Permit a CI TY OF TIGARD PLUMBING PERMIT
. a COMMUNITY DEVELOPMENT Permit #: PLM2009 -00304
Date Issued: 10/22/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15875 SW 72ND AVE
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project: Calypte
Project Description: Relocate (1) icemaker and (1) breakroom sink. Rough in for future sink.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Ice Maker 10/22/2009 $12.51
2 ea Sink 10/22/2009 $50.04
PHONE: 503 - 624 -6300 1 12% State Surcharge - 10/22/2009 $8.70
Plumbing
Contractor: 10 ea Minimum Fee Adjustment - 10/22/2009 $9.95
ADDISON PLUMBING Plumbing
27425 S BEAVERCREEK RD
MULINO, OR 97042
PHONE: 503 - 740 -8116
FAX: 503- 632 -1168
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: C �cQ.l ^ LAa Permittee Signature: � A 'l Call 503.639.4175 by 7:00 a.m. for an inspection that business day. i!�C/
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.
. r.
Plumbing Permit Applicatio
Building Fixtures tl ' � : «. 6 � '�. '''aJ "F Ol z ''�o I "ICi USE ONLY,
i u ' '... ,; ;',, : ' ,. ,.w,
e ea r' it rte,,, City of Tigard Received t P ermi No.: / yy��q� 003d X' 1;. i" tY g OCT 2009 Date/By:
PLX an
a
13125 SW Hall Blvd., Ti gar d, OR 97223 Plan Review b�
r Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.S 1 arc , C01 , 1 ,
, .et''% , ;' ), ..,Pg Inspection Line: 503.639.4175 CITY OF 'IIGARD Date Read /B uric: H See Page 2 for
RIGA I s e Internet: www.ti ard -or. ov DING A Ready /By: 1 g
g g R��g� D +e�IG DIUISIOf�! Notified/Method: l � Supplementallnfarmation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 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 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: ) _. 5_ 5 7R '.40,Je- Catch basin or area drain 18.76
Drywe
City /State /ZIP: � q d, d ) 0 X 9 ?/, 7, !l Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: G4 l y r T1 Footin 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
vel PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Namela L-r-r u.,5../.. Floor drain/floor sink/hub 25.02
Address: / 5 -3 5 Se K „et-
cq �k �a1 *30 Garbage disposal 25.02
It
City /State /ZIP: 4
• r a( b l 2(2 4 Hose bib 25.02
Phone: (5-'05) ( 24' . 33 o Fax: (503) 6-2 [- 4 s-S- Ice maker I 12.51
P' APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
p�
Business name: D v „ u 5 ( .1 r � �l�,n 1 2_4- 6 Medical gas (value: $ ) Page 2
Contact name: S 1- (,�)-p 4 d JAL / Primer 12.51
��� """ ^' L7 p � �� Roof drain (commercial ) 12.51
Address: /3-834, p� r 3 12_ Sink/basin/lavatory a 25.02
City /State /ZIP: L4 4 ‘95/14.1.„ J D lZ 7 0 35" Solar units (potable water) 62.54
Phone: (g'� 3 2 ®�-s_ (ea,/ Fax :: (5"173) 61 V- D / it{- Tub /shower /shower pan 12.51
E -mail: 5J f�V , V� d o r u 6 /f c,,, p rf/( 1 Urinal 25.02
Water closet 25.02
CONTRACTOR
• Water heater 37.52
Business name: Aa goy ?1,,.....,..z,,, LLC Water piping/DWV 56.29
Address: 2 "j BLS $ , 1Secwc.,-Gsr e.lc- Qt. Other: 25.02
City /State /ZIP: N Gig_ 91041,2, Subtotal (( ; 2,C J C )
Minimum permit fee: $72.50
Phone: (5o3 )63z 1657 Fax: (Sa3 ' )632.- 1( -- 11 SO
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
I S 175"1 g 3 -F'P6
(� State surcharge (12% of permit fee) v
Authorized signature: h cJt- TOTAL PERMIT FEE ra , 2 0
�A oo r e Date 'L /aQ This permit application expires if a permit is not obtained within 180 days
Print name:
X0 Z r !/ ` after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board.
1. 1Buildin g\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /O2JCOM/WEB) 8 1 • 2 _\ 'n 1 -- Q 0 6 99,02
l ` 8D. SS
l V r 1► rn � _ l \Jw �
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) . r and including $25,000.001'.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 " $379.50 for'the firse$25,000.00 and $1.45 for
hours (minimum charge - 2 hours) • each $100.00'or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000:00.
Additional plan review for revisions 90.00/hr $50,001:00and 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
Jacuzzi/Whirlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
D Tani ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator
❑ Any complex structure as defined in OAR918 -780 -0040.
Dishwasher - Commercial s
Domestic Submit 2 sets of plans with % any.of the above.
Drinking Fountain
Eye Wash Isometric or R Diagram ,
Floor Drain/sink - 2" 0 Isometric or riser diagram is required for new buildings
- 3 . ., - that meet-the•qualiftcatioris abovei- •`
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
ommet di
ns regarding xure; work?, _
- Industrial -C - g g fit
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 1 I increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be aid before the
Washer - Clothes p
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I:\Building \Permits \PLMF - PermitApp.doc 2