Permit CITY OF TIGARD PLUMBING PERMIT
0 COMMUNITY DEVELOPMENT Permit #: PLM2009-00191
T t G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/16/2009
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Subdivision: FARMERS INSURANCE Lot: 0
Project: Triangle Pointe
Project Description: Install (16) fixture /sewer caps, replace (4) lays,(1) service sink,(2) urinals,(7) w /c, and (1) w /h.
Install (2) new roof drains.
Owner: FEES
TRIANGLE POINTE LLC Quantity Description Date Amount
901 NE GLISAN ST #100
PORTLAND, OR 97232 16 ea Fixture /Sewer Cap 07/16/2009 $265.60
PHONE: 2 ea Roof Drain (Commercial) 07/16/2009 $33.20
1 ea Sink 07/16/2009 $16.60
4 ea Lavatories 07/16/2009 $66.40
Contractor: 2 ea Urinal 07/16/2009 $33.20
RAY'S PLUMBING 7 ea Water Closet 07/16/2009 $116.20
P.O. BOX 685 1 ea Water Heater 07/16/2009 $16.60
BRUSH PRAIRIE, WA 98606 1 12% State Surcharge - 07/16/2009 $65.74
PHONE: 360 - 892 -8700 Plumbing
FAX: 360 - 892 -9644
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $613.54
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 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 ma tain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
n ,
Issued By: ^ v � ^ 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.
PPuiinbinE Permit Application RECEIVED
Building Fixtures FOR OFFICE USE ONLY
City of Tigard JUL 16 2009 Received P X.09. pp M `
Date/By: Permit No'
..
0 13125 SW HaII Blvd., Tigard, OR 97223 Plan Review
2 Phone: 503.639.4171 Fax: 503.598.1 '/ O F TIGARD Date/By:
Other Permit No.:
Inspection Line: 503.639.4175
TIGARD Y Y� g
B UILDING DIVISION D ate Read B Ju ris: RI Se Page 2 for
_.. Internet: www.tigard - or.gov Notified/Method: T I C' Supplemental Information
TYPE OF WORK FEE* SCIHEDULE
•
❑ 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 (I) bath 249.20
❑ 1- and 2- family dwelling ® CommerciaUindustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 13333 SW 68 Parkway Catch basin or area drain 16.60
City / State/ZIP: Tigard OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Triangle Pointe Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Corner of 1 -5 and Highway 217 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
• Cap most fixtures throughout entire building. Replacing fixtures in two Backwater valve 16.60 c
restrooms on ground floor. Replacing water piping to fixtures beingreused, Clothes washer 16.60
leaving stubs for future TI's at abandonded restrooms Dishwasher 16 0
❑ PROPERTY OWNER l ❑ TENANT Drinking fountain 16.60 `
Ejectors /sump 16.60 In
Name: Expansion tank 16.60
Address: Fixture /sewer cap (` 16.60 °v CO
City/ State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) I Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 2 16.60 23,242
Phone: ( ) I Fax: : ( )
Sink/basin/lavatory 5 16.60 V3,00
Tub /shower /shower pan 16.60
E -mail:
Urinal Z 16.60 33...O
CONTRACTOR Water closet / 16.60 116.210
Business name: Rays Plumbing Water heater I 16.60 %64o
Address: PO Box 685 Other:
. Subtotal , - a
City/State/ZIP: Brush Prairie, WA 98606
• Minimum permit fee: $72.50 547. t f
Phone: (360) 892 -8700 Fax: (360) 892 -9644 Residential backflow minimum permit fee: $36.25 /
CCB Lic.: 33217 7 1( ) Plumbing Lic. no.: 37 -149PB Plan review (25% of permit fee)
'Or '--7 1 , State surcharge (12% of permit fee) (o(. .7
Authorized signature:
TOTAL PERMIT FEE (.
Print name: Peter Levanen Date: ?/#510 q 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\PLMF- PermitApp.doc 12 /27/06 440- 4616T(10/02/COM/WEB) /-v 15
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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' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer- 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit F'ee:
Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
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 report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
- Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain iy 161 Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" 244 20 that meet the qualifications above.
2* F5 -OP Ib g
-4
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory 5 SS ti
- Bradley *Note: If the fixture work under this permit results in an
. - Commercial '1 . y .. • increase of sewer EDUs, a sewer permit will be issued and . .
- Service y y l fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued..
Washer - Clothes
Water Extractor
Water Closet - Toilet 7a G S 1
Urinal �6 '•tN 2
Other Fixtures:
2C
is\ Building ermits\PLM- PermitApp.doc 12/27/06