Permit 4 1 CITY OF TIGARD PLUMBING PERMIT
! COMMUNITY DEVELOPMENT Permit #: PLM2011 -00063
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2011
Parcel: 2S 113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 300
Project: Food Sales West Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Interior plumbing for TI.
Contractor: CASCADE PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES
2630 N HAYDEN ISLAND DR #3 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97217 PORTLAND, OR 97224
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PHONE: 503 - 624 -6300
PHONE: 503 - 289 -7095
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Dishwasher 03/03/2011 $25.02
Specifics: 3 ea Floor Drain /Floor Sink/Hub 03/03/2011 $75.06
1 ea Interceptor /Grease Trap 03/03/2011 $25.02
Type of Use: COM 5 ea Lavatories 03/03/2011 $125.10
Class of Work: ALT 2 ea Water Closet 03/03/2011 $50.04
Type of Const: 1 ea Water Heater 03/03/2011 $37.52
Occupancy Grp: 1 12% State Surcharge - 03/03/2011 $40.53
Stories: Plumbing
Total $378.29
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 ■ • I'cation - -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -I A tO. You may obtain a copy of the rules
or d• -ct questions to OUN• • ailing 503.232.1987 or 1.800.332.2344. /
Iss ed By: 1 ii! .LV•.11_,A4.....1 :It ' / � /� Permittee Si nature: , / � /j
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Call 503.639.4175 by 7:00 a.m. for the next available inspe ' • n 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 \i i C t 0 _
Building Fixtures 4 � - " \ FOR orrlr_.E USr:. ONLY
Cif o Tigard .- `� ` Received '> Permit No.:
tY Datertsy; N i1I Y x - Q (,y
I - n 13125 SW Ball Blvd., Tigard, OR 9722.ke pta„ Review
Phone: 503.639.4171 Fax: 503.598.1 Date/By: Other Perinic No.: 44 i) _ lx
- Inspection Line: 503.639.4175 Dale Ready /By: �uns�� ® See Page 2 for
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TIGARD Internet: ww.tigard- or.gov Notified /Method: / , Supplementalinformation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition
For s,(swiol information use checklist
Description (BEM. Total
ddition /alteration /replacement El Other: New 1-2-family dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312,70
❑ 1- and 2- family dwelling ,mmercial /industrial SFR (2) bath 497.78
SFR (3) bath 500,32
❑ Accessory building ❑ Multi- family
Each additional bath /kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
- s i i INFORMATION AND LOCATION Site utilities:
Job site addreis: I b ^j -'1 t rlt1 ( C( (9 5 5 Catch basin or area drain 18.76 MI
n Drywell, leach line, or trench drain 18.76
City /State/ %1P: ,. t A � 0K
� Fooling drain (no, linear ft.: ) Page 2 EMI
Suite/bldg. /apt. no.: __ Project name: `bd 5 ,5 .s-f Manufactured home utilities 5003 MIMII
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary Sewer (no. linear ft.; _) •
Page 2
- Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear R.: _) Page 2
Subdivision: [Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer • 31,27
Backwater valve 12.51
DESCRIPTION OF WORK 25.02
�}► Clothes washer
t' ___ ______ -1 oJla _ Dishwasher .
II.1 25,02 pl in , 02., t
J T L . 1 r()Q Drinking fountain — 25.02 IMIM
Ejectors /sump 111 25.02
❑ PROPERTY OWNER El TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name.
Floor drain /floor sink/hub I;M 25.02 - , Q ,. r,--
— Address: _ ,- Garbage disposal 25.02
City/State/ZIP: — Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51 f ,.
❑ APPLICANT ❑ CONTACT PERSON Intercept grease trap I 25.02 , 5, 0 i.- Ell
Business name: CASCADE PLUMBING COMPANY Medical gas ) Page 2
Primer 12.51
Contact name: CRYSTAL JONES Roof drain (commercial) AA w . 111111
Address; 2630 N. HAYDEN ISLAND DRIVE #3 Sink/basin /lavatory _ i 25.02 � /Q ; j
City /State /Z1P: PORTLAND, OR 97217 Solar units (potable water) 62.54
Phone: (503) 289 -7095 Fax: : (503) 283 -9514 Tub /shower /shower pan 12.51
E -mail: CASCADEPLUM@YAhHOO.COM Urinal 25.02
Water closet Ca 25.02 O. RA r.."
CONTRACTOR
_..,- •.— Water heater i 37.52 31, 5
Business name: CASCADE PLUMBING COMPANY Waterpiping/DWV
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Other: EPIA 25,02 MI
City /State /ZIP: PORTLAND, OR 97217 3. Subtotal
Phone: (503) 289 -7095 Fax: (503) 283 -9514 Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: 120893 Plumbing Lic. no.: 34 -412PB (12% �f
State surcharge (12 of permit fee) "f Q r J 3 Authorized signature: �� TOTAL PERMIT FEE
Print name: CRYSTAL, JONES i Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
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PlulmbinQ Perm Applicatio - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total S Footage: Permit Fee:
Footing drain - 1' 100' 50,03 0 to 2,000 $121.90 .
g drain - each additional 100' 37.52 2,001 to 3.600 $169.69
—Footing 3,601 to 7,200 $233.20
Sewer- 1st 100' 62 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 - tst 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 includin $ 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 eharpee- 2 hours) each additional $100,00 or fraction thereof. to
Rcinspection 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 Plumbinnnnng 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
Provieus 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 ❑ Any multipurpose a
Car Wash. -Each Stall ❑ Medical gas and vacuum systems for health care facilities. .
-Each t fire sprinkler system.
Cuspidor/Water Aspirator . El Any comp structure as de in 0AR918- 780 -0040.
- Dishwasher - Commercial
Submit 2 sets of plans with any of the above.
Domestic
Drinking Fountain - -
E W Isometric or Riser Diagram
Floor Drain /sink - 2" — )1‘.1 * ❑ Isometric or riser diagram is required for new buildings
• 3" that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach. /Refriig. Drains - - —
Oil Separator qua. 25
Roc. Vehicle Dump Station _
Shower -Gang ■
-Stall
Sink - Bar /Lavatory 0 S-
-Bradley
- Commercial 5 *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
Urinal
Other fixtures; /
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