Permit CITY OF TIGARD PLUMBING PERMIT
0 ..'. COMMUNITY DEVELOPMENT Permit#: PLM2010 -00329
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/13/2010
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15951 SW 72ND AVE
Subdivision: OREGON BUSINESS PARK III Lot: 38
Project: Carmen Center
Project Description: Catch basin installation and 40 ft. of storm sewer.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Catch Basin or Area Drain 10/13/2010 $18.76
40 If Storm and Rain Drain 10/13/2010 $62.54
PHONE: 503 - 624 -6300 1 12% State Surcharge - 10/13/2010 $9.76
Plumbing
Contractor:
DEAN WARREN PLUMBING & REMODELING
INC
PO BOX 14701
PHONE: 503 - 236 -4152
FAX: 503- 296 -2218
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $91.06
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 : .tain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.33_ • 4.
Issued By: / r Permittee Signature:
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.
Plinnbing Permit Application
,, %
Site Utilities CV+,1 FOR OFFICE USE ONL
City of Tigard �� s1 ^ �+ _
V 13125 SW Hall Blvd., Tigard, OR 97223 ,,.`' L * Rev 1l Permit No.:
II
1 A A• r
C Phone: 503.639.4171 Fax: 503.598.1960 V `• 1, ' Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 001'G' dyBy: (o Juris: RI See Page 2 for
Internet: www.tigard or.gov C 1► " ,C1 otifie d/Method: 77 Supplemental Information
TYPE OF WORK N01 91 FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. i Ea. 1 Total
Rt Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
El 1- and 2- family dwelling fJ 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: 1515 S�J -7,2 O (w Catch basin or area drain ' 18.76 �g
City /State /ZIP: Drywell, leach line, or trench drain 18.76
TtiAPJ 0 O2 Z Zy Footing drain (no. linear ft: ) Page 2
Suite/bldg. /apt. no.: I Project name: C412M443 [li1t R oge. rII 21 ' f Manufactured home utilities t 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.: t-I(1) 1 Page 2 boa; _
Water service (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map /parcel no.: 1 SI 1 Z OCA070 (
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
1 Ail T lt.4.4ATkp:t1 of IVY C. TCW R4SMl AT LjrsTt Les.l Dishwasher 25.02
POIn1T As PA1 x- GIP PAJIK+►/IEnJT RF_PAM. ,&J021( Drinking fountain 25.02
Ejectors /sump 25.02
st PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: rr Fixture /sewer cap 25.02
Q Act c 2A� Rs,
TY cr. i.Or1u, P
4, Floor drain /floor sink/hub 25.02 -
Address: 11 5€,1 SF.euur, ()Kw ∎t Su. 1T6 3(70 Garbage disposal 25.02
City /State /ZIP: 1 . 2 o Q 2 9 . y Hose bib 25.02
Phone: ( ) ..Z H ( Fax: 6z3, ) c, v..4 1355 Ice maker 12.51
ail APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
5 t A� ' } ' i � � Primer 12.51
Contact name: �, w t TAt_.r Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
Urinal 25.02
E -mail:
Jor-lnl a 9gOT.0_uS -r . Co .0
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: _ t pe. 4 ,„ .�a/.7,er piping/DW V 56.29
Address: t1X 7 /vim 61 Py 25.02
City /State /ZIP: .craphee (50 ry 7 7 r i Subtotal $1 , 30
Minimum permit fee: $72.50
Phone: (5)S) ( - 11 3 Fax: ( ! j 3) Q T. _ 1 1 ? 57
Plan review (25% of permit fee)
CCB Lic.: 1 ii Lic. no.: n 73 (oP8 State surcharge (12% of permit fee) C(, .76
Authorized signature: 4 �_ �- TOTAL PERMIT FEE e' 1 . U(o
Print name: ( Date /, // This permit application expires if a permit is not obtained within 180 days
/� /°I b4,1 r /�1, -- / �� /� (� after it has been accepted as complete.
f� ` *Fee methodology set by Tri- County Building Industry Service Board.
1 \ Building \Permits\PLMU- PermitApp.doc 10/01109 440- 4616T(10 /02 /COM/WEB)
C
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
Storm & Rain Drain - 1st 100' 1 62.54 6ZSj Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Ram Drain - each additional 100' 37.52 $5,001.00 to $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
l� 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 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub /Shower as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive e Tani ❑ 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
3 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:
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IN Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. Er map & tax lot # p" project name Er address El suite number
2 zoning a applicant name a phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location. ./
2. PLUMBING PLANS - Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
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