee: $72.50 t
t ��}yPlan review (25%of permit fee) r
CC6 Lie.: 1.V26110 N Zvi/Z lunr_bing 1 ic.no.: P t o , �� `/ i
State surcharge 02%of permit fee) , 9
Authorized signature: , ,a 111S� Z, TOTAL PERMIT FEE latf.',/y
Print name: 1 q Dale:/ p /'�/'`g This permit This ration expires Ira permit u car ubraiaed within ISO days
• 4` ,. I r"s C tX)( (4 after it has been accepted as complete
.Foe methodology set by Tri•County Building Industry Service Board. t
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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
$4tlaTe Footage: Permit Fee:
Footing drain-I" IOU' ' 50 03 0 to 2,000 $12i90
Footing drain-each additional 100' 37,52 2,001 to 3,600 S169,69
S3,601 to 7,200 $23320
Sewer 1st 100'
62.54 7,201 and greater $327,54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 '' Medical Gas Systems:
Water Service-each additional 100' 37.52
Sturm&Rain Drain-1st 100' 62.54 Valuation:i Permit Fee:
.$I.00 to S5,00N10U Minimum fee$7250
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
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/hreach additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and includina$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 Replaces' Please check all that apply.
Work Performed: Capped acute aclocarc 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpoolengineer.
Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure
-Drive tall 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 0 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" I
•
Isometric or Riser Diagram •
•
4' 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain g j
Garbage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food.related _
Ice Mach./Refrig.Drains /Commentsf' � regarding fixture work:
}y
Oil Separator(Gas Station) t L4 I) CQ.i /') - Z
Rec.Vehicle DumpStation t`t7„ e-e.
Showier: -Gang
k. 9;t z kl t frl 11.01`,--Stan
Sink. -I.av/Bar non-food related ✓
-Bradley L t d1 4 I 14 V i;Sill g- (f71'i42.t,.,r )
-Com/Serv/Otil 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 i
Washer-Clothes -
Water Exiratxor fees assessed for the sewer increase must be paid before the
WaterCloset-Toilet I V plumbing permit can be issued.
Urinal Other Fixtures: 7"—
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