Permit CITY OF TIGARD PLUMBING PERMIT
"'a COMMUNITY DEVELOPMENT Permit #: PLM2010 -00050
i G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/17/2010
Parcel: 2S110DB01300
Jurisdiction: Tigard
Site address: 15298 SW ROYALTY PKWY
Subdivision: Lot: 0
Project: Legacy Clinic
Project Description: Instlal (1) map sink in janitor's closet.
Owner: FEES
PARR - FRANKLIN LLC Quantity Description Date Amount
1300 SW 5TH #2815
PORTLAND, OR 97201 1 ea Floor Drain/Floor Sink/Hub 02/17/2010 $25.02
PHONE: 1 12% State Surcharge - 02/17/2010 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 02/17/2010 $47.48
Contractor: Plumbing
DETEMPLE COMPANY INC
1951 NW OVERTON ST
PORTLAND, OR 97209
PHONE: 503 - 227 -2641
FAX: 503- 274 -7686
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions • •UNC by calling 503.246.6699 or 1.800.332.2344.
Issued 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 the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FEE /16 /2010 /TUE 03:311 PM FAX Nlo, 5032747686 P, 001/003
n I�E�
Plumbing Permit Applic Z3Li . 23g0
Building Fixtures FEB 1 6 2010 foil OFFICE USE ON!.Y
Cl of Tigard Received to
`� g Date/By: ,
i i ' erm;t No.: (�/ 1 / � w ecei D
.e 13125 SW Hail Blvd., Tigard, GT F TIGARD
9
i a,,
Phone: 503,639.4171 FaxBIRMING DIVISION DateiBy:iew Other Permit No,: a1pj ,_.. a 2__
• T 1 GARD Inspection Line: 503.639.4175 Data Ready/By: luri• Sec Page 2 for
Internet: www.tigard or.gov Notified/Method: . tej , Supplemental information
. ( . , c . 1 !� •Veil WQP. 4• 1 ,...,,` i 1. ke'atl ry... .i �I + P`....tu, i .:i .,:y l - l " V. : �.t:` i, '.
ry
r t ' 1 Description ' Forspec� - Total
I, ,1 w ay,,. „'•r,, ..
['New construction ii Demolition p 1 Qty 1 1
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
t; ^..r ` CA •E A :d + Nrisl il`"ttdd 1 �'�`�'R� d.r. p SFR ( 1) bat 3I2.70
1: 1 • and 2- family dwelling ® Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 50032
❑ Accessory building [] Multi - family
_ _ Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler (, sq. ft.) Page 2
',TOR' SITE I • FbRiv tl ,ION ANA �LOGATfQN 5, '' � I , t F Site utilities:
1 I ,
oh site address: 15298 SW Royalty Pkwy Catch basin or area drain I8.76
Drywell, leach line, or trench drain 18.76
City /State/ZIP: Tigard, OR 97224
Footing dram (no. linear ft.: ___) Page 2
Suite/bldg. /apt. no.: Project name: Legacy - King City Clinic Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76 µ
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 o f 6.1/674p0i3c70 )3ackf1& v preventer 31.27
i 2 R ,: 4 ri' .�(° 1 )4(WOl l�l a } 5 �1' rd� W r t- Backwater valve 12.51
C
m, -/ t �.» r.^ .f✓ni ::•, r J...�. :,�+(, -.t• -;. 4n, ?.re v. t Clothes washer 25.02
Add (1) atop sink in janitors room Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Is�..A01s '0TY OW 4iiit a •. .I` Vv; " r i ❑ TZ)N..N�' . , A
l} ,,I t Expansion tank 1151
Fixture/sewer cap 25.02
Name:
Floor drain /floor sink/hub 25.02
Address: Garbage disposal 25.02
City /State/ZIP: - Hose bib J 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
�i , (g;;AP)RII6AN'I'3 iy ;, 1# .r•. n r ❑ CT , doNTA PiRSbN n41i :4,s Interceptor /grease trap 25.02
Business name: DeTemple Co, Inc Medical gas (value: S ) Page 2
- Primer 12.51
Contact name: Linda I. hlval
Roof drain (commercial) 12.51
Address: 1951 NW Overton Sink/basin/lavatory 1 25.02 25.02
City /State/ZIP: Portland, OR 97209 Solar units (potable water) 62.54
Phone: (503) 227 -2461 Fax: • (503) 274 -7686 Tub /shower /shower pan 12.5I
Urinal 25.02
E-mail: 1.hval@detetnple.com
r� Water closet 25.02
'' , '' ;'(�i bikt Iuab ti ° 4 ! ! k I : , ` ( ; y4 k ? 37.52
_ _ _ .- _ .. _.._. Water heater
usltless nary' ` D eTemple Company, Inc Water piping/DWV 56.29
Address: 1951 NW Overton Street
Other: . 25.02
c ny/state/z Portland, OR 97209 Subtotal 25.02
Phone: ( P: 503.227.2641 F: 503.274.7686 Al 'A palmit fee: 872.50 72.50
Ljc: # 26 -25PB CCB # 2510 �' Plan review (25 %ofpermit fee)
CCB Li c.: - State surcharge (12% of permit fee) 8.70
Authorized signature •
- � i' e TOTAL PERMIT FEE 81.20
This permit ap expires if a permit is not obtained within 180 days
Ytint name: Linda I. Hval Date: 2/16/10 after it has been accepted as complete.
