Permit a` CITY OF TIGARD PLUMBING PERMIT
• a - COMMUNITY DEVELOPMENT Permit #: PLM2010 -00242
T f G .R)J 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/27/2010
A
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11131 SW GREENBURG RD
Subdivision: Lot: 0
Project: JUMP SKY HIGH
Project Description: Interior plumbing for TI: (2) 2" floor drains, (1) drinking fountain, (1) expansion tank, (2) primers,
(8) sinks, (1) shower, (2) urinals, (6) water closets, (1) water heater, (1) water piping.
Owner: FEES
ROBINSON FAMILY TRUST Quantity Description Date Amount
BY E LEE & EVELYN L ROBINSON TRS, PO
BOX 91305 1 ea Drinking Fountain 07/27/2010 $25.02
PHONE: 1 ea Expansion Tank 07/27/2010 $12.51
2 ea Floor Drain/Floor Sink/Hub 07/27/2010 $50.04
2 ea Primer 07/27/2010 $25.02
Contractor: 8 ea Sink 07/27/2010 $200.16
TAPANI PLUMBING 1 ea Tub /Shower /Shower Pan 07/27/2010 $12.51
PO BOX 2350 2 ea Urinal 07/27/2010 $50.04
BATTLE GROUND, WA 98604 1 ea Water Piping 07/27/2010 $56.29
PHONE: 360-687-3983 6 ea Water Closet 07/27/2010 $150.12
FAX: 360-687-4494 1 ea Water Heater 07/27/2010 $37.52
1 12% State Surcharge - 07/27/2010 $74.31
Plumbing
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $693.54
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 . •rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility • ification Cen - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or - rect questions to OUN call g 503.246.6699 or 1.800.332.2344.
I -sued By: k /� �/ ,/ / Permittee Signature: A
CaII 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
.:\ • -
Building Fixtures �� ' FOR OFFICE USE ONLI
III Cit of Tigard � 0 R eceive y d
`r g�� Date/By: Permit No.: ��
a 13 12 5 SW Hal Blvd., Tigard, O �97 caL74...,::'•
. ` -� + 0 "* "r 9 r .`.' Plan Review
0 • Phone: 503.639.4171 Fax: 3'8. � ( � !, Date/By: Other Permit No.: � IO y � Ir ��-
Ti G A R D
Inspection Line: 503 \-\ ! ,r a � � ® ll
` Date Ready /By: Juris: See Page 2 for
Internet: www.tigard or.gov (., . �''yi Notified/Method: /Jty Supplemental Information
• TYPE OF WORK c b � .. - ` - ': FEE SCHEDULE
• .. v
❑ New construction ❑ Dernt ttl b 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
❑ I- and 2- family dwelling ® Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
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: 11131 SW Greenburg Rd Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard, OR 07223 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: Jump Sky High 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
- DESCRIPTION OF WORK Backwater valve 12.51
)'-,- 4 Clothes washer 25.02
` tna,r p""r'` 1 "� r' • Dishwasher 25.02
Drinking fountain ./ 1 25.02 )c. to
Ejectors /sump 25.02
❑ PROPERTY OWNER I . • • ® TENANT / Expansion tank / 1 12.51 1 }-` 71
Name: Sky High Sports Portland LLC Fixture /sewer cap / 25.02
Floor drain /floor sink/hub c/ 2_ 25.02 ST 011
Address: 11131 SW Greenburg RD .
Garbage disposal 25.02
City /State /ZIP: Tigard, OR 07223 Hose bib 25.02
Phone: ( ) Fax: ( ) • Ice maker 12:51
® APPLICANT ❑ CONTACT PERSON: Interceptor /grease trap 25.02
Business name: Tapani Plumbing, Inc. Medical gas (value: $ ) Page 2
Contact name: Lars Hendrickson Primer 2 12.51 pv }.
i
Roof drain (commercial) 12.51
Address: 2103 SE 12 Ave 1 '' ./
Sink/basin/lavatory C k j1 5 8 25.02 ?V° . I (
City /State /ZIP: Battle Ground, WA 98604 Solar units (potable water) / 62.54
Phone: (360) 687 -3983 Fax: : (360) 687 -4494 Tub /shower /shower pan / 1 12.51 / 4. s
E -mail: Urinal / 2 25.02 Sv, 04
Water closet , / * 6 25.02 (3'0. ( ),
. • CONTRACTOR . • -
Water heater 1 37.52 3'7,5.
Business name: Tapani Plumbing, Inc.
Water piping/DWV t/ 1 56.29 Via. )1
Address: 2103 SE 12 Ave Other: 25.02
City /State /ZIP: Battle Ground, WA 98604 Subtotal
Phone: (360) 687 -3983 Fax: (360) 687-4494 Minimum permit fee: $72.50 G /q,
Plan review (25% of permit fee)
CCB Lic.: 60958 Plumbing Lic. no.: 37 -269PB
State surcharge (12% of permit fee) '74 , .
(
Authorized signature:
/� TOTAL PERMIT FEE 43.
Print name: Lars Hendrickson Date: 7/22/10 This permit application expires if a permit is not obtained wit rn 180 days . ,)
after it has been accepted as complete. N
1/ / *Fee methodology set by Tri- County Building Industry Service Boar .
