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Permit CITY OF TIGARD71 PLUMBING PERMIT 1 COMMUNITY DEVELOPMENTiir IC t Permit#: PLM2019-00245 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 (, Date Issued: 10/22/2019 l- Parcel: 1 S136DD02300 Jurisdiction: TIG Site address: 11799 SW 69TH AVE Project: HAMPTON INN&SUITES Subdivision: Lot: Project Description: Interior plumbing for a new 87,872 sq.ft.five-story, 152 room hotel. 4/6/2020: REPRINT permit to change contractor. 8/15/2020: REPRINT permit to change contractor. 10/25/21: REPRINT permit to change contractor. Contractor: SASQUATCH PLUMBING LLC Owner: DVKOCR TIGARD, LLC 8646 SW 9TH AVE 1419 W MAIN STREET, SUITE 110 PORTLAND, OR 97219 BATTLEGROUND,WA 98604 PHONE: 503 307 1328 PHONE: 360-723-0024 FAX: FEES Quantity Description Date Amount 1 ea Drywell, Leach Line or Trench 10/08/2019 $18.76 Specifics: Drain 2 ea Backflow Preventer 10/08/2019 $62.54 Type of Use: COM 1 ea Backwater Valve 10/08/2019 $12.51 Class of Work: ALT 2 ea Clothes Washer 10/08/2019 $50.04 Type of Const: 1 ea Dishwasher 10/08/2019 $25.02 Occupancy Grp: 2 ea Drinking Fountain 10/08/2019 $50.04 Stories: 3 ea Ejectors/Sump 10/08/2019 $75.06 1 ea Expansion Tank 10/08/2019 $12.51 39 ea Floor Drain/Floor Sink/Hub 10/08/2019 $975.78 10 ea Hose Bib 10/08/2019 $250.20 5 ea Ice Maker 10/08/2019 $62.55 2 ea Interceptor/Grease Trap 10/08/2019 $50.04 16 ea Primer 10/08/2019 $200.16 37 ea Roof Drain(Commercial) 10/08/2019 $462.87 202 ea Sink 10/08/2019 $5,054.04 152 ea Tub/Shower/Shower Pan 10/08/2019 $1,901.52 Total $18,910.33 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 Issued By: Permittee Signature: .1rrr"' . -✓i7 I .„4„..".. 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 ApplicatioRECEIVED ������ Building Fixtures FOR OFFICE LSE ONLY oe+� ���� EIeW 0. DtNo0II 1/11 13125 SW Hall Blvd,Tigard,OR 97223 _ Y Phone: 503.718.2439 Fax: 503.598. Date/By: Other Permit No.: Inspection Line: 503.639.4175 �i+' Dn �� ��UAtgL� - T I G A R D p �x t Date Ready/By: tuns ® See Page 2 for Internet: Www.trgard-or.gov BUILDING DIVISION -thod: Supplemental Information TYPE OF WORK , aj, t 4 r. FEE* SCHEDULE New construction ❑ Demolition 12A 1.- For special information use checklist �� Description 1 Qty. I Ea. 1 Total ❑Addition/alteration'replacement ❑Other: ty 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 S,Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 bli i "'A ! '. #�. ..P v�r .k.,f Site utilities: Job site address: r i 7 11 ‘ ( 4-14 yN Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: - i, 0P-- 91 Z Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name: I t'i '1Yi 1 f n l) Manufactured home utilities 50.03 Cross street/directions to job site: 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: 1 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 Dishwasher 25.02 ( \Gone p owl-bract-Dv 01,1 p-erm4 4- ._ Drinking fountain 25.02 ,M2o19 00 act j Ejectors/sump 25.02 I ❑. PROPERTY OWNER 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 ) CAN 0 CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: _`^C` iGykiLX) ,J ti of f I VAI Li Li C- ^ Primer 12.51 Contact name: VoczAvA ti vrion Roof drain(commercial) 12.51 I Address: S(04(0 c.,Z-. ) ef'}"h �-uE Sink/basin/lavatory 25.02 City/State/ZIP: $ c 2 tt4 1(� / 6 Z. t", z!C Solar units(potable water) 62.54 Phone:(5i)' ) - `1 i Fax: :( ) 1 Tub/shower/shower pan 12.51 E-mail: .--)1'1rml ,s11 pi pL�yylbioti L1 . c .)rn Urinal z5.o2 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: S 112f a \fw:14.QJt1 pUmn IN 0 ti L( L Water piping/D W V 56.29 Address: e)(Q(,1(o emu) Q4y\ Other: 25.02 City/State/ZIP: 1)o Q,A-Uyorn a 1 O'- 91 z i 1 Subtotal Phone:(`')1i2>) O1 i3Z') Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.: Z ZZ(p25 Z,,, Plumbing Lic.no.:.f7k?jis-2,0 State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE This permit application expires if a permit is nut obtained within 1110 days Print name: 4 a '44.. frry.., Date: t%/!1_�/ after it has been accepted as complete. G (/ !s�'7 *Fee methodology set by Tri-County Building Industry Seri ice Board. I:\Building Pe \PLMU-PermitApp.doc 10/01/09 440-46I 6T(I0/02/COM/WEB) C h'i S 1ti k Ls 3 l z_ 7 2 3 Z 97 2145^ CITY OF TIGARD 7 w? 77 ' PLUMBING PERMIT 111 2: ' COMMUNITY DEVELOPMENT ©7 Permit#: PLM2019-00245 T1GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2019 Parcel: 1S136DD02300 Jurisdiction: TIG Site address: 11799 SW 69TH AVE Project: HAMPTON INN&SUITES Subdivision: Lot: Project Description: Interior plumbing for a new 87,872 sq.ft.five-story, 152 room hotel. 4/6/2020: REPRINT permit to change contractor. Contractor: OREGON PLUMBING AND PUMP LLC Owner: DVKOCR TIGARD, LLC PO BOX 261 1419 W MAIN STREET, SUITE 110 MOLALLA, OR 97038 BATTLEGROUND,WA 98604 PHONE: 503-678-9886 PHONE: 360-723-0024 FAX: FEES Quantity Description Date Amount 1 ea Drywell,Leach Line or Trench 10/08/2019 $18.76 Specifics: Drain 2 ea Backflow Preventer 10/08/2019 $62.54 Type of Use: COM 1 ea Backwater Valve 10/08/2019 $12.51 Class of Work: ALT 2 ea Clothes Washer 10/08/2019 $50.04 Type of Const: 1 ea Dishwasher 10/08/2019 $25.02 Occupancy Grp: 2 ea Drinking Fountain 10/08/2019 $50.04 Stories: 3 ea Ejectors/Sump 10/08/2019 $75.06 1 ea Expansion Tank 10/08/2019 $12.51 39 ea Floor Drain/Floor Sink/Hub 10/08/2019 $975.78 10 ea Hose Bib 10/08/2019 $250.20 5 ea Ice Maker 10/08/2019 $62.55 2 ea Interceptor/Grease Trap 10/08/2019 $50.04 16 ea Primer 10/08/2019 $200.16 37 ea Roof Drain(Commercial) 10/08/2019 $462.87 202 ea Sink 10/08/2019 $5,054.04 152 ea Tub/Shower/Shower Pan 10/08/2019 $1,901.52 Total $18,820.33 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 byy calling 503.232.1987 or 1.800.332.2344.1 / // Issued By: 4\� � ,/ / e Permittee Signature: "NP1./CUN //Y`�/ 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. NI u,frn b of 1Kt'wiro Plumbing Permit Application " - Building Fixtures REL,t V CU FOR OFFICE USE ONLY Received City of Tigard /�p2 Permit No.: `IS 114 • 13125 SW Hall Blvd.,Tigard,OR 97223 r 2020 Dan Rev y /� �� /- a�d�-�2 = Plan Review Phone: 503.718.2439 43. Fax: 503s96f Y OF TIGARD Date/By' Other Permit No.: T I G A R D Inspection Line: 503.639.4I75 Date ReadyBy: kris: I B1 See Page 2 for Internet: www.tigard-or.gov gl-1�(_��N� DIVISION Notified/Method: Supplemental Information k3,.. P�"-�. v, t - aY ix k;:ti ni,4t llt **I '' q'`t., 4fi. t;...R ...e r..w..,sr ,�w,.ea 4 ffi `..; 3,.. 5 ew construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total ddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) ,+ a u sf r: z^ 2'° mt .r .