Permit //0 COCea4 floor otizoW IC( (iNctiX &Arc) p4N)Itr\Q"-.
l CIT Y OF TIGARD PLUMBING PERMIT
ir COMMUNITY DEVELOPMENT Permit #: PLM2010 -00151
13125 SW'Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/11/2010
�A Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 450
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: ACE American Insurance
Project Description: Relocate (1) sink & (1) garbage disposal. Replace (1) dishwasher. Add (1) ice maker, (2) water
heaters. 6/29/10 added (1) 2" floor drain, (1) ice maker and (1) primer.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Dishwasher 05/11/2010 $25.02
PHONE: 503-624-6300 1 ea Garbage Disposal 05/11/2010 $25.02
1 ea Ice Maker 05/11/2010 $12.51
1 ea Sink 05/11/2010 $25.02
Contractor: 1 ea Lavatories 05/11/2010 $25.02
DEAN WARREN PLUMBING & REMODELING 2 ea Water Heater 05/11/2010 $75.04
INC 50 da Plumbing Permit 06/29/2010 $50.04
PO BOX 14701 6 da 2% State Surcharge i • • ' e $6.00
PHONE: 503 - 236 -4152
FAX: 503- 296 -2218
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $243.67
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: / i /
Call 503.639.4175 by 7:00 a.m. for an inspection that,busil)ess day.
Thispermit,card shall be kept in a conspicuous place on the job site until +c'ompletion of the project.
,Approved plans are required on the job site at the time of each inspection.
•
•
Plumbing-Permit Applicati ...›.
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Building Fixtures v ° 1 ��ryry� ��I� � ����, FOR OFF u ICE�IUSEi � OyL1 �p��: „ l �'„t
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City Of Z lgilr(� � � l �<?" :lat er v ed
Q 13 Permit No.: i ?i /j,�
v 13125 SW Hall Blvd., Tigard, OR 9722 y. A.,- • , ? ' Plan Review:
C Phone: 503.639.4171 Fax: 503.598960 V � � Other Permit No.: .�--
Date/By: •
Inspection Line: 503.639.4175 . � Date ReadyBy: 7ur ®See Page 2 for
fIGARD
Internet: wwWaigard- or:gov f , e , , ,, Notified/Method: 'r(;. Supplemental Information
::TYPE,.OF WORKS f>��`'v_ s _ ' _. FEE *• SCHEDULE !s �.. } i
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. I -Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
• CATE GORY' OE "CONSTRUCTION 'e ' i 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: /).101 s ci✓ G S '3- w 4 Catch basin or area drain 18.76
Drywell, leach line, or trench dram 18.76
City /State /ZIP: 4 722 e/
Footing dram (no. linear ft.: ) Page ;2
Suite/bldg. /apt. no.: I 'Project name: /fig 't a ti 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
• -- ,•,: Backwater valve 12.51
-' : . - DESCRIPTION Or. WO ,. ` f
/ / Clothes washer 25.02
4'ida J -roe.. e ∎rlafj� / 11. - ' ' VG Dishwasher 25.02
F- 16%5 Ar s" 1'71 Drinking fountain 25.02
Ejectors /sump 25.02
',' . ® PROPERTY OWNER * I... 0 TENANT.,r ,. Expansion tank 12.51
Fixture /sewer cap 25.02
Name: AA_ ryyy/- /�, Floor drain/floor sink/hub / 25.02 5- i p`t<
Address: / `7 1 S U S •w S egtro a ,4- � "'a- G arbage disposal 25.02
/
City /State /ZIP: ,,c4--f, G4. S 7 21 cr Hose bib 25.02
Phone:,( ) Fax: ( ) Ice maker / 12.51 ) .., 5:1
=;CONACT 1 PER3r 502
. ... ,❑ .APPLICANT, >" - "° µ ❑T ON Interceptor /grease trap 2_
Business name: Medical gas (value: $ ) '.Page,2
Primer / 1.2:51 lit - c
Contact name:
Roof drain (commercial) . 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone:, ( ) . Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
4. ' - 4CONTRACTOR, > ' 1 1
Water closet 25.02
. ; ' ��' %� 37.52
Business name: � i,/,e� Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: . Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 51 0
Plan, review (25% of permit fee)
CCB Lic.: • Plumbing Lic. no.:
State surcharge (12% of permit fee) (p -
Authorized signa e• (l ., TOTAL PERMIT FEE S�
This permit a a is obtained within 180 days
plete.
Print name: - Date:� -Z q_(,v after n it ex has been if accepted a not com
• A *Fee methodology set by Tri- County Building Industry Service Board.
