Permit CITY OF TIGARD PLUMBING PERMIT
g COMMUNITY DEVELOPMENT Permit #: PLM2011 -00080
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/17/2011
Parcel: 25101 DB00100
Jurisdiction: Tigard
Site address: 7340 SW HUNZIKER RD 210
Project: Cornerstone Clinical Services Subdivision: Lot: 0
Project Description: Relocate (1) sink, rest of fixtures are new, additional.
Contractor: WESTERN PLUMBING Owner: HILLTOP BUSINESS CENTER LLC &
9460 SW TIGARD, AVE STE 101 HUNZIKER LLC
TIGARD, OR 97223 9430 NW KAISER RD
PORTLAND, OR 97231
PHONE: 503 - 639 -5296 PHONE:
FAX: 503 - 684 -9015
FEES
Quantity Description Date Amount
1 ea Dishwasher 03/16/2011 $25.02
Specifics: 1 ea Ice Maker 03/16/2011 $12.51
1 ea Sink 03/16/2011 $25.02
Type of Use: COM 1 ea Water Heater 03/16/2011 $37.52
Class of Work: ALT 1 12% State Surcharge - 03/16/2011 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.08
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 qu ins • •UNC b calling 503.232.1987 or 1.800.332.2344.
Issued By: ,` ! Permittee Signature:
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.
03/16/2011 08:59 5036849015 WESTERN PLUMBING INC PAGE 01/03
Pium bin gPe.rmit Application .s 10 1 O® lob .
Building Fixtures - = -. •
FOR 01'110 L USE (ALl
City of Tigard • r : }uceived
•
• 13125 S W Ball Blvd Tigard, OR 97223 t �1\ DatefBy: i r1= Permit Ne :: PI, �„ // c) q
IN
Phone: 503.639.4171 Fax: 503.598.2960 v � - Pie¢Lteview O(J
F T Col R Inspection Line: 503.639.4175 I \- , naw Other Pocmxt No.:
merzrct: svww tigard -or. v t�� DT Reedy /13y:
g° �P N C E1 See P age 2 b br
Su JE mental Information
New construction 0 Doniolitjon •-
tc For special6Jl/ wee checkGsc
-
Addition /sltcraticm/replacement ❑ Other
scri
New), 2- family dwellings (includes 100 if for each utility connecti ij
CATEGO12I' OF CONSTRUCTION SFR (1) bath 312.70
0 1- and 2-family dwelling Commericial /i SFR (2) bath 437.78
CI Accessory building ❑ Multi - family SFR (3) bath_ 500.32
0 Master builder Each additional bath/kitchen 25.02
Other; --.. _ Fire
7 ...-
sprinkler ( sq. ft.) Page 2
(j JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ��� u � .1 n Catch basin or area drain 18.76
City /State/zip; Q� Ft -, �JJ Drywell, leach lice, or trench drain 18.76
Suitt/bldg./apt. uo_ t Footing drain (no. linear rt.: - _
it, Project name: ,� e t ,•- C 1 ,,, (� ) Page 2
�� mil t 5rl t / I�tYl3C 3blanufackucd bonze utilities 50.03
Cross street/directions to job site; rz
1 u Manholes
1R.76
Rain drain connector 18.76
N Sanitary sewer (no, linear ft.: __) Page 2
Storm sever (no, linear ft; ) 1 Page 2
_ Water ar service (no, linear R-' _ Page 2
Lot no.: Fixture or item: -
Tax map /parcel no,: -
8ackflowpreverder 31.27 -
• DuP'1'I�QN'.OP " WORK: Backwater valve 12.71
M V M _,, 1C I ' / / / e6 r1) Clothes washer 25.02
tot t Dishwasher - _..... 25-02 ♦ (�
, Drinking fountain 111 25.02
r.4 . Ejectors/sump 25.02 NM
x_1 3.OPE1 r' OWNER, CI TENANT Expansion tank NM 12.31
Name! w µ Fu mre /sewer cap 25.02
Address: Floor drain/floor sink/hub
III 25.02
City /StateJZIP: - Garbage disposal 25.02
Phone: ( ) Hose bib 25.02 ME
Fax ( ) Ice maker
• Li APPLICANT T d, 4"f,1NTACT. ` PERSON Interceptor/grease trap linil 25.02
Business name: Medical gas (value;) OZER
Contact name: - -m I2.51
Address: Roof drain (oamtncrcial) 12.5!
