Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2009 -00167
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/26/2009
Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15895 SW 72ND AVE 190
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project: Truman Capitol Advisors
Project Description: Relocate breakroom sink.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
#300 1 ea Fixture /Sewer Cap 06/26/2009 $16.60
1 ea Sink 06/26/2009 $16.60
PHONE: 1 12% State Surcharge - 06/26/2009 $8.70
Plumbing
Contractor: 39 ea Minimum Fee Adjustment - 06/26/2009 $39.30
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: an A v n \ o /( � .QA ,L. Permittee Signature: aQJL- •
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.
RECEIVED
JUN 2 5 2009
Plumbing Permit AunlicatioflITy I O1 !.ii. t. ,,,,I,: ONI.∎
City of Tigard BUILDING DIVISION R � H 1 w all Pa,.r;l • • �� �,• . & O ,7
13 123 SW Han e!V . Tigard, OR 97223 Plan Review
_ 1 ' Phone: 503.639.4171 Fax: 503.598.1960 Other Permit N (5
(X' 1
Infection Ling 503,639.4175 per " " - W I I I
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Internet:
tl� g Not mVhilethed: • la - was tnterroaKee
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[] New construction 0 Demolition Par special 1pjeratation sue checklist
• Description ey. Ea. Total
1 "4: dation/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R. for each utility cuemection)
iv`t t'�w rO "''F1L •. .:iy n,f i, FL: Y.�.gO " I , .. 4�•
( if'a• +i,: Z j� - `�t i� r ... o f l. ti ac j �t i t { " ( .-.. p. j " .; F*'i spit (1) bath 249.20
D'.'.r �tAYAf •,ptM1J.(;R tW:], Ja�f h_c∎..: .t,...,..R;l ?s .). .:Fx: :;; .aa16t A � 4r. 7 ' ':,�( , t : ' r.? ,
[] 1" and 2.thnUly dwelling rte- ommercl&llndustrlal I SPR (2) bath _ 350.00
O Accessory building ❑ Multi- family SFR (3) bent 399.00
O Heeler builder Each additional bathAtitchen 45.00
Off' Fire sprinkler ( aq. R.) Page 2
. �y� s � Lty7� t �(� .' 7J 44P n tr34w xr3Ti��5� 'X.y�-•�s'9Si�'xhrtiw;i-t .��.: > t t ei�5�
t't�.�Y aliT:u,., ta c'>.?at.11,l ;tr 4. .,... S: ri '•,c4efMf�t'tk},!'1ci ;'y:'', `'i ^'eT', ''''''!'+' site udlltles
Job site address: g' 5 ` , �...st. t Catch basin or area drain _ 16,60
City/State/ZIP; a'jr0i..4 * " Drywall. leach line. or trench drain ■ 16.60
Suite/bldg./apt. no.: tR i f Protect name: 1)1),11 G�� Footing drain (no. linear R.:. _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
J Rain draln connector 16.60
Sanitary sewer (no. linear ft.: _1 Page 2
_ Storm sewer (no. linear R.: -) Page 2 _
Subdivision: I Lot no.: Wa ter service (no. linear fl.: _1 Page 2
Fixture or Item
Tax map /parcel no.: -
; ,r ; ;u�,,. - , /y raa��,, n ;,,a ;:,, ,. . 4 Backtlowpreventer Page Absorption valve 16.60
nt:; a ? {f ., 'Ali 4:t ky R; ",. .S S r,A :4'+�f i °,.. t" L-'A ti n ,
�t�: �fl} �i�r '�:�t�a��:ad;i.�::!���11;:4i ; pp..�`aG. ua� '4•� , 6; 'T "f't2 °?�;•
Y.. xl. nl ':1.:.::Mf "..71•il�.�."��,:lA'2' "`t7l ln.: tl. ( {✓.