I:\Buildin \Permits LMU Per it
g pp.doc 10/01/09 440= 4616T(]0/02/COM /WEB)_
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire. Suppression Systems:
i Q ` Fee!(ea) Total S (1.uai'e �Foo
iS><teaUt><lrties t ge ` P ermi t' ee � • :,•
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 5233.20
Sewer - l st 100' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - lst 100' 62.54 Medical Gas Systems
Water Service -each: additional 100' 37 "52
Valuation P.erm><t Fee, ;._
Storm & 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
�Qty:� Fee (ea) ;Total:' each additional $100.00,or fraction thereof, to
r I
O theYispec - ionsyoree'S } and including $10,000:00:
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.011and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00:orufraction 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 /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 Plumbin Installatlions
gt'
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 (FixtureyWork`Perforthed. ;; ❑ 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 /Showower r ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower 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:
I:\Building\Permits\PLMF- PermitApp.doc 2
•
Accumulative Sewer Tally Parcel # !2S101A®03200' ': 0
"Tenant Name Arnj rust ** *RL 7ISLD46 /29%.10 * * *" This SWR# 1N /A _ ` ,� ` ,� t' g {
� na 9., 93, n ��.3 tkhS�,..e&
Site ti Nt§09 SW# 68th l vy #4601, r( v Z, r ` fir, This PI M# 2010 00097 ' a s 1,
Fixture Value Previous . Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # v alue #s values
Ba - tiscr Font 4 `"
Bath - Tub /Shower 4 - e, t, 0 ,.' 0 ' fa, M 0 0 0
- Jacuzzi /Whirlpool 4 Ili i W- 0 r iign 0 , 0 0 0
Car Wash - Each Stall '6 03
z,, iti 0 *'411; 0 FIRM 0 0 0
- Drive through 16 2 0 i 1 0 0 0 0
Cuspidor /Water Aspirator 1 ; , .„ 0 ;,, .° `. 0 ' * §�w 0 0 0
Dishwasher - Commercial 4 iallid 0 , iw { 0 ,C 4 w ' ! 0 0 0
- Domestic 2 f ! !'' '. 11 0 `. 0 Z:, r a 0 0 0
Drinking Fountain 1 ' ` ' ' 0 ritti 0 i i ,. 0 0 0
E.ye Wash ' , ' .1' 0 c , '' fi' 0 ! O 0 0 0
Floor Drain /Sink - 2 inch . 2 F 0 _ ; ,� ws � ,, _,. 0 15)„ 2 1 2
- 3 inch 5 _. .-? �` 0 0 '.4"'1,; 0 0 0
- 4 inch 6 A, lil 0 t 0 ViTia, 0 0 0
- Car Wash Drn 6 igg.did 0 „ , .e ti, „ `., 0 Nit „ ",s 0 0 0
Garbage Disposal
- Domestic (to 3/4 1 -IP) 16 ' '1, 7, ,N1 77 1 . 1 0 t , 4t'mf `;. 0 ;14;1 0 0 0
- Commercial (to 5 I -11) 3 !" 0 ;,p .. 0 ix °; ,` 0 0 0
* i _ a
- Industrial (over 5 FIP) 42 i , ; g n 0 � _,: 0 "`s
* .. w 0 0 0
Ice Machine /Refrigerator Drain 1 11111 ~ = 0 0 1.;; 1 1 1
Oil Sep (Gas Station) 6 jab 0 , `„ . - 0 , : ,,, , ,7.-4,, i i`,Y,:tli 0 0 0
Rec. Vehicle Dump station 16 ,G+,,.� n 0 0 ?ri�s �.F:: 0 0 0
Shower - Gang (per head) 1 0 E. .- ' ` 0 iniA7: o 0 0
- Stall 2 , I 4 , 0 e
i ' 2 1 a=' 0 -1 -2
Sink - Bar /Lavatory 2 itb, : „ 0 , 1 1, i ; 2 11111111',1 0 4 -2
- Bradley 5 itlaitka 0 m.. 0 '-- A :- : ,- = ` 0 0 0
� 0
x - 0 " `` ` 0 '`'' ::z�,,_
- Commercial 3 ;, � _- ,z
0 0 0
- Service 3
} FIN 51, 3 1 3
;di:, A :::.'":.„,1 _ ._ 0 k °, ,�.��
Swimming Pool filter 1 MIN: 0 ,A, ,k _ 0 s A w.a'. 0 0 0
Washer - Clothes 6 , _ , i , 0 erg" " r Tri 0 :;? , 0 0 0
Water Extractor 6 s,$ .0 E¢- i<_ 0 e =,:€ 0 e .F`�'�`;; 0 0 0
Water Closet - "Toilet 6 MAW 0 1.... 6 . i : i, 0 -1 -6
Urinal 6 tl4 141t 0 0 a .1,1;44 0 _' gl� }.�. 0 0 0
Previous EDU Count q It s� 0 0
" a "
Capped EDU Credit , t ;� 0
'IOTA LS _ 0 0 3 10 3 _ 6 0 -4
Current Fixture Value -4 divided by 16 = -0.3 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -4 divided by 16 = -0.3 over (under) $ (1,080.00)
Enter EDU Change Here �O 3' p.
Notes: ** *CREDITS * ** 5/11/10, Revised to include capped shower stall. 6/29/10, Revised to include floor drain'and ice maker•(B.T.).
