Permit CITY OF TIGARD 1 ' PLUMBING PERMIT
COMMUNITY DEVELOPMENT NMI Permit #: PLM2011 -00052
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/15/2011
Parcel: 2S113AB00600
Jurisdiction: TIGARD
Site address: 16160 SW UPPER BOONES FERRY RD
Project: Dow Agrosciences Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Modification of plumbing for new TI. 3/11/11, reprinted to correct street name from 72nd Ave.
Contractor: ADDISON PLUMBING Owner: PACIFIC REALTY ASSOCIATES
27425 S BEAVERCREEK RD 15350 SW SEQUOIA PKWY #300
MULINO, OR 97042 PORTLAND, OR 97224
PHONE: 503 - 624 -6300
HONE: 503 - 740 -8116
FAX: 503 - 632 -1168
FEES
Quantity Description Date Amount
2 ea Dishwasher 02/15/2011 $50.04
Specifics: 1 ea Drinking Fountain 02/15/2011 $25.02
5 ea Floor Drain /Floor Sink/Hub 02/15/2011 $125.10
Type of Use: COM 5 ea Sink 02/15/2011 $125.10
Class of Work: ALT 8 ea Lavatories 02/15/2011 $200.16
Type of Const: 1 ea Tub /Shower /Shower Pan 02/15/2011 $12.51
Occupancy Grp: 2 ea Urinal 02/15/2011 $50.04
Stories: g ea Water Closet 02/15/2011 $225.18
3 ea Water Heater 02/15/2011 $112.56
100 Misc Other Fee 02/15/2011 $100.08
1 12% State Surcharge - 02/24/2011 $123.09
Plumbing
Total $1,148.88
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 obtain a copy of the rules
or direct que ons to OU C by c- 'ng 503.232.1987 or 1.800.332.2344.
Issued By: / • Permittee Signat
.1.1A O
Call 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.
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00052
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/15/2011
Parcel: 2S113AB00600
Jurisdiction: TIGARD
Site address: 16160 SW 72ND AVE
Project: Dow Agrosciences Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Modification of plumbing for new TI.
Contractor: ADDISON PLUMBING Owner: PACIFIC REALTY ASSOCIATES
27425 S BEAVERCREEK RD 15350 SW SEQUOIA PKWY #300
MULINO, OR 97042 PORTLAND, OR 97224
PHONE: 503 - 624 -6300
HONE: 503 - 740 -8116
FAX: 503 - 632 -1168
FEES
Quantity Description Date Amount
2 ea Dishwasher 02/15/2011 $50.04
Specifics: 1 ea Drinking Fountain 02/15/2011 $25.02
5 ea Floor Drain /Floor Sink/Hub 02/15/2011 $125.10
Type of Use: COM 5 ea Sink 02/15/2011 $125.10
Class of Work: ALT 8 ea Lavatories 02/15/2011 $200.16
Type of Const: 1 ea Tub /Shower /Shower Pan 02/15/2011 $12.51
Occupancy Grp: 2 ea Urinal 02/15/2011 $50.04
Stories: g ea Water Closet 02/15/2011 $225.18
3 ea Water Heater 02/15/2011 $112.56
100 Misc Other Fee 02/15/2011 $100.08
Total $1,025.79
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 Notificati n C,P ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. Yiu may obtain a copy of the rules
or direct estions to OU " b - •Ilin• 503.232.1987 or 1.800.332.2344.
Issu d By: / / , /r Permittee Signature: 4• 1/
Call 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 ,fit Err 1 , FFD
Building Fixtures 0. w , FOR OFFICE USE ONLY •
City of Tigard ved �� p20r'r''t700So2
Ty g FEB 1 5 201 Recei Dale /By: s I S5-0 , I PennitNo.: e
w 13125 SW Hall Blvd., Tigard, OR 97223
: Plan Review cA /( OdO30
Phone: 503.639.4171 Fax: 503.598.1960 +, Other Permit No.:
Inspection Line: 503 CITY OF Tiu . D Dat /B
TIG?.RD (gy Date Ready /B Juns: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING � Dt� I ° I5I °.!t Notified Meth od: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
® Addition /alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 II. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I- and 2- family dwelling ® Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder El Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE - INFORMATION AND LOCATION Site utilities:
Job site address: 16160 SW '77 4 /✓C • Catch basin or area drain 18.76
City /State /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: C 1 Project name: DOW Building C Manufactured home utilities 50.03
Cross street /directions to job site: SW 72" Ave Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Stone sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: 0251 / 5 "9-6 00600 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
TI
Dishwasher A- 25.02
Drinking fountain / 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: PacTrust Fixture /sewer cap 25.02
Address: 15350 SW Sequoia Pkway #300 Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City /State /ZIP: Portland, OR 97224 Hose bib 25.02
Phone: (503)624 -6300 Fax: (503)624 -7755 Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Durus Construction, LLC Medical gas (value: $ ) Page 2
Contact name: Steve Adams Primer 12.51
Roof drain (commercial) 12.51
Address: 15836 Upper Boones Ferry Road
Sink/basin/lavatory �- 9 S^ jr/3 25.02
City /State /ZIP: Lake Oswego, OR 97035 Solar units (potable water) 62.54
Phone: (503) 320 -8601 Fax: : (503) 684 -8144 Tub /shower /shower pan / 12.51
E -mail: steve @durusllc.com Urinal a 25.02
CONTRACTOR Water closet 9 25.02
Water heater 3 37.52
Business name: Addison Plumbing, LLC
Water piping/DWV 56.29
Address: 27425 S. Beavercreek Road Other: t`/E ' Y 25.02 /pd.dg
City /State /ZIP: Mulino, OR 77042 Subtotal /0 g.677e
Phone: (503) 740 -8116 Fax: (503) 632 -1168 Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: 151754 Plumbing Lic. no.: 3 -449PB
State surcharge (12% of permit fee) /R.+�,
Authorized signature: . \"� 1 , ` Ga,�-- TOTAL PERMIT FEE 1 /q8,. QV
Print name: Jay Moore Date: 2/15/11 This permit application expires if a permit is not obtained within days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Penns \PLMU - PermitApp.doc 10/01/09 440-4616T( I 0 /0JCOM /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' 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 tFixture) 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
Bath - Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
b /S i/Whirlpool as defined in OAR918- 780 -0040.
Car Wash - Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator CI Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
- Domestic 2 1 1 Submit 2 sets of plans with any of the above.
Drinking Fountain l 1
Eye Wash 3 1 Isometric or Riser Diagram
Floor Drain/sink -2" 3 ❑ Isometric or riser diagram is required for new buildings
- 3" 1 2 2 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 I
Sink -Bar /Lavatory ' I 7
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service 2 1 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 4 5
Urinal 1 I
Other Fixtures: No() 5,0"...„ �� 2
C: \Documents and Settings \Steve 2 \My Documents \STEVE ADAMS \DU2US \DOW\DOW- tigard \Bldg C \PLMF- PermitApp.doc