Permit ' CITY OF TIGARD PLUMBING PERMIT
,,
' COMMUNITY DEVELOPMENT Permit #: PLM2010 00379
TIGARD 13125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Date Issued: 11/23/2010
. , Parcel: 2S101DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Project: Triangle Pointe Subdivision: FARMERS INSURANCE Lot: 0
Project Description: Interior plumbing: Replacing (5) sinks, (2) urinals, (7) water closets, and (2) water heaters.
Contractor: RAY'S PLUMBING Owner: TRIANGLE POINTE LLC
P.O. BOX 685 901 NE GLISAN ST #100
BRUSH PRAIRIE, WA 98606 PORTLAND, OR 97232
PHONE: 360 - 892 -8700
PHONE: 503- 297 -8791
FAX: 360- 892 -9644
FEES
Quantity Description Date Amount
5 ea Sink 11/23/2010 $125.10
Specifics: 2 ea Urinal 11/23/2010 $50.04
7 ea Water Closet 11/23/2010 $175.14
Type of Use: COM 2 ea Water Heater 11/23/2010 $75.04
Class of Work: ALT 1 12% State Surcharge - 11/23/2010 $51.04
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $476.36
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 -0090. You may obt ' a copy of the rules
or direct questions to OUNC by calling 503.232.1987 . ;' I 32.2344.
Issued By: _ Permittee Signature:
di'
44 0A1 . P
C. 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Plumbing Permit Application
Building Fixtures 4 t r FOR ;OFFICE'USE : ONLY» _ l v
f Tigard O�O Received i .,
I 3 25 O lg8 d 1. // (j' j 0 ()Tr Permit No.. P L. n o i (i� 170 76
13125 SW Hall Blvd., Tigard, OR 97 Date/By:
Phone: 503.639.4171 Fax: 503.59 `` )Pl Review
8.1 ' 60
Fr
Inspection Line: 503.639.4175 O V �`�� �� /g y Other Permit No.: �o� 1 v CZ7��
.T[GARD ( ` Date Ready /By: Juris: gi See Page 2 for
Internet: www.tigard e r�l V Q� Nonfied/Me[hod Supplemental
f TYPE OF WORK N %ALA . E*�SCHE
D E
For special information use checklist
® New construction ❑ Demolitn
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 r SFR (1) bath 312.70
❑ 1- and 2- family dwelling ® 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
- ts .y s' " sraa �= sa . n. ;n " �. ' : I « -"` a a*a r
JOB f INFOR1447(N AND LOCA 01 fi Site utilities:
Job site address: 13333 SW 68th Parkway Catch basin or area drain 18.76
City /State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite /bldg. /apt. no.: 1 Project name: Triangle Pointe
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
corner of 217 and 1 - S Rain drain connecto 18.76
Sanitary sewer (no. linear ft.: _) Page 2
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
DESCRIPTION OF kWORK Backwater valve 12.51
' ., �1 t . 0 :0_ I _ in - ' tlan -. `." Clothes washer 25.02
Replace existing fixtures with new ones
R:17 Dishwasher 25.02
2 w, t- ` oth p.r --c
P e ,r f / ' / 6 Drinking fountain 25.02
Ejectors /sump 25.02
� i ❑ PROPERTrY OWNER F ®TENANT :n Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
":nglifilerilR5141141,116ANT, '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 S 25.02 to s- , 1 v
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal a 25.02 St5.O L.%
Water closet 4 25.02 17 5 _ ly
Wit:
VI � / ' CONTRACTOR � e " Water heater 2 37.52 '7 �, u■-1
Business name: Rays Plumbing
Water piping/DWV 56.29
Address: PO Box 685 Other: 25.02
City /State /ZIP: Brush Prairie, WA 98606 Subtotal
Phone: (360 ) 892 -8700 Fax: (360 ) 892 -9644 Minimum permit fee: $72.50 1.-0,913%,
CCB Lic.: 3 3 217 j Plan review (25% of permit fee)
/31 //i Plumbing Lic. no.: 3 7-149 PB
` State surcharge (12% of permit fee) 51,0-(
Authorized signature: TOTAL PERMIT FEE (p%;
P eter Levanen Date: l l / 2 3 10 This permit application expires if a permit is not obtained within 180 days
Print name: / after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10/02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site ilYilities 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
Perri it'Fee:
Storm &Rain Drain - 1st 100' 62.54 ValUatlOn:
$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
Qty. Fee'(ea)' Total each additional $100.00 or fraction thereof, to
Other Inspections 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 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 5
- 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 Z
Urinal 7
Other Fixtures:
I:\ Building \Permits\PLMF- PermitApp.doc 2