� .Sw,y"- 'f`^° 4J1'('i '7'vs � +14#^ SFR(1)bath 312.70 ❑ 1-and 2-family dwelling La Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 50032 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 ff t� ;Tt•..,v��_. �a7"vl �f� � � '' .t Site utilities: Job site address: i I q-1 S w Co-I t'�'1 �� Catch basin or area drain 18.76 City/StatelZIP:'�ge el-122'3 Footing•leach line,or trench drain 18.76 1 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name:-� IQ 1 Qjrd �} Inn Manufactured home utilities 50.03 Cross street/directions to job site: �J 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: ( Lot no.: Fixture or Item: Tax map/parcel no.: Backflow preventer 31.27 iea 3'-" ' t;,.;, es') Fp Backwater valve 12.51 � Clothes washer 25.02 � L N �� � Dishwasher 25.02 C to Atr7 C T-e1L D/4 1ST?14- - P 02-1 1 i Drinking fountain 25.02 �r1 Q-0 I q -Q U a�5' Ejectors/sump 25.02 ttr v -- Sfy`4 s "$'i "" Expansion tank 12.51 Na tne: 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 ' '1 �"'' ' , ,'��; ) 0.ta-1 Interceptor/grease 25.02 Medical gas(value:$_) Page 2 Business name: 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 Urinal 25.02 E-mail f{(k't, )t4 M-0 /�T Cr YJ M r„ - r r �'li Water closet 25.02 ',' _ a , . `'". ""nAwts =t u'E,s, It ze Water heater 37.52 Business name: reAov1 P I iunb in and u d.� -4+p 1�(.,(/ Water tin WV 56.29 CC P P g� Address:213/�/�N ^ r ' 0`(l j� /p0 Q�j�t I 1 Other: List0- City/State/ZIP: l l to iii CL`^pus (JJ1{w0�/��8 Subtotal (iyl� „le, . gQ:3lj Minimum permit fee: $72.50 Phone:( ) _/VU{!/ Fes'( ) Plan review (25%of permit fee) CCB Lie.: ✓�t3 4 Plumbing Lie.no.:f�le,(�, State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: l Date. 4// . 6i2t) This permit application esplres If a permit is not obtained within 180 days after it has been accepted as complete. Andrew L Goettel 'Fee methodology set by Tri-County Building Indusay Service Board. L1BuiidioglPermils'PLMU-PermiiApp.do° 10/01/09 44046167(10/02/COM/WEB) CITY OF TIGARD PLUMBING PERMIT 11 4i ,. COMMUNITY DEVELOPMENT Permit#: PLM2019-00245 f G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2019 T- Parcel: 1S136DD02300 Jurisdiction: TIG Site address: 11799 SW 69TH AVE Project: HAMPTON INN&SUITES Subdivision: Lot: Project Description: Interior plumbing for a new 87,872 sq.ft.five-story, 152 room hotel. Contractor: YORK CUSTOM MECHANICAL Owner: DVKOCR TIGARD, LLC PO BOX 21474 1419 W MAIN STREET, SUITE 110 KEIZER, OR 97307 BATTLEGROUND,WA 98604 PHONE: 360-723-0024 503-554-1771 FAX: 971-273-0647 FEES Quantity Description Date Amount 1 ea Drywell,Leach Line or Trench 10/08/2019 $18.76 Specifics: Drain 2 ea Backflow Preventer 10/08/2019 $62.54 Type of Use: COM 1 ea Backwater Valve 10/08/2019 $12.51 Class of Work: ALT 2 ea Clothes Washer 10/08/2019 $50.04 Type of Const: 1 ea Dishwasher 10/08/2019 $25.02 2 ea Drinking Fountain 10/08/2019 $50.04 Occupancy Grp: Stories: 3 ea Ejectors/Sump 10/08/2019 $75.06 1 ea Expansion Tank 10/08/2019 $12.51 39 ea Floor Drain/Floor Sink/Hub 10/08/2019 $975.78 10 ea Hose Bib 10/08/2019 $250.20 5 ea Ice Maker 10/08/2019 $62.55 2 ea Interceptor/Grease Trap 10/08/2019 $50.04 16 ea Primer 10/08/2019 $200.16 37 ea Roof Drain(Commercial) 10/08/2019 $462.87 202 ea Sink 10/08/2019 $5,054.04 152 ea Tub/Shower/Shower Pan 10/08/2019 $1,901.52 Total $18,775.33 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 03.232..4 87 or 1.801.332.2344. Issued By: /.0011119' 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. Jjumbing Permit Application j a ,0' _ , , wilding Fixtures RECEIVED FOR OFFI( F l SI. 0\F1 City of Tigard ReceivN 12 2019 Date/By: �p) ',ii' Permit No. 1 t*"®f Cf lk�iZ 7� 14 41 13125 SW Hall Blvd.,Tigard,OR 972231 y '1 /�` 2 f Plan Review, p Phone: 503.718.2439 Fax: 503.598.1 Date/By: 1-5' [ alOther Permit No.:/fit. ) 17.