Permit I. ,I; CITY OF TIGARD PLUMBING PERMIT
` - COMMUNITY DEVELOPMENT Permit #: PLM2010 -00085 I
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/23/2010
,TIGAAD: Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16505 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Liberty Mutual
Project Description: Install waterline for icemaker & water cooler.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 2 ea Ice Maker 03/23/2010 $25.02
PHONE: 503-624-6300 1 12% State Surcharge - 03/23/2010 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 03/23/2010 $47.48
Plumbing
Contractor:
DEAN WARREN PLUMBING & REMODELING
INC
PO BOX 14701
PHONE: 503 - 236 -4152
FAX: 503 - 296 -2218
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 N ' cation Cente . ose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir questions to OUNC b • mg -,' - 246.6699 or 1.800.332.2344.
Iss ed By: ` 1 Permittee Signature: / / �/
Call 503.639.4175 by 7:00 a.m. for an inspection that b .s ess day.
This permit card shall be kept in a conspicuous place on the job site p [completion of the project.
Approved plans are required on the job site at the time o each inspection.
Plumbing Permit Application
N1 M; ,'�' ��.p aG�a Gxk"�`�`, ��i�.n,°tr i"'kl'�'` 7 " a) , r� 3 � � y � l ri -i
Building Fixtures RECEIVED ' D '`° A -r Ls cM � #yJs � 1 4!'��Ixvn �iW f :
t City of Tigard Received 3 as ,o permit No.: �
q Date/By: /Q
1 3125 SW Half Blvd., Tigard, OR 9 ,,' 2 2 ,, plan Review
'`' ® Pho ne: 503.639 Fax: 503.598.1960 / 11 f ti Other Permit No.: �J, 7
' ��.
Date/By: ��l�a� /�"�J f
Inspection Line: 503.639.4175 CITY Ready/By: furls: ® See Page 2 for
I I(iA1.l) r G /,Ry
-. Internet: www.tigard-or.gov Bari Dr ® FT Date Ready/By:
Supplemental Information
T YPE OF WOR v t�i6' ° - - • FEE* SCHEDULE • •
❑ New construction ❑ Demolition For special information use check list
Description Qty. 1 Ea. 1 Total
F.-Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ 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: P.:5 - t - 72 Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: l . GP- 5 72-4-( Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: in.t 6fej Y } t.-Ttu1FL_ 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
.4-57-c-) �� CA--a f.� //11 L 1.12_ ,- j c e 044- CAA-K• Dishwasher 25.02
C ce>'I Drinking fountain 25.02
Ejectors /sump 25.02
' ❑ PROPERTY OWNER 'I , ' • ❑ TENANT , . Expansion tank 12.51
Fixture /sewer cap 25.02
Name: /°,. \ fr.- 57
Floor drain/floor sink/hub 25.02
Address: (5 5 S w S, U,; Cl .Ph .--y
Garbage disposal 25.02
City /State /ZIP: Pct _ OA. ' 7 Hose bib 25.02
Phone: (5•) ) C y. y C 'j co Fax: ( ) Ice maker 2 12.51 2 7(j 2
❑ APPLICANT ❑ 'PERSON Interceptor /grease trap 25.02
Business name: 0.,_,.5...L.- �arr�• - / /(,,. / c7 '�a.k 04./ Medical gas (value: $ ) Page 2
Contact name: X ,AS Primer 12.51
-' a Roof drain (commercial) 12.51
Address: / 0 i icy /V 7c / Sink/basin/lavatory 25.02
City /State /ZIP: /e -1- cm . 4 7 2. . ' 3 Solar units (potable water) 62.54
Phone: ( r ) -,? ?L-( e C Fax: : ( �) 2 5 C--2-.4 Tub /shower /shower pan 12.51
p L , ' /a 0,4
_ Urinal 25.02
E -mail: ��o Cvr� J
. ' CONTRACTOR Water closet 25.02
//�� I // Water heater 37.52
//
Business name: Ot./�yy P x,41 �ot•,c,n6 / Water piping/DWV 56.29
Address: (, G . /5,0)c, /c, 7 l Other: 25.02
City /State /ZIP: Per 7- CA' S 72S') Subtotal 2 . c2-
Phone: ( ) 7g0 - S y Q( Fax: ( St") ) g G -7- 2- / 8 Minimum permit fee: $72.50 7 6p
CCB Lic.: / 9" g/ `j Plumbing Lic. no.: 2 C -73 6". Plan review (25% of permit fee)
State surcharge (12% of permit fee) b_
Authorized signature: / 70 TOTAL PERMIT FEE S • PO
Print name: �,,-^ 1 a S Date: 3 •- 2 ?- A o This permit application expires if a permit is not obtained within l k0 days
S 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 dram - 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_Ins ections or Fees Qtr Fee (ea) Total 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 ", • 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 El 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 - Tub /Shower ❑ 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 Stall ❑ 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
Eye Wash Isometric or Riser Diagram - •
Floor Drain/sink - 2" ❑ 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)
Rec. Vehicle Dump 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
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:
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