l - 'Fee methodology set by Tri County Building Industry Service Board.
I: 18uildine \PcrmIts''t-MU- PermitApp.doc 10/01/09 440- 4616T(: 0102/COM/weB) ! 6 �to .4'2° ilt,CO
FEB /16 /2010 /TUE 03.31 PM DETEMPLE FAX No, 5032747686 P. 002 /003
Plumbing Permit Application. - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
.,, , c. n? In -aw t ? , !S F "a w Y
>SliteUtilities j ' ' .r,. Qty ,A F ar T S o y ,, : �I ernu e`e.'w.t,�,,.f., ;'.d,' = , • Ne• ti ,
Footing drain - 1" 100' 50.03 0 to 2, $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 _ $169.69
3,60I to 7,200 $233.20
Sewer - 1st 100' • 62.54 7,201 and greater 5327.54
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 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain each additional 100' 37.52 55,001.00 to 510,000.00 572.50 for the first 55,000.00 and $1.52 for
i 91),!.,.,,, e ' 8 ota ,i each additional $100.00 or fraction thereof, to
Qtbie5r Ins 'ectious o�r,Eees . ,. ; fe ( :f ,_.,, :, t; and including 510,000.00. _
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first 510,000.00 and 51.54 for
which no fee is specifically indicated 90.00/hr each additional 5100.00 or fraction thereof, to
minimum charge- 1/2 hour) and including 525,000.00.
Inspections outside of normal business 90.00 /hr $25,001,00 to $50,000.00 $379.50 for the first $25,000.00 and 51.45 for
hours (minimum charge -2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr ^^ and including 550,000.00.
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 5100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", -,,,, <lit Yrl1i Ri :ew fgkr, ' tt0)1 $X#4la; 0 9 '
'7r ,.a. ..
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.
(uatiti by (Fixture Work:Perforined ;. ❑ Any new commercial building with water service 2" and
Fixture Type: r Repla greater, except systems designed and stamped by licensed
' ; Previous Capprd Aide _. Exlsting..e engineer.
Ba. tistry/Font .- - ❑ New exterior plumbing site utilities for any complex structure
Bath -Tuh /Shower - as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool 0 Medical gas and vacuum systems for health care facilities_
Car Wash -Each Stall ❑ Any multipurpose fire sprinkler system.
-Drive Thru
❑ Any complex structure as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator
Dishwasher -Commercial Submit sets of plans with any of the above.
- Domestic
Drinkin_ Fountain G4 t }g ^ w ' r " "' q i i
Eye Wash 1 " $44Iet141G. > Wiser b a 4tb f 1 /4 ^` a • •s
Floor Drain/sink • 2" - 0 Isometric or riser diagram is required for new buildings
- 3 " that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
- Industrial
Comments regarding fixture work:
Ice Maeh./Refrig. Drains
-
OiI Se•arator Gas Station)
Rec. Vehicle Dum s.Station
Shower -Gang •
-Stall
Sink - Bar/Lavatory
- 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
Swimmin: Pool Filter fees assessed for the sewer increase must be paid before the
Washer-Clam plumbing permit can be issued.
Water Extractor
Water Closet - Toilet -
Urinal
Other Fixtures:
http:/ /www,tigard- or.gov/ city_ hall / departments /cd /does/PLNIT- PermitApp2doc