©�) it Inspection Line: 503.639.4175OF TIGARD Date Re /B turfs. H Seer�F)agee121nor(V (/ 71GARD CITY r g Internet: www.tigard-or.gov In�' � � BUILDING DIVISION Notified/Method. �� a/ C.r Supplemental Information TYPE OF WORK "'���111///FEE* SCHEDULE New construction 0 Demolition For special information use checklist Description I Qty. I Ea. ( Total ❑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 El1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78 1.0 Accessory building 0 Multi-family SFR(3)bath 500.32 N- - Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 tJ JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 1 I'71 l ,qJ Catch basin or area drain 18.76 ^�.� Drywell,leach line,or trench dram 18.76 � City/State/ZIP: �4� I 0 (2 - /O /!�-I 3 Footing drain(no.linear 8.:_) Page 2 Suite/bldg./apt.no.: '1 I Project name: 1-14*rive, /VI 11 s"-DV/ Manufactured home utilities 50.03 Cross street/directions to job site: `� Manholes 18.76 4 1 52 r13,d' v oo 5 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: 15 1A 203 0; Qi Lot no.: Fixture or item: ' ✓ Backflow preventer 31.27 Tax map/parcel no.: DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 f%. ` , Dishwasher I 25.02 �,,, Drinking fountain a 25.02 Ejectors/sump % 25.02 ❑ PROPERTY OWNER I 0 TENANT Expansion tank 1 12.51 �` Name: Fixture/sewer cap 25.02 ,....1t1), Floor drain/floor sink/hub 2,2 25.02 Address: Garbage disposal 25.02 #4 City/State/ZIP: Hose bib i © 25.02 Phone:( ) Fax:( ) Ice maker N 12.51 0 APPLICANT j2CCONTACT PERSON Interceptor/grease trap 25.02 Business name:(� C 112 Wi Peri/1414 i 41 I I v'c Medical gas(value:$ ) Page 2 L `' l Primer 12.51 a Contact name: I i2.vIS `}0r Roof drain(commercial) �j 12.51 Address: Y v V f �1 LT-10 Sink/basin/lavatory 2,t �I 25.02 City/State/ZIP: ---h,I Lam' , v'� g Solar units(potable water) 62.54 Phone:(9) �'.3Z -1 le if I Fax: :( ) Tub/shower/shower pan /5.. 12.51 , E-mail sf 15 o 40.4e.... (1 `I�( �7„M r C, Urinal 25.02_ 4 Water closet 1�© 25.02 ,� CONTRACTOR - Water heater "'r 37.52 Business name: \Jo(V._ C d J7t h"of(41 1 1'L Water piping/DWV 56.29 4 Address: Tr) X Z`E.,111 t Elle Other: Ertvl51A I 25.02 City/State/ZIP: 1�: .2 f '- - O 2 "1 q--1.. 0-7 raze 611444,e(1 Subtotal /I IA/.&A Phone:( 3) 9j7,- l tc,t-1 Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Z b 534\ t Plumbing Lic.no.: - " Plan review (25%of permit fee) l State surcharge(12%of permit fee) 1 Authorized signature: \___,0"--2„.4"--- ...---1QQ 1141. TOTAL PERMIT FEE i Print name: T- V i 1 or V Date: tc„ 'I 1 t 1 This permit application expires if a permit is not obtained within Iho days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.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-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 5233.20 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 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 Plumbin' 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 greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru Cuspidor Vl ater Aspirator 0 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" Isometric or Riser Dia'ram 4 ►a 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./Re frig.Drains Comments regarding fixture work: 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 Water Extractor fees assessed for the sewer increase must be paid before the Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 4 Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard ReceivedB /' �� f/ry Permit No.:pill�ol(�� II 13125 SW Hall Blvd.,Tigard,OR 97223 Plato Q45 Dan Re ((J /I^7 "' 1 Plan Review I Phone: 503.718.2439 Fax: 503.598.1960 �' Other Permit No.: t Inspection Line: 503.639.4175 Date Ready/By:_5_ Juris: Vi See Page 2 for e ��� �� T l G A R D Internet: www.ti and-or. ov �_� g g Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE r[ New construction El Demolition For special information use checklist. - Description Qty. Ea. 1 Total ❑Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 El 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑ Accessory building El Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Catch basin or area drain 18.76 Job site address: 11 ricri1 S,L) ,c1 ... 4(f,.Z t Drywell,leach line,or trench drain / 18.76 >8,1/4 City/State/ZIP: T-1L 1 a t 'e a a 3 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: 14 OkWk.lifa i,.%- Liv 4- So. 1 S Manufactured home utilities 50.03 Cross street/directions to job site: 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: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer a 31.27 .6%54 DESCRIPTION OF WORK Backwater valve / 12.51 4:151 l ` 13 i Clothes washer a 25.02 SQ„0(( in��r i Q`. kiwi t 1 y f Q Wit.+ Etc ilei Dishwasher i 25.02 )5 r `� J Drinking fountain 2 25.02 3d.04 Ejectors/sump 3 25.02 75,06 0 PROPERTY OWNER 0 TENANT Expansion tank / 12.51 /a.s I Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub -31 25.02 d75."pg Garbage disposal 25.02 City/State/ZIP: Hose bib Jo 25.02 D50,20 Phone:( ) Fax:( ) Ice maker L 12.51 6 ,55 0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap cse f,, 25.02 53,04 Business name: Medical gas(value:$ ) Page 2 Contact name: Primer i 6, 12.51 ,Q0e, Roof drain(commercial)d-i;-:, 3 q 12.51 c ,841 Address: Sink/basin/lavatory a Q a 25.02 510540911 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan /'5a 12.51 94/5,) E-mail: Urinal / 25.02 115+0,2 CONTRACTOR Water closet /51 25.02 397D,/5 Water heater 7 37.52 Q‘D, 0 Business name: Water piping/DWV 56.29 Address: Other: -See- ofiltr SItia+ rl 25.02 113,i 4 City/State/ZIP: Subtotal i 1r/Q ,62 Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) VI,e 16 CCB Lic.: Plumbing Lie.no.: State surcharge(12%of permit fee) .I TS5 Authorized signature: TOTAL PERMIT FEE iK75533 Print name: Date: 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:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) •'/�)�C+le /.7 �_ 7 3 9.1 /) -71` !"-.. �.- 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 first$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 Inspections 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 0 Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower i.j -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. 111Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: -Commercial ❑ 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" 3.3 3" Isometric or Riser Diagram peel- Dr.;i ' L 14() ❑ 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)Pea ki.tt Rec.Vehicle Dump Station Shower: -Gang • -Stall Sink: -lav/Bar non-food related 19 8 -Bradley -Com/Serv/Util food related _ 3 -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 afees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet _ )�z� plumbing permit can be issued. Urinal J _ Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2