Permit lit? CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00238
, .....44.. Date Issued: 07/27/2010
T I GAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S127DD01200
Jurisdiction: Tigard
Site address: 10031 SW CASCADE AVE
Subdivision: LEVITZ BLDG Lot: 0
Project: Ultimate Electronics
Project Description: Capping fixtures: (1) drinking fountain, (2) 2" floor drains, (4) lays, (2) water closets and (1) urinal.
Adding new fixtures: (1) drinking fountain, (2) 2" floor drains, (4) lays, (1) service sink, (5) water
closets and (1) urinal.
Owner: FEES
ULTIMATE ELECTRONICS Quantity Description Date Amount
321 W. 84TH AVE., STE. A
THORNTON, CO 80260 1 ea Drinking Fountain 07/27/2010 $25.02
PHONE: 303-412-2500 10 ea Fixture /Sewer Cap 07/27/2010 $250.20
2 ea Floor Drain/Floor Sink/Hub 07/27/2010 $50.04
1 ea Primer 07/27/2010 $12.51
Contractor: 5 ea Sink 07/27/2010 $125.10
ATLAS PLUMBING CONTRACTORS 1 ea Urinal 07/27/2010 $25.02
P.O. BOX 1352 5 ea Water Closet 07/27/2010 $125.10
RIDGEFIELD, WA 98642 1 ea Water Heater 07/27/2010 $37.52
PHONE: 360 887 -8054 1 12% State Surcharge - 07/27/2010 $78.06
FAX: 360 - 887 -8504 Plumbing
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $728.57
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 952-11 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUN by calling 503.246.6699 or 1.80rI♦
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.
Jul 21 10 07:45a Atlas Plumbing Contracto 3608878504 p.2
Plumbing Permit Application RECEIVED T s ,6CiP,2, 0 - 0/ o?
Building Fixtures FOR 01 f If L 1 SI- O'sI
,,: . , _ � . . .
jut_ 212010 ...
City Of Tigard Received Yo2.2,-//d III •J g Date/By: 44 Pei nit No ., O�� oO 23 131 25 SW Hall Blvd., 'Tigard, OR 97221ITy OF T ' IGARD Plan Revi / Y "! oY/
a r - Phone: 503.639.4171 Fax: 503.59 I Other Permit N�'a2 e o n 0 9 9
Inspection Line: 503.639.4175
DING DIVISION Date/BY: /D
T l i G A D < Date Ready/By: - / H See P age 2 for
Internet: www.tigard- or.gov Notified/Method: / '1 K - Supplements! Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special inforn aiion use checklist
Description 1 Qty. 1 Ea. 1 Total
laAdditionlaheration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath I 312.70
❑ I- and 2- family dwelling Q[ Cotnmercialfindustrial 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. It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: atch basin or area drain 18.76
/ fi ? j I C,. i f' C c Cl I C v' Drywell, leach line, or trench drain 18.76
City /State/ZiP: 1 c c; ., ' ,:,1
Footing drain (no. linear ft.. ) Page 2
Suite/bldgJapt. no.: Project name: /_ , r'h ct C ' " /e c. '1 - , 1. C 7 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
Le ;i,Dt e'_.h'; f, P1 ('cC) r4.: ' . ,'i1) 1 Ci 4
t : Dishwasher 25.02
'.-1,,<.% 4 i € sl - i "-t ; Drinking fountain I -' 25.02 2..5. 412-
Ejectors /sump 25.02
Tr PROPERTY OWNER ❑ TENANT Expansion tank , 12.51 ;250 0 , .20
. Fixture/sewer cap -
/0 , 25.02 -=
Name: i / , f C L: (t c:.: f G - ; : L..
- h y L
Floor drain /floor sink/hub ,/ _ 25.02 i1; i-I
•
Address: • 2 1 i, . ': -a, .;a. ;�' c2` . 5 't ' . / J P Garbage disposal 25.02 r
City/State/ZIP: 7 / ; , - 1:.. ,,., I '1„_ i `J 25.02
( 7 '• C Cr' 3 Hose bib
Phone: (5c j) `// 2. - 2- 5 Fax: ( 1 ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name: '�
Primer 1 12.51 i 2 y i
Contact name:
Roof drain ( mercial) 12.51
Address: ,�jp
(i_fAink/basinHa>edlory 5" 25.02 / 2,5. 1 rJ
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
Urinal - 25.02 '2. L
E -mail: / ✓ c
CONTRACTOR Water closet y ../ % Z7
25.02 • /i 1
n Water heater ! 37.52 ' r 4; 2
Business name: , '1(c, 5 J (c, t c' vi-' b. -
), Water piping/DWV 56.29
Address: 7 c' , ' ' `- 5: V C t C%. / j ,k' % 1 c 2. Other: 25.02 6$Q . S/
f e:'' ,� L' i• ''i: � y A
City /State/ZIP: ia� , s.(,a;'- , e. ( c ,(' d" A- q 5_ ` "2,- Subtotal � el
t -r - � 7 Minimum permit fee: $72.50
one: (3te) •., :. Fi'. y F ax: ( e G) r. { --
raS
J n . C Plan review (25% of permit fee) ,e, Oro ! s L., CCB Lic.: , 7 / 1 2 11 if Plumbing Lic. no.: f /15 O v y `
0 State surcharge (12% of permit fee)
•
Authorized signature: '• :: -. -- TOTAL. PERMIT FEE
-"' This permit a expires if a permit is not obtained within 180 days
Print Warne: - (/` i t . i - . 7 �,. c -� Date: -2 J -/ � after it has been accepted as complete.
"Fee methodology set by Tin- County Building Industry Service Board.
Jul 21 10 07:45a Atlas Plumbing Contracto 3608878504 p.3
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 2.00I to 3.600 $169.69
Sewer - 1st 100' 62.54 3,601 to 7.200 5233.20
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
51.00 to 55,000.00 Minimum fee $72.50 •
Storm & Rain Dram - each additional 100' 37.52 55,001.00 to 510,000.00 572.50 for the first 55,000.00 and 51.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional 5100.00 or fraction thereof, to
and including 510,000.00.
Inspection of existing plumbing or for 510,001.00 to 525,000.00 5148.50 for the first $10,000.00 and 51.54 for
which no fee is specifically indicated 90.00/hr each additional 5100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr 525,001.00 to 550,000.00 5379.50 for the first 525,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including 550,000.00.
Additional plan review for revisions 90.00/hr 550,001.00 and up 5742.00 for the first $50,000.00 and 51.20 for
(minimum charge - 1/2 hour) each additional 5100.00 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.
ront
Baptistry/fF
Bath
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR9I8- 780 -0040.
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Arivc Thru ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain 1 1 ✓ .
Eye wash Isometric or Riser Diagram
Floor Drain /sink - 2' 1 .Z sr ❑ 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 I
Shower -Gang
-Stall _ -
Sink -::1 vator . 1
- Commercial *Note: If the fixture work underr this permit results in an
- Service I 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 plumbing Extractor p g p ermit can be issued.
Water Closet - Toilet .. . /
Urinal / /
Other Fixtures: