Permit CITY OF TIGARD PLUMBING PERMIT
11 COMMUNITY DEVELOPMENT Permit #: PLM2010 -00292
T i G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/02/2010
Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12220 SW SCHOLLS FERRY RD
Subdivision: Lot: 0
Project: Greenway Town Center
Project Description: Replace broken catch basin. Behind grocery store in rear parking lot.
Owner: FEES
FW OR- GREENWAY TOWN CENTER LLC Quantity Description Date Amount
PO BOX 790830
SAN ANTONIO, TX 78279 1 ea Catch Basin or Area Drain 09/02/2010 $18.76
PHONE: 1 12% State Surcharge - 09/02/2010 $8.70
Plumbing
54 ea Minimum Fee Adjustment - 09/02/2010 $53.74
Contractor: Plumbing
RIVER CITY ENVIRONMENTAL
PO BOX 30087
PORTLAND, OR 97220
PHONE: 503 - 252 -6144
FAX: 503 - 288 -3658
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if , • ' •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility 'cation Center. Th• - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or • ect questions to OUNC by calli • • 5 +3.246.6699 or 1.800.332.2344.
sued By: //d � / Permittee Signature: /-
CaII 503.639.4175 by 7:00 a.m. for an inspection that b iness day.
This permit card shall be kept in a conspicuous place on the job site u til completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
Received n ./�
City of Tigard Date /By: 9 /D Permit No.: 44,720/0 -O A9 2
li
0 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read /B Ju ris: ®$ee Page 2 for
TIGARD Ready /By: g
Internet: www.tigard- or.gov Notified /Method: Supplemental lnformation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition 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 0 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: 12220 SW Scholls ferry rd Catch basin or area drain 1 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: Greenway Manufactured home utilities 50.03
Cross street /directions to job site: 121 ave Manholes 18.76
Rain dram connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Stonn 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
f O-u �j �,, , Clothes washer 25.02
replace broken catch basin f�f'L `��F e .
4 / [ Dishwasher 25.02
_N.`c_ pa_i l4 / .4 Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Regency centers Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12220 SW Scholls Ferry Rd
Garbage disposal 25.02
City /State /ZIP: tigard Or Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: River City Environmental Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Patrick Speer
Roof drain (commercial) 12.51
Address: po Box 30087 Sink/basin/lavatory 25.02
City /State /ZIP: Portland Or Solar units (potable water) 62.54
Phone: (503) 252 -6144 Fax: : (503) 288 -3658 Tub /shower /shower pan 12.51
E -mail: pats @rivercityusa.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: River City Environmental Water piping /DWV - 56.29
Address: po box 30087 Other: 25.02
City /State /ZIP: Portland Or 97294 Subtotal
Phone: (503) 252 -6144 F . 03) 288 -3658 Minimum permit fee: $72.50 /,2 -
Plan review (25% of permit fee) -1 9"
CCB Lic.: 147355 NA7/t' Plumbing Lic. no.: 26 -789pb
Authorized signatur State surchargeTOTA (12% of permit PERM feeFEE 9. 8" , ... ) 70 0
e �t L IT 2
Print name T� f91� Date �. ?I �� This permit application expires if a permit is not obtained within 180 days
��/ after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits\PI.MU- PennitApp.doc 10 /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 - I" 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 _ 5327.54
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 55,000.00 Minimum fee $72.50
Stonn & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first 55,000.00 and 51.52 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 525,000.00.
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 5100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including 550,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up 5742.00 for the first 550,000.00 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
as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Stall ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each S
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
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:
http: / /www. tigard- or.gov /city_hal l /departments /cd /docs /P LM F- PermitApp2doc