Permit II CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00164
13125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Date Issued: 06/03/2011
�!°�� Parcel: 2S113AB00500
Jurisdiction: TIGARD
Site address: 16083 SW UPPER BOONES FERRY RD 105
Project: Metro Multifamily Housing Association Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37, F
Project Description: Add (1) dishwasher, (1) hub drain, (1) ice maker(no drain), (1) breakroom sink and (1) water heater.
Contractor: MARXMEN PLUMBING & CONSTRUCTION INC Owner: G &S FC LLC
9665 SW 163RD AVE 16083 SW UPPER BOONES FERRY RD,
BEAVERTON, OR 97007 STE
TIGARD, OR 97224
PHONE: 503 - 579 -2200 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 06/01/2011 $25.02
Specifics: 1 ea Ice Maker 06/01/2011 $12.51
1 ea Sink 06/01/2011 $25.02
Type of Use: COM 1 12% State Surcharge - 06/01/2011 $10.51
Class of Work: ALT Plumbing
Type of Const: 0 12% State Surcharge - 06/03/2011 $4.50
Plumbing
Occupancy Grp: 1 ea Floor Drain /Floor Sink/Hub 06/01/2011 $25.02
Stories: 1 ea Water Heater 06/03/2011 $37.52
Total $140.10
Required Items and Reports (Conditions)
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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 not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to foil• the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. \u ma obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. I
Issued By: J tC� Permittee Signature:
° °° VVVCCC I It
Call 503.639.4175 by 7:00 a.m. for the next available inspection d. e. ,
This permit card shall be kept in a conspicuous place on the job site until complete• of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicatio CEI,VED
Building Fixtures FOR OFFICE USE ONLY •
City of Tigard JUN 1 2011 Received ( t f OD / Permit No.: ° Zi t i
F. 'I g 13125 SW Hall Blvd., Tigard, OR 97223 y
Plan Review ` �/yp ®
IN
Phone: 503.718.2439 Fax: 503.59�II 0 OF TIGARD Date /By: Other Permit No.: _ €20 // DA9 0
Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By , (J Juris. ® See Page 2 for
TIGARD
Internet: www.tigard - or.gov Notified /Method: to f (/ / ,y1 Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
;.: mss. , ,. , s: " ; . �• -6. ,.: y +., ; :, S FR (1) bath 312.70
- ; r,', � , " , sn`.�` a ^ : - .�� ':� a
W:,'',;
,; ;: '; ;: C ATIaGOAX,OF-- CQ1 ,' , , , ,
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
>�st: �` � • � r' J() B =;SITE;TNI♦ORiFK'ATIUN *i11VD °" I;ijC PION:: W'''' < % ` ; ; : - „ ': �' ; Site utilities:
Job site address: (10 `k
^ �a•.w �� vz•,�r.4>.: - :' � $v5!�.Sro;:r > "::<.:.•*�r�a 4/Z4k./ � --�. D 5 5u u P `k4 Catch basin or area drain 18.76
I"" 7 Drywell, leach line, or trench drain 18.76
City /State /ZIP:
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: /OLD Project name: H fr12o H (
�}f`I I Lv _ Manufactured home utilities 50.03
Cross street/directions to job site:
/419(151 ,3� fr �j 5p6-f fl O s) 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 ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
/
Tax map /parcel no.: AS ` 1 " D SCC) Backflow preventer 31.27
u ., < _fir ! ,, ii viiiii ' 5 '" :, ;7 ., Backwater valve 12.51
. '?.OIiK „ -_ ;:
i�i� ..-te ':? %,. ", x�"n .. ,. .. -, ,,: � a ;; '�x-:•<,i • . ., , .. ...� � ,.
� f' ' ry p Clothes washer 25.02
1 ,, grew RD� W) S 1 Fi (L Dishwasher ' 25.02 � 5 Q7--
5 014 cmit' � - T ( - n i 4 Drinking fountain 25.02
11 Ejectors /sump 25.02
RU > WAiE : <
��'- Expansion tank 12.51
<<' :,;���;� ";, � �_� - T NTH•.
';`.:: � 'P.,. R R'r�Y O. I2 ,.v ' °: ; �� « E1VA s ;;. :,,, ,r,�. :,
�I 6�'r ® M IA ^ Fixture /sewer cap 25.02 p j,.
Name: i
li i .PMl N �^� �, y " ' cS Floor drain /floor sink/hu i 25.02 '
Address: I koro $a uppep e V1e c� .p o n 1/44\--,De) Garbage disposal r 0 25.02 Age
City /State /ZIP: c-V¢"c (i Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 1 12.51 1).,5 i /
,� - :,�•• te r,. a:�r:; � P, � � =�" T;�: � <<T.
-t; ° -„ Interceptor/grease tra
`�'�� ,Fri: ®,AP EtiIGA N T. �� ❑CONTACTPERSON��; _`';; trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory / 25.02 6 °
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
., F «<„ Water closet 25.02
. : ` ,.: , : CON 1 2AC TOR ... . • °., % , t, ::: 4`
water eat er � ,'7 3
� : � �,;,:,'.,. ��, ;F�.:,:��, � _:..,,,..< ^. _ - .�n, „ _ �.;�; ` ..,...‘ ' - „ _,,.���:_x W h 37.52
Business name: ‘,4A trout 0 p iI e lu Cam Waterpiping/DWV 56.29
Address: 1 6 S ,1 , un3 Ave. Other: 25.02
City /State /ZIP: Subtotal ir• 57
Phone: () 57.01A21_,CZ Fax: (5O j ) C °7y' n2' p I Minimum permit fee: $72.50
CCB Lie.: tb'4,t42_ State surcharge bing Lie. no,: 3 et_1 op Plan review k (22 %ofpermit fee) 1 1. , .
e (12% of permit fee) � J 1
Authorized signature: - , TOTAL PERMIT FEE yg. Oq
Print name: V . r �' Date: �+ A r `�' This permit application expires if a permit is not obtained within 180 days
1r 4. f J 1 after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board. D
C\Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(l0 /02 /COM/WEB) l S 0 , izg il'
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Fee e a Total
S>!te <UtaLtYe �
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 s. , ",� t ; ;` ; ` 61i te 4: 4 °"� "°�
Valuat�ori �- Per>rriit;F ee � ;: i ��:
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
to
, , each additional $100.00 or fraction thereof, to
C3ther, inspectign 4 , „�: Fees n , tal ':>
b >�� • -: �` -< 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
,
IlRetiT r = Plu�mbri : Iris allatiainis
ant►ty, iztur ,.:� .I' : f0 ;*, � h;
;3- eplace!
r oe ^• - ,:_- .,, Plan is required for any of the following.
d 9 Y
`. " Gappe�a °`� :Added•.: ' "Relo2at ,
Work Performed:::` . <.ii }a::- € x .:::. -
°` ' 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 d ❑ Any multipurpose fire sprinkler system. •
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain
orI2i serrDagra?n?3,;.' : -:
Garbage - Domestic - food ( ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic - food 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
-Stall
Sink/Lav - Non -food related I
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter * Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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http: / /www.tigard- or.gov /city_hal l /departments /cd /docs/P LMF -Perm itApedoc