�' _ .:- at ' r Il' . M. l�' .i . Backwater valve 16.60
a Clothes washer 16.60
G Dishwasher 16.6D
A` 41 ��r =use lq`:^ m; ,A:i:�y: :';'c "�"e3,�r(trw, '},P ,, 191 N"- •: :r,,,;,,,�.,s,, wTJy hr Drinking fountain 16.60
. ; i�...n'LF; :;".h!r :•:,itPae ",.i' uiat:ir.:i�'.:if��: ' tat: /.,uE"6i W � t7l'(' s1:i ;4 %1 FK'!.. Yr.,;.J
Name: Ejectors/sump 16.60
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/2T: Floor draln/t)oor sink/hub 16.60
Phone: ( )
Fax: ( ) Outrage disposal 16.60
u1�ilk pr`tnyl+!x,l "'•",' `."V.4{�; ,!W! 1t'h7 Hose bib 16.60
7� "'lA E. :i+�l`;.`.%r'stw..n ?;tWIONE � ; i.4�:s1^ i:itlk `f r im 2 ice maker 16 60
" / interceptor /grease trap I= 16.60
Contact name: / y Medical gas (value: $ )
Address: • rr J Primer r 16.60 •
City/State/ZIP: 4%0 4 ° 9 7, • Roof drein (commercial) 16.60
Phone: ( ' f p 3 ) r 9 4 1 � i 1.04:5" Fax :: ) 5 •' J i Tub/shower/shower wer/s owe W 16.60 2
Tub/ahower /shower pan 16.60
E.mall:
Urinal 16.6D
� c �tg " r'J''4" t, t i IvttF'' j +: I ..L rI.1 ..• Water closet 16.60
_rkr ?a'at;�u' 'i (!n�l�tAivi ';'':'?'Mr. i` a,.:�_, ... ,::::,' ':; ''.. i::
,', ;.�.. �, •. .., r , �'
Business name: /_ __*' ■ ' . Water heater S 16,60
Address: r [ ,. - � uA.. I / Other;
City/State/ZIP: li is G'' A- 7_/ Subtorol
� Minimum permit tl:a: $72,90
Phone: ft )3) a ( . - 74.5 I Fax: (503 ) 9'E' 7 14 _ Residential backflow minimum permit Pee: $36.25 7Z .so
CCB Lie.: r 1 , Plan review (2554 of permit fee
P lumbing Wc. tto,: r •4 at 3-J )
Authorized signature: I / Stare surcharge (12%orpennit fee) ;
L./ lsi . TOTAL PERMIT FEE i r AP]
Print name: � r A • t!_ Date: This permit application expires If a permit Is not obtained within
180 days after it has been accepted u complete.
i / ■ ., "Fee methodology set by Tri- County Building industry Service Board.
5 a,mdir�7Petmw>m.nt.0- " .p.d.. 06n � Ier(la*VCOM ' gS)
1 ' Xdd 13C2IBSEi'l dH Wd2E:2 6002 62 unr
Plu - n Per is t i n - City of Tigard
Page 2 - Supplemental Information
Fee Schedule. Residential Fire Sus . reselon S terns:
,r J r te ; ., h M'• -. rz,ti.r5sk , „, .*, Ai, `7 7 i t--4, 0• ��t
:• i � ; � , � i _ .. �,y� i� { �i 1c� ,�•.•�:.'” , , -,(gyp 11..,1::,• ' i ' c L � ,le i , ' , NQ a
.
