Permit n CITY OF TIGARD PLUMBING PERMIT
` t:..- COMMUNITY DEVELOPMENT Permit #: PLM2010 -00269
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2010
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 200
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: CNA Insurance
Project Description: Relocate (1) lay and install (1) water heater.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Lavatories 08/18/2010 $25.02
1 ea Water Heater 08/18/2010 $37.52
PHONE: 503 - 624 -6300 1 12% State Surcharge - 08/18/2010 $8.70
Plumbing
Contractor: 10 ea Minimum Fee Adjustment - 08/18/2010 $9.96
Plumbing
CASCADE PLUMBING CO
2630 N HAYDEN ISLAND DR #3
PORTLAND, OR 97217
PHONE: 503 - 289 -7095
FAX: 503 - 283 -9514
Type of Use: COM .
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: / Permittee Signature: / e f}7',e.iC� �dN
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing.Permit Application , -
Building Fixtures r ' Fi)k Orrli EE; l til: O\l,1
City of Tigard A U G 1 2 Q Q pig er c.
/ ,, :emit No, /Y p/0 .....60 6 7
13125 SW Hall Blv Tigard, OR 97223 plan Review �� �� �C i J
' Phone: 503.639.4171 pax: 503.59$x1960 D Othc PctmitNg/a 7 /11 -evo 9
r . i , . „ i ,, Inspection Line: 503.639.4175 Date Ready/By. 10 ® See Page 2 for
Internet www.tigard -ur.gov NotifiedlMethod: Su y • !mental Information
.. ,: • :.. ... , :TYPE : ".QF. .WORIi' FEE* SC iEDUY;E
❑ New construction Q Demolition For special information use checklist
•- Description J it . J Ea. J Total
[] Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
• CATE Ohl SFR (1) bath 312.70
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437,78
-
E] Accessory building 0 Multi - family
SFR (3) bath 500.32
❑ Master builder Each additional bath/Idtchen 25.02
--- ❑ 2
.
Other: Fire sprinkler . _ 6p � (_ s4. ft) Page
3018 SITE i.. R M UON AND LOCATION Site utilities:
Job site address: Om S co 6 va.A. Ar• 4 a,4 Catch basin or area drain 18.76
�- Oki "`4 Drywc11, leach line, or trench drain 18.76
City /State/ZIP: t �� Footing drain (no. linear ft.; ) Page 2
Suite/bldg./apt no.: di %l� 'roject na me: Q.4j • / _ r /'-e- Manufactured home utilities 50.03
Cross street/directi• sitc: CA /i9 9 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Pagc 2
Storm sewer (no. linear R.: _) Page 2
Subdivision: Water service (no. linear ft: ,,,-,,,•„) f Page 2
14t no Fixture or Item:
Tax map/parcel no-: Baclflow preventer 31.27
DiSE!(iTPTION'OF 'WOK ' ;:
Backwater valve 12.51
P,/ __ _ / r a r o I- Clothes washer 25.02
` tf-!�' Dishwasher 25 -02
x 1 - Drinking fountain 25.02
Ejectors/sump 25.02
0 'PROPERTY OWNF1i. •••:' ' `:::. ');.:: :0,, TANANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
-W-- Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
y :, ERSON Inter tor/ ease tr 2
':" � :; cep Br aI► 5.02
Business name: Medical gas (value $ ) - Page 2
Primer 12.51
Contaot name: .
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory J . 25.02 2 5, 62,
City/State/DP: Solar units (potable water) 62.54
Phone: ( ) Fax :: ( ) Tub /shower /shower pan 12.51
E -mail: - Urinal 25.02
.. Wager closet 25.02
CQNTIL#CIl'OR /� _ • Water heater / 37.52 32.5-2_
Business mum nq�(► �� aril � VI ( -. - - 4�(.) Water pipittgf DWV 56.29
Address: �••�- ��i f� Other: 25.02
City/StateZI t rt .kt,riel ` d -2 c 7 subtotal
Phone: (gyp 3 01' '769 Q3 Fax: 56 3) Minimum pemrit fee: $72.50 92 � b ! Plan review (25% of permit fee)
CCB Lie.: Plumbing I.ic. no.: 3L1.....1.02/eft State surcharge (I2% of permit fee) F..
Authorized signature: 1 ..r / (r`i� TOTAL. PERMIT FEE v. /
Print name: j.. S i L s.-1(! n s I Date: This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
"Fee methodology set by Tri -Connry Building Industry Service Board,
1 :18w rsBlPemritslPLMU- PermitApp.doc 10/0 9 4404616T(lo/n2/CQM/WPb)
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Pluinbint Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su' . ression S stems:
F 1 .t ,l Y ti: tip t fJ , , r , Y...; ,, ,IPi:Nyte , %. '',.:;,,:r t ,! 7 P,� ^ e, �
� { �t'�rk,'� � ft s1 ti` i '��4 .,��.1. �.��.7�'�ie;(17?t � i _ �.v.b,. , ._. { .r.. ' : ;.1..
