Permit PLUMBING PERMIT
CITY OF TIGARC
COMMUNITY DEVELOPMENT
Permit #: PLM2010- 00195
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/29/2010
�! Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 92
Subdivision: - Lot: 0
Project: Fantastic Sam's
Project Description: Setting of previously roughed in (5) sinks and (1) water heater. Rough -in and setting of (1)
clothes washer.
Owner: FEES
13500 PACIFIC CORP Quantity Description. Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS
INC, 21500 HAGGERTY ROAD, SUITE 100 1 ea Clothes Washer 06/15/2010 $25.02
PHONE: 5 ea Sink 06/15/2010 $125.10
1 ea Water Heater 06/15/2010 $37.52
1 12% State Surcharge - 06/15/2010 $22.52
Contractor: Plumbing
WOODBURN PLUMBING
PO BOX 252
WOODBURN, OR 97071
PHONE: 503 - 981 -4053
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
•
Total $210.16
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 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 obtai ...py of the rule -"
or direct questions to OUNC by calling 503246..609 or 1.800.332.2344.
Issued By: / Permittee Signature: /
mss= L.
Call 503.639.4175 by 7 :00.a.m. for an inspection th. .usiness 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 Appl 202004/6—e0.0 Ll1 'd ` j� . ,,,, ,,�, ik,, X13 ,,, 4, ,t,S,', ti1 i , ,,,t,4, tF o e' � ��� �+�v01TM s y� , «a r µ 4,, + q
•
Building Fixtures' 4 , °t 10 WiO FICC USEv'ON t.' :"� y k;11�y ,4 ' r
City of.Tlgard i EN 15 2010 Received : O �� `D PerinirN
q 13125 SW Hall Blvd Tigard; OR 97223 Date /B P lG- 'UO LgS .
Plan Review
® Phone: 503.632:4171 Fax;, 503.598 Y¢6i OF TIGARD Date/By: Other Permit No.((PD ��
639
Inspection, Line: 503..4175 D ate Read /B Ju rist ®S ee'Pa e 2 for
1"r I cy A It D BUILDING DIVISION Ready /By: g'
, Internet: ww.w.tigard- or.gov . Notified/Method: . Supplementallriformation '
.: TYPE: >;OF - WORK FEE* 9SCHEDULE' .,
'111 -New construction ❑ Demolition For s • eclat information, nse checklist'
Description Qty. Ea. Total
Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings'(includes 100 ft. for each - utility connection)
' : CATEGORY • O F� 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 ❑
- Fite sprinkler,( sq. ft) ' , = Page'2 ;
. JOB; SITE INFORMATION AND LOCATION ' • Site utilities:
Job site address: /c „ cz.) i G /Yu/ Ff 9 Catch basinorarea'drain 18.76
Drywell leach line, or trench drain 18.76
City/State/ZIP:
Suite/bldg. /apt. no.: Project name:ts ( f f Manufactured home utilities 50.03
Cross street/directions'to job site: • Manholes 18.76
Rain drain connector 18.76
SanitMy 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
Tax map /parcel no.: V ' —. 0 6 5 ' preventer 31.27
• • " DESCRIPTION OF WORK • 9 g •
Clothes washer 25.02 p2..
® i
• ® PROPERTY OWNER TENANT •,'
- M1
• Name: p 1
si o• . 25.02
• Address:
Garbage.disposal 25.02
City /State /ZIP: • - , , 25.02
Phone: ( ); Fax: ( ) Ice maker , 12.51
APPLICANT ' _ w ❑ e ONTACT'PERSON ' • = ' 1
Business nanie: Medical
Primer 12.51
•
• Contact mine;
Roof drain
Address iasin/lavatory 1 y /Q
City/State/ZIPT - - -- -- - - Solar units (potable water)
Phone: ( ) • Fax: : ( ) Tub /shower /shower pan
E- mail:, Urinal 1 • CONTRACTOR, r . • : y. - .
• Water'eloset 1
- ' • _ - W ater heater
Business name: /�> � /�/.1/l�- 4 ', tiI , Water•piping/DWV . . 56:29
Address: ` 0,. 5Z Otherz 25.02
City /State /ZIP: - 0 # 7 7 2 Subtotal r ,
Minimum permit fee: $72.50 ' '.
Phone:, ,.3 )' g/....11,53 - Fax: ) 7,1,0 /
Plan review (25% of permit fee) •"®—'
CCB Lic.: / Plumbing Lic. no: State surcharge (12% of permit fee) .92 ?.
/�
Authorized si atur� I � TOTAL PERMIT FE ` �'
A V�
Print name: A,7./4../ - Date: g/f//() This permit application expires if a permit is not obtained within 180 da "
after it,has.been•accepted as complete
•Fee'methodologyset by Tri- County Building Industry Service Board. .
I.\ Building \ Permits \PLMU- PermitApp.doc 10/01/09 440- 4616T(l0 /02 /COM/WEB) • • /, t5 /)
Pluinl in2 Permit- Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems: •
Qty Fee (ea) Tota
SiteUt><li " ties _' Square •I+'oota 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 •
Valuati011 •Permit 'ee:
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
thepnSj3eQt10I1S Or -CeS^E Qhax: Fee_(ea) Total, each additional $100.00 or fraction thereof, to
arid- 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 Re iew 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 (Future) W,o"rkPer'formed ❑ 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 OAR91 &780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ 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 �-
g
Eye Wash Isomefr c4or Riser4Diagram = •
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