Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 00372
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/12/2010
Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 460
• Project: Pacific NW Title Subdivision: Lot: 0
Project Description: Relocate (1) breakroom sink, (1) hub drain & (1) water heater.
Contractor: GRIDLINE PLUMBING Owner: WISCO REAL ESTATE EQUITY
4343 SE 37TH FUND I LTD PARTNERSHIP
PORTLAND, OR 97202 BY WYSE INVESTMENT SRVS CO
1501 SW TAYLOR ST STE #100
PORTLAND, OR 97205
PHONE: 503 - 771 -8790 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 11/12/2010 $25.02
Specifics: 1 ea Sink 11/12/2010 $25.02
1 ea Water Heater 11/12/2010 $37.52
Type of Use: COM 1 12% State Surcharge - 11/12/2010 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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 • ' ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow t. - u es a•'pted by the Oregon
Util'. otification C- er. Ti -- rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. •u may obtain a copy of the rules
direct questions to OU .y callin .. %.232.1987 or 1.800.332.2344.
Issued By: • Permittee Signature: L /
/ u
CaII 503.639.4175 by 7:00 a.m. for the next available ins
This permit card shall be kept in a conspicuous place on the job site until complon of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures I 'R orrice: 1 is1: oiyI.v
City of Tigard Date/By: et ��.' /n <ll,.)4 Permit No.: P 61-/A10 _ 3 77_
III • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.:
Th.; 1 t :; n It 1 Inspection Line: 503.639 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
'A ddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
�� CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling tommercial/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 LOC TION , Site utilities:
Catch basin or area drain 18.76
Job site address: �� 2 � �� ��� . Y�
-� 7 Drywell, leach line, or trench drain 18.76
�--�/ �� Q
City /State /ZIP: / E q r 4 . Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: ig., t, I Project name: frit (17 l C A4 77 V I Imo Manufactured home utilities 50.03
s
Cross street/dir tions to job site: Manholes 18.76
// J / A� l) N 4 _ e + VA^ lit SS `)( , e J j , Rain drain connector 18.76
����1111 s Sanitary sewer (no. linear ft.: _) Page 2
9 / /- V ` /( / D s J Storm 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
ESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
• -- 0 - �7 ` t ' / ` Dishwasher 25.02
r
/ N Fe l V 3 , Q /'1�a. / ' Drinking fountain 25.02
77 /44 h Q o J, v ' / $ 1 • . , Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Address: Floor drain/floor sink/hub L' /hub > . ( 25.02 -
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory )( [ 25.02 ac ni o
r
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
ONTRACTOR Water closet 25.02
Water heater )( ,l 37.52 3 7 c2.
Business name:
/ / � , %, e. i i /� �i f /7 9 � � Water piping/DWV 56.29
Address: 1L 3 i fr„ 7 .4,rz__, Other: 25.02
City/State /ZIP: t / /// .
4 . (w., 9
4.„? . 54
Subtotal
Phone: (10) 7 79v Fax: (‘I5 77/- -/08'3 Minimum permit fee: $72.50
/ Plan review (25% of permit fee)
CCB Lic.: 71/'i 7 % , bing Lic. no.: a�j G State surcharge (12% of permit fee) ./
Authorized signature:. /.....,/-_ / � TOTAL PERMIT FEE m g.` 0 7
Print name: 1 S� v� � " Date: ! ` /ii This permit application expires if a permit is not obtained within 180 days
C after it has bee accepted as complete
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Pennits\PLMU- PermitApp.doc 10/01/09 440- 4616T(I0 /02/COM/WEB)
Plumbing Permit Anplication - 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 Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain 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
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 Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator Thru ❑ 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 p
Water Extractor plumbing permit can be issued.
•
Water Closet - Toilet
Urinal
Other Fixtures:
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