City/State/ZIP:
Sink/basin/lavatory ( 25 -02
Solar units (potable water) 62.54
Phone: ( ) 1 Fax: • ( . ) Tub/ahower /shower pan MI 12.51
E-mail: Urinal MI 25 -02 -
t71VT [t11 I`(7R Water closet 25.02 MN
Business name: Western Plumbing, Inc Water heater 37 S2 klia
Water prpmg/DW V 56.29
Address: 9460 SW Tigard Avenue Suite 101
Other: 25.02
City /State/ZIP: Tigard, OR 97223
Subtotal 0.0 4
Phone; (503) 639-5296 Fax: (503) 6134 -9015 Minimum permit fee: $72.30
CCB Lin.: 2439 Ala Plumbing Lic. no.: 34 -29PB Plan review (25% of permit fee)
Authorized signature- / � `t 1 State surcharge (12% of permit fee)
41I.A J/ �,.�_
Print name: Dana Jensen t ' " T TOTAL PERMIT FEE
I / .,� Date: .. -/6,_ / Perniltapplicstlon expires if permit is not obtained within x80 tlayt
(� attar it has been accepted as complete.
* Rro .w.tl1rvi ninon, ..V by 7 .:_r. , ,w..R11:1,1:.,.. r...r..
03/16/2011 08:59 5036549015 WESTERN PLUMBING INC PAGE 02/03
Pit unibing Permit Application - City of Tigard
Page 2 - Supplezneutal Information
Fee Schedule: Residential Fire Su ression S stems:
telleilitiis. . Qty. Fee oio Tote gOare Poota @.; 'erw 'ee:
Footing drain -1 100' 50.03 0 M2,000 $121.90
Foaling drain -each additiotal . 100, 37_S2 2,001 to 3,640 $169.69 '�^
Sewer - 1st 100' 62.54 3.601 to 7,200 $233.20
7,201 and greater $327.54
Sewer - each additional 100'
37.52
Water Service • 1st 100' 62,54
Water service -each additional 100' 37.52 Medical Gas Systems:
Storm & Rain Amin -1 un 100' 62.54 V$iElatiOntt L Permit Fee:
Storm &Raul Drain - each additiagil 100' 37 g2 - $1.00 to $5,000.00 Minimum fee $72.50
Fees $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
'Other IiSp,eCtl0i1S> or Jt CQSY• kEt (ra) Tow ' fraction ea ch additional $100.00 ofraction thereof, to
Inspection of existing plumbing or for and including $10 000.00,
which no fee fisting tally indicated 90_QOthr $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
(minis charge —112 hour) each additional $100.00 or fraction thereof, to
inspections outside ofnooUlai business 90.00/br and ineludin_ $25,000.00,
hours m n imum ch — 2 hours $25,001.00 to $50,000.0 $379.50 for the first $25,000.00 and $1.45 for
Reinspection Fees 90.00/hr additional $100.00 or fia ciion thereof, to
Additional plan review for revisions V and includi _ $50,000.00.
90.00/hr 550,001,00 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:
Comm ercial Fixtu W ork:
Are you capping, adding or replacing lb If "yes",
please indicate work performed by fixture. Failure to v iew e u for of t he following.
Installations,
re .. Plea renew i s required for any of the following.
accurately rt fixtures could result in increased sewer fees *. Please check all that apply,
• , b Ihire Work P:. armed 0 Any new commercial building with water service 2" and
1 711u:. greater, except systems designed and stamped by licensed
engineer.
h - Tub/shower CI New exterior plumbing site utilities for any complex structure
Bat
Ssctlzri/w rlpool as defined in OAR918- 780 -0040.
Car wash Each Stall ❑ Medical gas and vacuum systems for health cam facilities.
Drive Ttu,t ❑ Any multipurpose fire sprinkler system,
cy,spidor/water Aspiratcv 0 Any complex structure as defined in OAR918 780 -0040.
Dishwasher - Co rator mmercial
-Domestic Submit 2 sets of plans with
Drinki ; Fountain �� Et any Of the above
Eye Wash
Floor Drain/ sink 2" Zs wietric or I ser,DiagraM ,
• 3 , Isometric br riser diagram is required for new buildings
4 " that meet the qualifications above.
Carr Wash Drain
Garbage - Domestic
EMI
Disposal -Commercial
-lnduetnal _ Comments regarding fixture work: Mach. /Refri&. Drains
oil Se . Gas Statioa ��
Rec. Vehicle bin, Station MIIIIMMI
Shower -Clang l agE111111111 -Stall —
Sink -Bar/Lavatory .
- Bradley
-Commercial MOM ��. ��irr = �
- service �� "Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EA1Ta, a sewer permit will be issued and
Washer - Clothes Maim MEM fees assessed for the sewer increase must be paid before the
w"r°r Extractor plumbing permit can be issued.
water Closet - Toilet IMINEMOMMIIIM
Urinal
Other Fixtures; 1