Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00494
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/29/2017
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16620 SW 85TH AVE
Project: Clean Water Services Subdivision: None Lot: None
Project Description: Hypo Project-Solids Building: Installation of site utilities for 220'storm sewer, 100'water service,and(1)catch
basin.
Contractor: RL REIMERS CO Owner: CLEAN WATER SERVICES
3939 OLD SALEM RD STE 200 2550 SW HILLSBORO HWY
ALBANY, OR 97321 HILLSBORO, OR 97123
PHONE: 541-926-7766 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 11/29/2017 $18.76
Specifics: 220 If Storm Sewer 11/29/2017 $137.58
100 If Water Service 11/29/2017 $62.54
Type of Use: COM 1 12%State Surcharge- 11/29/2017 $26.27
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $245.15
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,<62 _- Permittee Signature: 0'01/ C j7C _ /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applier;tCcIVEP� I/y�o P, o,7-6-r r- "" Z.
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Building Fixtures FOR OFFICE LSE ONE)
City of Tigard A U G 1 6 2 n / Received 4 permit No �/
' 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review�/ � �7 GSI�2 L�/.1�E,y�!
e Phone: 503.718.2439 Fax: 1Q6 Pian
k, 1 t' RD Date/By: / Other Permit Nc
Inspection Line: 503.639.4175 -
T 1(,A R D Date Ready/By: !a See Page 2 for
Internet: www.tigard-or.gov$� T y� )q1 ) V"S 1) Nntirimfm rh�d• i•
i31I�E, L��a�DVL %a�;, I I Supplemental Information
TYPE OF WORK 7 1
❑New construction 0 Demolition -r-c-7 For special informaQn use checklist
Description I Qty. I Ea. I Total
IA Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑ ' zbniidia 0 Multi-family Each additional bath/kitchen 25.02
,i Master builder - 0 Other:
Fire sprinkler( sq.ft.) Page 2
'= ORMATION AND LOCATION Site utilities: ! r 7
I site ad•41: �t LJ 6 5--it, qV Catch basin or area drain 04_,� 18.76
City/State 1': -r pp [� /, .a (s r Drywell,leach line,or trench drain 18.76
Oe..... l 7 C[a d ,4Ld tr_SiviAzo Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: auP.\ 41/V Y\R-F S 101,,k,\AA Manufactured home utilities 50.03
Cross street/directions to job site:etpot ElA ck, C ,c{1 C. ill/10,0,5 iiict13.'-S_Manisoles• 'I' 18.76
D i.Q n o 6 -1' A (4 ( l_ //(' DRain drain connector 18.76
9� , /� Sanitary sewer(no.linear ft.:_) Page 2
��r-/ .� Storm sewer(no.linear ft.:2,d V Page 2 /37.Sg
Water service(no.linear ft.:/0C) 1/ Page 2 6,9,-6-9Subdivision: QQ Lot no.: Fixture or item:
Tax map/parcel no.: a Z I
?j6
j )(Dl d b0 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
ywLL
ULTic-S 6 Fii ST tn!?;l r9AP lacJ `z PtrieCrrt2,J l Dishwasher 25.02
Qi.`v^P 5, pi 0 wL J2 l(arAtclgs-i.4-n � Drinking fountain 25.02
6( Nei C 4 1DflA61 < kitV< 7-tq.,,sk S Ejectors/sump 25.02
PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: C - a3 1,J 1y 6�/1, $4lLv(Cc 5 Fixture/sewer cap 25.02
Address: Floor drain floor sink/hub 25.02
i��(�bO yU S Garbage disposal 25.02
City/State/ZIP: '[t(7 4-/1-C / 0(L ?.7 Z -4 Hose bib 25.02
Phone:(c-O3) 54 7 fj q•- 3 Fax:(52? )S f 7 60 35-
Ice maker 12.51
('APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer I 12.51
Contact name: D 4/LA Lei �) '- Roof drain(commercial) I 12.51
Address: (}1-.tom i 6 c tri O s.::, i;'� (Ni- ) sinkihn;;../1,--...._• 25.02
City/State/ZIP: Soia w�..,u,.,.....ue water) 62.54
Phone:(5-0S)5 4 7 U G 4 3 Fax::( ) Tub/shower/shower pan V 12.51
E-mail: �94, h(�1d� G �Nv,w C✓ «V ( ') l✓`r 1 Urinal 25.02
` ater closet 25.02
CONTRACTOR II ( o' s -T,D Q 1 Q ater heater 37.52
Business name: ;/� el Waterpiping/DWV I I 56.29
Address: 3739 61_6 591.-&71-1 � _$%' I C) Other: • 25.02
City/State/ZIP: en1 _
' / � ,C !J -ubtotal i�r kg
9`2f7
Phone :/ f Fax:( ) Minimum permit fee: $72.50
�1" Plan review (25%of permit fee)
CCB Lie.: ��'0 � Plumbing Lic.no.: �
' '' I I State surcharge(12%of permit fee) 4 ,
Authorized siriff
e: n I TOTAL PERMIT FEE ys,/3
Print name: v,„„.),...\ l I Date: e I 1 to I This permit application expires if a permit is not obtained within 18U nays
tit !! after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PemitApp.doc 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-1g 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 first$5,000.00 and$1.52 for
Other Inspections or Fees Fee(ea) Tom each additional$100.00 or fraction thereof,to
h 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/ Pleas- check all that apply.
Work Performed: Capped Added Relocate
❑ • y new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whir.ool A New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 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"
3" 2 ®2.. Isometric or Riser Diagram
4„ 0 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 regarding fixture work:
Oil Separator(Gas Station) 2-41..1M7 lf.feig M�Z�'P •`= 5g7/• /7 Z"
Rec.Vehicle Dump Station
Shower: -Gang /f 7)ej / 7U7.- t"!
-Stall
Sink: -Lav/Bar non-food related / a /-44. S1. _ eV tj,/77 es CJI✓ ty 7
-Bradley /°C-72-. ', CT
" -/IA i3 cz //2`//
-Com/Serv/Util food related
-Service / I *Note: If the fixture work under this permit resultsin a
Swimming Pool Filter .1 crease of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fe• assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet / ` plu,i bing permit can be issued.
Urinal
Other Fixtures:
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