I , ' � � c s'k -N :: �� '�''C " ✓%� ;'I k.A01,f� . . .. ., ... . c . ��. �A. N . ... ,.u_ .�L.�l� 7+. l
Footing dram • 1 100' 55.00 I 0 to 2 000 3115.00
Footing drain - each additional 100' 46.40 2 001 to 3 600 S1 • x.00
3 601 to 7 00 220.10
Sower - let 100' 55. 7 201 and : eater ' . A
Sewer -each additional 100' - AO
Water Service . lit 100' 55.00 MN Medical Gas S stems:
100' in- ' 7,03 t9CeRl ;i ':,1;y, ,�'fj,.A,14i1
Water Service • each additional 46.40 � �:� °, •� ;Ti, `, ` . ■�;�.� .' ;• , , I y ; ,
33.00 w;l :
Stone & Rain Win -1st 100' . 1.00 to 35 000.00 Mini , , Ate 572.50
Storm & Rata Drain • each additional 100' — 46.40 35,001.00 to S10,000.00 .10 for the rat $5,000,00 end S1.52 fbr each
tt , 1 . ., • ,,r'. a` J r { , � y � .� 1y1 additional 5100.00 or fraction theraot,10 and
•.. 4'rNW2, ! �.+ .: + includin: S 0000.1 1
Commcrolal Back Flow ' „ ion Device 46.40 S10,001,00 to 525,000.00 314 ,SO fbr the first S 10,000.00 04 51,54 for
Rceiderdal Sackdow Prevention Device coon additional 5100,00 or fraction thereof, to
mirdrnum .i ;u, fee v .. 27.55 and Inoludtn 325 000.00.
Rain Drain, single family &oiling 65.25 IIMI 125,001.00 to 350,000.00 1379.50 fbr the first 12.5,000.00 and 31.45 for
each additional S100.00 or Elation thereof. to
Inspection of existing plumbing or and i to udl : 50 000,00.
• dell n • u ' - ' . . • cations - • hour 11111 72.50 S50,001 00 and up 3742.00 • r the first 550,000.00 and 1, 0 for
Subtotal: NM each additional 3100.00 ar fraction thereof.
Filxture Work: / °r it re f 1> A , r , , i 'l a
Are you capping, adding or replacing natures? If "yes", Plan review is required for any of the following.
please hldteate work performed by fixture. Failure to Please check all that apply.
accurate! re , oixture
rt fixtures could result In Increased sewer fees*. ❑ Any new commercial building with water service 2" and
�< 1 F I > � i greater, except systems designed and stamped by licensed
i x47 , ,iolipty3i Ir , 1k %'" , engineer.
L :11.111'E ,I „tt 1 ,, , _ ntkZ v b Any new exterior plumbing sits utllides.
. : � 1 0 Medical gas and vacuum systems fbr health care lkeilities.
MINN r 0 Any multipurpose fire sprinkler system.
IiiiliF—RIMMIIMEMINI MIN= ❑ Any complex structure as defined in OAR916- 760 -0040.
Car Wash Each Stall
-Dri . t MIMEO= Submit / seta of plans with any of the above.
« - • idorlw .., .. • r — IIMMOIMONi
Dishwasher -Commercial - ” .`r ;Ir r , • 5 6 1 411
.D01/18164 MOM Wa sh I �
■ Isometric or riser diagram Ls required for new buildings
5 Wa
Dnr Fountain � � r that meet the • ualifications above.
��
Floor DraWsl - 2" inumia . MIN
•3" MIIMINlioll
.a" �
Comments regarding fixture work:
��r
or wash Dtaia 11=11= MIIIIIMI
Garbage - Domoatie MIMEO MOM
Disposal Commercial MM.
-Industrial 11111iMINNMININIM=Mil
lea MaehiReM_. Grabs ii=i1MIIIMMII
011 Gasstaion MIMI e - -
Rec. Vehicle Dvm • Station
Shower -Gal MINE +Note: if the fixture work under this permit results in an
Stall IiMlinniiiiIMMII increase of sewer EDUs, a sewer permit will be issued and
Sink •eern,avatory - MIME . fees assessed for the sewer increase must be paid before the
-Bradley ��� plumbing permit can be Issued,
-Commercial MIME Mill= - Service NEM
Swimmin Pool Fitter - MIME MIMI
Washer - Clothe —
Water lodractor .
11 atm Closet - oiler MM.
Other Fixtures; mow
2 • d Xijd 131: 213Sd1 dH Wd2E s 2 6002 S2 tare["