- A o 6 aifeo'Z3 i iJSo.J eo n« - s%20 /0 - 00 /7/ k
1:\Building\Permits \PLM - PermitApp.doc 10/01/09 440- 4616T(10 /02 /COM/WEB) •
7� v,r ca P y � 45 45 f �• 779 / ,
. 11 GJ 673-6 6+rCi S5T7• f • . urz-& •
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 $5,001.0010 $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 27 and
Fixture Type: A Replace greater, except systems designed and stamped by licensed
• Previous Capped'. Added Existing' engineer.
Baptistry/Font
Bath Tuh iawer� ❑ 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.
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 Z
Eye Wash •Isometric or-.Riser Diagram .
Floor Drain /sink ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
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 1 4 -Bar /L to
- Bradle
1. - ommer '. *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 aid before the
Washer - Clothes p
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
•
http: / /www.ti gard -or. gov /city_hal l/ departments /cd /docs /P LM F -Perm itApedoc
.. . . . _
CITY OF TIGARD j • ,---s, • off 2dio- aot_.(46),
.
BUILDING DIVISI01(1 ‘ ' /I : :,
'-PERMIT #: .
13125 SW Hall Blvd44Tigard, OR 97223' ISSUED:
Phone: (503) 639-417 -' _ :artivit ,, .
( I- - ection RequeSis (24 Hrs.): (503) 639-4175 ljp. et L L
INSPECTION WORKSHEET FOR DATE: q /0 TIME: PAGE:
‘...), 1 i ••,,, :
., . • .. . 1. . •
SITE ADDMESS: / 1 / S / r,.,,n ,., .
CLASS OF WORK: ree,
. :
, .
SDBDI\YISION: Lai: .,,\ I , TYP OF USE: •
FRoJECT NAME: :# .
. ,,-
-, DESCRIPTION: , '=,-i, . . / 340 60/ z6
..
;- i/
I .
. ..
• , • ,..,
.:.,„
..,. , ,
,o. .,„, ,
WNER: . PHONE #:',
C)
N,CONTRACTOR: - :'': e "':' • • . PHONE #:f I - • ' i •.,
A • V. ' ' '• .''. ./ ,•-• '
' L; H.&
4-1
• t:
Inspection Request Scheduled For: .
• ', Date: -0 (S7 2. 0 I Pour Time
\. .
Code # ',, .: Inspection Des '' Confirl Contact # Message '0
,. ...,
1 : 1 '''' • ,'
— AA.1 7-
. .
. .,,
Corrections/Comments/InstructiOns: •
• •'
. , • i . , ., . . ---..,
\ t '', ,•'" „. ,
i ,
, , .
LI
, ,. - ...
• , , ,-.
‘-t, • • ,
, - .7.. 1 k ' 2 " .. „ - .1:.,4;liN'-- , A. , , , ., ,: A ,-; •
.
" 1 v; ' ,. ' ::''. / •:, .1 ; , , , r :
. .
,..... ,
ii,) . ..„„....,„...........„,............„..„....."--,,.....
- .:, 1 . ., . . ,,
.
,
„. .
.' %) ..,..
,....... , p o t...-4.6-- :'
, If ei ; ' ,„ ? . ' e l . , r:-.,e '• 4,,(1
'''; i'' : ''
-
.. . ,
.. ' • ,e ,....,_,,,,,„.,,,,.) ,;',,, i '.:;,- ,,,'''' —.)" V.. 0 /
.
■ . • . . .:" / r - ) • ..
. , ■ :`, • ' . • t.` 4,. • ',, i ' -..... . ,; „
. • :. . . , 'r ; -1
. .
. . .'" .,.. '.. 4, ..r,,.....k, •
..4".4 7
I . • ' .
•
. .
_ . •
. , , '''' ' •
. ,
. . .. •
. i •r : , 1 ':
c , I
. . . .
. .
, .•• . -• („/,/,..- 15% - -';',, 0; / / (
- , ,,,,.. ":":-, . . 7 ..',/ . 7) r • "7 :'
■.. , . , j - 4 .eAt.-? '4' ' . . /
0 "I. ). ' ■ „re .J.' , '
.v.
...._,.,...... ,„.:. -
t \ .,. i .. . , , •
• '1 ,
,. .. . .
. .
. ', . 6 - ,_ . ,., .,
.ye ,: ' . , ,- t, , . , -
• ,-.
• , . i we
^ 9 ■, t . ,.
.
•• .30
\ r t-1 'r . • . . . ,
..,.. c''
, .
. ,
• V)
i...... - , ' / • • ,-
. fl .,,, 1
,
1 .
. ,
. ,
, ' , ' ' ' •
PASS ‘ i , , PARTIAL APPROVAL fl '' CANCE L. fl NO ACCESS
__-, / •
.„, I FAIL • •- 1 - I I CALL FOFHNSPECTION.„ pi ADDITIONAL FEES ASSESSED
'\•,_ / - ! `'N- c. -'''' 1 '., '-,''; • . ‘;‘,
) .
..,
, .4.•
• ...
t . 1 -1
,1
0 . Inspector: j'.. 3 ,...,..,...( . ,:z. .i ..,,-..zt . q:) •' • Phone #: (503) 718- .
- - --- - -- ,,..;., ., ,Th. ,--,..., • . , d . q '
. • . . . . .