Footing drain -1 100' 55.00 010 2 01 5115.
Footing drain -tech additional 100' 1111.1111 46.40 NM 2 001 to 3 600 $160.00
3 b01 to 7 200 $221 .00
Sewer -1st 100' NMI 55.00 7 201 and : eater 5309.00
Sewer - each additional 100' IIIM 46.40
Water Service -1st 100' 55.00 Medical Gas S stems:
Water Service - each additional 100' 46.40 fir ' , '-',,, 5c,1r. SF, � 1 - }r4, y' „ .; i ,' + t k� > ` ' ..i x;;_;
Storm & Rain Drain -1st 100' 55.00
illie, 51.00 ,'
I OO $5 000.00 Minimum fee 512.50
Stone & Rain Drain - eadt additional 100' MI 46.40 $5,001.00 to $10,000.00 572.50 for the first 55,000.00 and $1.52 for each
7 e, at -401,i.; l additional $100.00 or fraction thereof, to and
;? 7 i .. `.k4s#7,4., r 'ii includin_ $10000.00.
Commercial Back Flow Prevention Device 46.40 510.001.00 to $25,000.00 5148.50 for the first $10,000.00 and $1.54 for
Residential BacldlowPrevention Device Me each additional 5100.00 or fraction thereof, to
minimum . - it fee 536.25 and ineludin: $25 000.00.
Rain Drain, single filthily dwelling 1111111112=1=11 525,001,00 to 850,000.00 $379.50 for the first $25,000.00 and $1.45 far
each additional 5100.00 or fraction thereof, to
Inspection of existing plumbing or and includin _ $50000.00.
um feasted ,..actions - r hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 end $1.20 for
Subtotal: each additional 5100.00 or fraction thereof.
'p . f . : i , ; , L'3 • x7 I x y , r k t j7.'u t `' r i
Fiztull'e Work: � , " + , •
Are you capping, adding or replacing fixtures': if "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply,
accurately re ■ I rt fixtures could result in increased sewer fees ❑ Any new commercial building with water service 2" and
y . ..: lt 1 ,i,V ' , .. . 7 , . : ! �" r ` , t� greater, except systems designed and stamped by licensed
t L +3,� ' t'' 3 ,t nth t yt4 ` ' } engineer .
1 v , , i',s ''s,',, ' _, Y�', ,, , i L '� '� : «F .^ f ❑ Any new exterior plumbing site utilities.
B / Fi at ! ❑ Medical gas and vacuum systems for health cart facilities.
Bath ;Tub/Shower rIIIMIIIMIMMllMll ❑ Any multipurpose fire sprinkler system.
_3acu2zi/Whid , • • 0 Any complex structure as defined in 0AR918 -780 -0040.
Car Wash Each Stall MIll IMMII
- Drive Thrums MIONIMIlli Submit 2 sets of plans with any of the above.
C :. idor/Water M . irator �
Dishwasher _
' lF Y5> u fi r +`' r
~. s r h.t
-Domestic ' : Fountain MIIIIIIMIll 0 Isometric or riser diagram is required for new buildings
1. ��
E c Wash ENNINIIIII that meet the ■ ualifcations above.
Floor Drain/sink . 2" illiM
-3" IMMO
• 4" Comments regarding fixture work:
�
Car Wash Drain - � . i --
Garbage - Domestic MiliiiiiMiliallMIIMIIM
Disposal - Commercial -
Industrial 11.111Mi MN= NMI
lee MacbiRefri: Drains 1111111/1
Oil armor Gas Station MiiliiMMINNINIIMIEll "-` _
Rec. Vehicle Dum. Station IIIMMiiiin
Shower -Gang 1111■Min■1 *Note: lithe fixture work under this permit results in an
-Stall .11111111. increase of sewer EDUs, a sewer permit will be issued and
Sink -Ba vatoty . M1111 WM fees assessed for the sewer increase must be paid before the
-Bradley rNIMINI
- Commercial 1111111.111MMIIIIIMIIIIIIIMINI plumbing permit can be issued.
-Service MEOW
Switmnin: Pool Fitter MEM r -
Washer - Clothes INIMMIIIMMINNIIIIIIIMM
Water Extractor lliM il=.11
water Closet - Toilet -IMEMIMIll.1
Urinal IIIIIIIMMIN
otherFixtutes: MIIM 11.1111111111.11
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