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Permit • • CITY OF TIGARD PLUMBING PERMIT 11'2 COMMUNITY DEVELOPMENT Permit #: PLM2009 -00232 .TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2009 Parcel: 2S113AA00300 Jurisdiction: Tigard Site address: 16316 SW 72ND AVE B3 Subdivision: OREGON BUSINESS PARK I Lot: 0 Project: Spec space Project Description: Relocate (1) floor drain, (1) primer, (2) lays, (2) water closets (1) water heater, cap (1) drinking fountain and add (1) sink. Owner: FEES PACIFIC REALTY ASSOCIATES Quantity Description Date Amount 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 1 ea Drinking Fountain 08/25/2009 $16.60 PHONE: 503-624-6300 1 ea Floor Drain/Floor Sink/Hub 08/25/2009 $16.60 1 ea Primer 08/25/2009 $16.60 2 ea Sink 08/25/2009 $33.20 Contractor: 1 ea Lavatories 08/25/2009 $16.60 DEAN WARREN PLUMBING & REMODELING 2 ea Water Closet 08/25/2009 $33.20 INC 1 12% State Surcharge - 08/25/2009 $15.94 PO BOX 14701 Plumbing PHONE: 503 - 236 -4152 FAX: 503 - 296 -2218 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $148.74 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 que ' • • . • UNC by calling 503.246.6699 or 1.800.332.2344. Issued , / ,� / Permittee Signature: Call 503.639.4175 by T:00 a.m. for an inspection that busi -day. This permit card shall be kept in a conspicuous place on the job site unti completion of the project. Approved plans are required on the job site at the time of each inspection. -Plumbing Permit Application City of Tigard R Date ecei B ve y: �j r d ��Si /D � Permit No.: L��09��� 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C y p Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: O t w ��jo -c-1(.,:5 7 f l G A R D Inspection Line: 503.639.4175 Date Ready/By: >r- la See Page 2 for Internet: www.tigard or.gov Notified/Method: / t ra Supplemental Information TYPE OF WORK FEE* SCIIEDULE ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: % (oat (o S,...., --)..A ‘k) 0 A vg- Catch basin or area drain 16.60 City/State /ZIP: T-49AQc, o, it4ay a Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 3 I Project name: 1 , ,O¢ C PALCI__ Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: �y / Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: acs / ! 3(1" 0-v0 56)0 Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 feokt. - c rONP2overr-Nea.DT Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 IltPROPERTY OWNER I ❑ TENANT Drinking fountain 1 16.60 Ejectors /sump 16.60 Name: ` * t J -1-10,0 bl Expansion tank 16.60 Address: 16 S 5 0 w U O ©I Pv Pg Fixture /sewer cap 16.60 City /State /ZIP: :(DAVS) 9 aaL{ Floor drain /floor sink/hub % 16.60 No • Phone: ($ 03) (44 - 6 00 Fax: ( ) Garbage disposal 16.60 'e APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: peP1k 0 A(2-RJLI\3 piurritI(.T0 Interceptor /grease trap 16.60 Contact name: 3 t F L1416 Medical gas (value: $ ) Page 2 Address: Po p)o?C 1,,,,,t1-10% Primer % 16.60 dig iag- C ity /State /ZIP: CO A� 9 3-4),( Roof drain (commercial) 16.60 Sink/basin/lavatory S 16.60 Phone: (503) `ac;;�')- C Fax: : ( ) Tub /shower /shower pan 16.60 E -mail: JGG./7��'� Urinal 16.60 , CONTRACTOR , Water closet 16.60 Business name: bZflG t■D P1v 111\80 (J Water heater , 16.60 1.(0 c ` ° Address: Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 q Plumbing Lic. no.: 7 36 AW Plan review (25% of permit fee) CCB Lic.: � 5 9 / / g ZG - State surcharge (12% of permit fee) Authorized si:: ure: ' e � TOTAL PERMIT FEE Print name: [r�� Date: 9 -)r-42 S 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\PLM- PermilApp.doc 12/27/06 440.4616T(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 - 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 Fee: 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 Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and Fixture or Item 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 specially requested inspections - per hour 72.50 and including $50,000.00. 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: 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 Tub /Sow ❑ New exterior plumbing site utilities for any complex structure Bath -Tub/Shower Tub /S as defined in OAR918- 780 -0040. -Jacuzzi/Whirlpool Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. 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 1 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 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 *Note: If the fixture work under this permit results in an - Bradley p - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service r 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 Urinal Other Fixtures: i:\ Building \Permits\PLM- PermilApp.doc 12/27/06