Permit CITY OF TIGARD PLUMBING PERMIT
11 11 COMMUNITY DEVELOPMENT
P ermit #: PLM2011 -00085
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2011
Y f <'ARD Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 130
Project: Yecuris Subdivision: Lot: 0
Project Description: Interior plumbing for TI.
Contractor: EK PLUMBING Owner: PACIFIC REALTY ASSOCIATES
PO BOX 1898 15350 SW SEQUOIA PKWY #300
BATTLEGROUND, WA 98604 PORTLAND, OR 97224
PHONE: 503 - 624 -6300
HONE: 360- 687 -4648
FAX: 360 - 687 -6473
FEES
Quantity Description Date Amount
5 ea Floor Drain /Floor Sink/Hub 03/22/2011 $125.10
Specifics: 9 ea Sink 03/22/2011 $225.18
2 ea Tub /Shower /Shower Pan 03/22/2011 $25.02
Type of Use: COM 1 ea Urinal 03/22/2011 $25.02
Class of Work: ALT 3 ea Water Closet 03/22/2011 $75.06
Type of Const: 1 ea Water Heater 03/22/2011 $37.52
Occupancy Grp: 1 12% State Surcharge - 03/22/2011 $61.55
Stories: Plumbing
Total $574.45
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 direc ; • Is to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: aec 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.
Plumbing Permit Application ii S( • f _ _ t L(
Building Fixtures rORR Orr•l(l: I se ()NI.A
City of Tigard Received Al
:III M Permit No.'. r_ /A .I t -' e S
• 13125 S Hall Blvd., Tigard, OR 97223
Date /13
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: i / 9 - yyt lldJ 143
T I G A r,1? Inspection Line: 503.639 Date Ready/By: Juris: 21 See Page 2 for t/
Internet www.tigard or gov Notified/Method:
t c - � sSr, �' ::;1' �M"t'-9: � ,;� } ��+, ;r , u a r» . ' sa Supplemental Information 1 .• p { '' it ,T_ Y 7 `^}r' " `K' Fes..
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;New construction ❑ Demolition For special information use checklist
Description I Qty. j Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
' 'a 'AS.r p: �' 5 +te ' `„ rR 3 4A , » % to r.3 . r SFR (1) bath 312.70
I -and 2 -famii dwellin SFR (2) bath 437.78
❑ y g Commercial /industrial
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
A H` , Firesprinkler sq. ft.) Page Pa e 2
.i� , ' . - ttl I ltd i t , 3 i , iriHro 4, I Na j'` ,r ' StrdL_ r' ,^, Site utilities: "
.0;] „ si�.ti?. .» .s',,,:v n 3r ^ir .l t t e .r., •;, .•. 0
0
Job site address: ISO 'S" SW � 0 X ,,. Catch basin or li drain 18,76
x . �� Q ( ��9 70.2.4.1 D oting leach line, or trench drain 18,76
City / State/ZIP: Pp
t Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: ‘: 1 Project name:NlexittAp. 5 Manufactured home utilities 50.03
Cross street/directions to job site: _ • r _ , .■ J.L Manholes 18.76
t�
/' � �,, J e - �
rr +) �, � u � O k� Rain drain connector 18.76
'� ' ` 1 Ic' "on � \ Sanitary sewer (no. linear ft.: �) Page 2
r te ,�As , t • r s. `,` • 1 ' ; ici Storm sewer (no. linear ft.: ) Page 2
• -- ` -� LtO� /� r��+� Water service (no. linear ft.: _) Page 2
Subdivision: it no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
=fiIiii ' • �1 a, "z r er 57fAiN a 1 r , A a 1 .. G : ;re;a� :... Backwater valve 12.51
,
Clothes washer 25.02
* .re-oAvv' `o 101X 12rt. 'gib(' A I PAO • A 41'`sok t Dishwasher 1 25.02
(d ' k, i44`1 A t k si"a j Z LfW0.c-CS ZS Drinking fountain 25.02
t rwrt • Si . .5 Ejectors /sump 25.02
v� -
$d i i' ' 7 r�1 1 j1 ° t , Fn +�•t0f Expansion tank 12.51
Name: 1 �L _'1 - yk• Fixture sewer cap 25.02