Authorized Name /Signature s D e bbieYA "damtiliti x , g! „ _, „;, a o, Date 4 /2/2010 & /T10&`6/, '` ”,
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City ofTigard Building Division to redeem credits towards future system development charges.
I:\ Building \Sewer Tally \SewcrTallySheet- 3600.xls 06/25/08
ii,A CITY OF TIGARD PLUMBING PERMIT
,;:w; V
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00151
[ G Alt D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/11/2010
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 450
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: ACE American Insurance
Project Description: Relocate (1) sink & (1) garbage disposal. Replace (1) dishwasher. Add (1) ice maker, (2) water
heaters.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Dishwasher 05/11/2010 $25.02
PHONE: 503-624-6300 1 ea Garbage Disposal 05/11/2010 $25.02
1 ea Ice Maker 05/11/2010 $12.51
1 ea Sink 05/11/2010 $25.02
Contractor: 1 ea Lavatories 05/11/2010 $25.02
DEAN WARREN PLUMBING & REMODELING 2 ea Water Heater 05/11/2010 $75.04
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 $187.63
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 • - • - - r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or • ect questions to OUNC b • - 'ng 13.246.6699 or 1.800.332.2344.
I sued By: / d / e/ / ,� /,{ y Permittee Signature: /1/
:�/�fJ -44 A
Cali 503.639.4175 by 7:00 a.m. for an inspection that bus' -s day.
This permit card shall be kept in a conspicuous place on the job site unt' cmpletion of the project.
Approved plans are required on the job site at the time of e ch inspection.
Accumulative Sewer Tally Parcel # 2S101AD03200
Tenant Name: ACE American Insurance This SWR# N/A
Site Address: 12909 SW 68th Pkwy #450 This PLM# 2010 - 00151 • '
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
•
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
1.1p: Wash 1 0 • 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
-4inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -IP) 16 0 0 0 0 0
- Commercial (to 5 I -IP) 32 0 0 0 0 0
- Industrial (over 5 I -1P) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar/Lavatory 2 • 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 • 0 0 1 3 1 3
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0.4 6.4
'l'O'I'Al S 0 0 ' 0 0 1 3 1 -3.4
Current Fixture Value -3.4 divided by 16 = -0.2 Current EDU 1 EDU = S 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -3.4 divided by 16 = -0.2 over (under) S (720.00)
Enter EDU Change Here -0.2
Notes: ** *CREDITS FROM P1.,M2010- 00097 * **
Authorized Name /Signature: Debbie Adamski Date: ' 5/11/2010
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \Building \Sewer Tally \Sewer l'allyShect- 3600.xls 06/25/08
Plumbing Permit Application
Building Fixtures �:� �& ,. ,�, �,,1 �)a G)I I Ic1:�1n1 3/4�`I y w �� ,�M,, �
vtx t L ieki4a141 �. gig .ail
'' City of Tigard Received �� Permit No.: ' p20 /Q co/5 7
/� C�II 5/
v 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ^
. Date /By:
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No. ,(/+ 0'400 .9 7
Inspection Line: 503.639.4175 Dat Read /B Ju ris: ® See Pa e 2 for
I'I( i\R1 t Ins
1 Ready /By: B
': I . . :7.7 Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
0, Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I- 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: / `, C j ? 5-' w GEL') 1,2,-4 6, q
Catch basin or area dram 18.76
City /State /ZIP: tr "� �,� C 7 -<f Drywell, leach line, or trench drain 18.76
�` Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: �C e
�' 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 12.5 l
Clothes washer 25.02
A Q- / ce7Ic / St' ' °% G. - n, P Dishwasher / 25.02
/4 4, I St - -A Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
0 - Fixture /sewer cap 25.02
Name: i .r-s)s✓ Tai >f Floor drain/floor sink/hub 25.02
Address: l 5 3 5� s C.- Se) c/�;
'. /�--/iva / •
r�
Garbage disposal 25.02
City /State /ZIP: / C' /"1. Grp , 5 j' 7 2 L i/ Hose bib 25.02
Phone: (y• - , 'S ) GAL/ -G j c' 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 .. 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 2 37.52
Business name: /2,7.4),..." Wol- -ff.,, -, 7 u J � ,L �` w,a , / Water piping/DWV 56.29
Address: J" - C, (s / (' fi e / Other: 25.02
City /State /ZIP: f2 ,'-•j-,. G , `7 J' Subtotal
Phone: ( - 5) - 7 W- 94/ c`/c Fax: (?,,:)) 29C Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: / 5 1 Plumbing Lic. no.: 2 i;•- 7 36 /-'L3
Authorized signature: Oe..eAl- State surcharge (12% of permit fee) c-7
TOTAL PERMIT FEE II/ /'
This permit application expires if a permit is not obtained within 180 days
Print name: S -CrQ i a Date: 5 - t cJ after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits\PLMU- PermitApp.doe 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
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
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 - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR918- 780 -0040.
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
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 / 1
•
- 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:
1:\ Building \Permits \PLMF - PermitApp.doc 2