Permit CITY OF TIGARD PLUMBING PERMIT
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2 . COMMUNITY DEVELOPMENT Permit #: PLM2010 -00201
Date Issued: 06/18/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S110AA02000
Jurisdiction: Tigard
Site address: 14255 SW PACIFIC HWY
Subdivision: Lot 0
Project: 99W Sidewalk Infill Project
Project Description: Irrigation backflow device.
Owner: FEES
WEC97H- OREGON -2 INVESTMENT TRUST Quantity Description Date Amount
BY COMMACK LAND DEVELOPMENT, 7 PENN
PLAZA, STE 618 1 ea Backflow Preventer 06/18/2010 $31.27
1 12% State Surcharge - 06/18/2010 $8.70
PHONE: Plumbing
41 ea Minimum Fee Adjustment - 06/18/2010 $41.23
Plumbing
Contractor:
CASCADIAN LANDSCAPERS, INC.
21510 NW FARM PARK DR.
HILLSBORO, OR 97124
PHONE: 503 - 647 -9933
FAX: 503 - 647 -9922
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 to OUNC 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.
Plumbing Permit Application
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of , 4 ty Ti and JUN 1 8 Q 2 010 Received /77o JU DateB : T" Permit N �L�9a0�0 'Q
' a 13125 SW Hall Blvd., Tigard, OR 97223 Y
�t l ®, Plan Review
Phone: 503.639.4171 Fax: 503.598.190-Ty tt ff�� Other Permit No.:
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aY* t r I ns p ���/ L/ ection Line: 503.639.4175 t' Date/By:
Date Read B Juri See
0;1 GnRD; BUILDING ``��) i t v DIVISION Iran at cr, Internet: www.tigard-or.gov UUILUt � �')VISIOi'i Notifie
Y d M etho Y d: �t Supplemental e 2
B lnf ormation
, TYPE OF WORK ,. . FEE *. SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. 1 Total
❑ Addition/alteration/replacement ❑ 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 Z 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:
9.Z - s S-f,rl / C Catch basin or area drain 18.76
Job site address: s `� /�/ y� C Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard, OR 97223 .
Footing drain (no. linear ft.: ) Page 2
_
-- Suite/bldg. /apt. no.: • 1 Project name: 99w Sidewalk Infill Proje Manufactured home utilities 50.03
Cross street/directions to job site: 99 w and SW Gaarde Street Manholes 18.76
Backflow is closes to / ne/LF 0 eir / 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 I 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
backflow Dishwasher 25.02
/1✓ee.0j1 /i/EiQ. /1/E6/L & //%,t7J/.tl� Wail Drinking fountain 25.02
Ejectors /sump 25.02
0 PROPERTY OWNER I ' ❑ TENANT Expansion tank 12.51
•
Name: City of Tigard Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: 13125 SW Hall Blvd.
Garbage disposal 25.02
City/State /ZIP: Tigard, OR 97223 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
' ® APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: Cascadian Landscapers, Inc. Medical gas (value: $ ) Page 2
. ,,_ Primer 12.51
Contact name: Art Meisner
Roof drain (commercial) 12.51
Address: 21510 NW Farm Park Drive Sink/basin /lavatory 25.02
City /State /ZIP: Hillsboro, OR 97124 Solar units (potable water) 62.54
Phone: (503) 647 -9933 Fax: : (503) 647 -9922 Tub /shower /shower pan 12.51
E -mail: art@cascadianlandscapers.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Cascadian Landsca ers, Inc. Water p g/ 1 to DWV 56.29
Address: 21510 NW Far 1 ' ar 1 t
Other: 25.02
City /State /ZIP: Hillsbt o, OR ' 1 Subtotal 31.27
' one: (503) 647 -99 3 Fax: (503) 647 -9922 Minimum permit fee: $72.50 72.50
1 v CCB Lic.: 51443 A-0 0 Plumbing Lic. no.: I 185 07/30 • Plan review (25% of permit fee)
1111111111/ State surcharge (12% of permit fee) 8.70
Authorized signature: i- TOTAL PERMIT FEE 81.20 1
-�' r
This permit application expires if a permit is not obtained within 180 days
Print name: Art Meisner L� /� Date: 6 -15 -2010 after it has been accepted as complete.
'�� � ��� �D / � / �� Service methodology set by Tri -County Building Industry Se�ce Board
I\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02 /CO,'WWEB)
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 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 ", 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 - 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 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
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 " 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:
http: / /www. tigard- or.gov /c ity_hal I /departments /cd/docs/PLM F -Perm itAp1doc