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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2010-00032 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/26/2010 Parcel: 1 S134B000300 Jurisdiction: Tigard Site address: 12210 SW SCHOLLS FERRY RD Subdivision: Lot: 0 Project: Coffee Rush Project Description: Installation of (2) floor drains, (1) lav, (2) sinks, (1) water closet & (1) water heater. Owner: FEES FW OR-GREENWAY TOWN CENTER LLC Quantity Description Date Amount PO BOX 790830 SAN ANTONIO, TX 78279 2 ea Floor Drain/Floor Sink/Hub 01/26/2010 $50.04 2 ea Sink 01/26/2010 $50.04 PHONE: 1 ea Lavatories 01126/2010 $25.02 1 ea Water Closet 01/26/2010 $25.02 Contractor: 1 ea Water Heater 01/26/2010 $37.52 BOGDAN 1 12% State Surcharge - 01/26/2010 $22.52 13512 SE MARKET STREET Plumbing PORTLAND, OR 97233 PHONE: 503-254-6932 FAX: Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $210.16 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty odes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not acted within 180 days of issuance, oriLAtodds. suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the les adopted by the Oregon Utility ification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. Yo ay obtain a copy of the rules or i ect questions to OLIN c Ili 503.246.6699 or 1.800.332.2344. Is ued By: Permittee Signature: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on thejob site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures City of Tigard R eceived / r �U Permit No.: �o�o -et�3� III V 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Pl C Phone: 503.639.4171 Fax: 503.598.1960 an Review D Other Permit No. ate/By: pG ()4j.06 9' 00060 Inspection Line: 503.639.4175 I ® See Page 2 for I I (;i A R I) ardor. ov Date Ready/By: / B g g Notified/Method: /� Su pp le mentallmformati Internet: www.ti on TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use check list Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility_ connection) CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 ❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑ 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: 112 S 44-) � ( /f a Fier 6eD Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: C Footing drain (no. linear ft.: ) Page 2 Suite/bldg./apt. no.: I Project name: ((E` Pu.5 fi 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: 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 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 - Floor drain/floor sink/hub Z 25.02 56.0q Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ 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 3 25.02 75 0(p City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 Water closet i 25.02 ag.o2 CONTRACTOR Water heater ! 37.52 5 .6 Business name: (I ig C C I 4 - 14,0,10V el-UM J l P77 Water piping/DWV 56.29 Address: / 3s 2_ 5 ( M Other: 25.02 City /State /ZIP: elit D -T-Z, 33 Subtotal [-f t 1 t��� Minimum permit fee: $72.50 g 7. Phone: (C, 3) J '► ' Far: ( ) Plan review (25% of permit fee) -6) CCB Lic.: J /C/ 7, f 1t Plumbing Li no.: 2 -C9 �� State surcharge (12% of permit fee) A9,t5 '01 Authorized signature: /l H / l -� A o o �le � TOTAL PERMIT FEE pins MO / Print name: l�� ,� ,V ©� 9/VI Date: / �� his permit application expires if a permit is not obtained within 180 days l I 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 $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 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 $5,000.00 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 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 ", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees * . Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font Bath -"rub/Shower as New exterior plumbing site utilities for any complex structure as defined in OAR918- 780 -0040. - Jacuzzi/Whirlpool Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. • Drive Thru ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain dirr Eye Wash Isometric or Riser Diagram Floor Drain /sink - 2" a ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. - 4" Car Wash Drain Garbage - Domestic Disposal - Commercial - Industrial Comments regarding fixture work: Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rcc. Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory i - Bradley - Commercial *Note: If the fixture work under this permit results in an - Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: I:\ Building \Permits \PLMF - PermitApp.doc 2