,(.../-:) 0. L /4 4j1 4t�30 Floor drain /floor sink/hub i 5 25.02 19.5. i 0
Address: 1� 35
� 1,4( Garbage disposal 25.02 F
City / State/ZIP: l tor� n t q7Zz e. _--71 75 Hose bib 25.02
Phone: (',SOS 6zei -630G Fax:( ) Ice maker 12.51
api t �� ' ' , �' F� i t„ ' �' r b' Interceptor /grease trap 25.02
Business name: Ri $ ijC t. Medical gas (value: $ _ ) Page 2
Contact name: - ��r��r�
Primer 12.51
Roof drain (commercial) 12.51
Address: P . Q . ge›k `! Q Sink/basin/lavatory 6 1I, 25.02 ,
City / State/ZIP: ,„ „ t A - D 1 - �o Solar units (potable water) 1 62.54
Phone: ( 3G0 ) 6A 7_ 4 z z Fax: : Cita ) c, .II` 7 ...-6 .`f 7 3 Tub /shower /shower pan ( Z 12.51 a-5 Os
E -mail: Svic,0 - 4- 4 ,i1 . ‘CA rti, Urinal t 25.02 , d IN
,r r ii, , i,Ir O :_ s.. • Water closet 11 3 25.02 7S, r X p
�;#3.t �. „ �'•,•a r"`;�SELI Water heater 37.52
Business name: {! K 4��
✓ Water piping/DWV 56.29
Address: N D . s '% 'p Other: 25.02
City /State/ZIP: (;k1t .-4 / {r" ` Lt Co 6( 9 Subtotal 5 L �j
Phone: (3C0 CA .- 1 ` i 6 4 $ Fax: (5l�) gg`j - C et 3 Minimum permit fee: $72.50
Plan review (25 %of permit fee)
tact 3
- CB Lic.: 1Z - s Plumbing Lie. no.:3'7_!.(3o e I,55-
State surcharge (12% of permit fee)
.wthorized signature:
CMS TOTAL PERMIT FE457 5l k
(Print name: 5 E� Date: '3 - `l - `l This permit application expires if a permit is not obtained w hin 180 days
after it has been accepted as complete.
.Fee methodology set by Tri- County Building Industry Service Board.
11Building '\Permils\PLMU-PermilApp.doc 10/01 /09 440 -4616T(10 /02/COM/WEB)
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i
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
- Si t 6 ', 1 ' CWi ' � . . ' 14%4: a P , E 3y , „ ' - 11 r : 5 l i s , 'e 1 ' lf ..::: •
;.. m k. .. tx
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 7201 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 ,E; w
�.`�����a` tfiLt; .0 slims' -- '. : -
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
y,•'= ; �•• ^ r •;- ,, ,t,y,;:• r - , 1� t' ' v each additional $100.00 or fraction thereof, to
DtII I'` ��..�.., �_ l_ .-E t. +' � O ' ' ` 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 ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
ouatttity by y i v�r (`I I llai 1.e fq>lk l b Installations
Fixture Type for `°/ Plan review is required for any of the following.
Work Perfor med. C'P...'; AdEde� 4''`
Please check all that apply.
Baptistry/Font
Bath Tub/Shower ❑ Any new commercial building with water service 2" and
Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher Commercial ' ❑ Medical gas and vacuum systems for health care facilities.
- Domestic El Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918 780 - 0040.
Eye Washj
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
3 ,.
Car Wash Drain . , r }.., , .
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang 0 AD
-Stall _
- Sink /Lav - Non -food related •fit 5 IMF
- Bradley
- Commercial -food related 1
-Service 1
Swimming Pool Filter *Note: If the fixture work under this ermit results in an
Washer - Clothes p
water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet I fees assessed for the sewer increase must be paid before the
Urinal fj plumbing permit can be issued. _...:: Other Fixtures:
http:// www, tigard- or.govkity_hall/departments c F- PermitApedoc
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