Permit 1 , CITY OF TIGARD
PLUMBING PERMIT
"'� g,." COMMUNITY DEVELOPMENT Permit #: PLM2011 -00204
TI.GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/30/2011
Parcel: 1 S126CA00100
Jurisdiction: Tigard
Site address: 9225 SW HALL BLVD F
Project: Ideal Image Subdivision: FAIRVIEW PLACE CONDO Lot: 20
Project Description: Interior plumbing: relocating (4) sinks, (2) water closets and (1) water heater.
Contractor: PMSI LLC Owner: GREENBURG CORNERS LLC
21195 NW EVERGREEN PKWY #204 BY MENASHE, R BARRY
HILLSBORO, OR 97124 621 SW ALDER, SUITE 605
PORTLAND, OR 97205
PHONE: 503 - 466 -2222 PHONE:
FAX: 503- 466 -2211
FEES
Quantity Description Date Amount
4 ea Sink 06/30/2011 $100.08
Specifics: 2 ea Water Closet 06/30/2011 $50.04
1 ea Water Heater 06/30/2011 $37.52
Type of Use: COM 1 12% State Surcharge - 06/30/2011 $22.52
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $210.16
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 questions to OUNC by calling 503.232.1987 or 1.800.332 2344. `
Issued By: Permittee Signature: _Sa
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.
Jun. 29. 2011 1:36PM • No. 3616 P. 2
Plum bin Permit A licat'
CEID Building Fixtures FOR OFFICE USE ONLY
City ofTigard Received ,
II /1 � permit Dlo.:
y 13125 SW Hall Blvd., Tigard, OR. 972 20 , l o a t� y. 4 11/11' V ii •
Plan Review
Phone: 503.718.2439 F ax: 503.5 GI TIGAD Date/13x: Other Permit No.:� _., //- 00113
Tr c. A Rn Inspection Line: 503.639.4175 Date Ready/By: nris: ® See Page z for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: ''o Supplemental Information
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❑ New construction El Demolition For special information rise checklist.
Description I Qty. Total
® Addition/alteration/replacement ❑ Other; New I- 2. family dwellings (includes 100 ft. for each utility connection) .
_ -. 7
` ' `,. �f fi ,,.y W `� ��"�'.'c _.. .: R (1) bath 312.70
S F
- - s s. .. s.;tZ/ ; t
0 1- and 2- family dwelling ® Commercial/industrial Comercial/industrial SFR (2) bath 437.78
- ❑ Accessory building SFR (3) bath 500.32
ry g ❑ Multi- family
Each additional bath/ldtchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
=- -= � �. ' } t, ` :, ii ti.kii t9w - et u tiliti es:
Job site address: 9225 SW Hall Blvd Suite F Catch basin or area drain 18.76
City /State/ZIP: Tigard, OR 97224 brywcll, leach line, or trench drain 18.76
footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: F I Project name: Ideal Image Manufactured home utilities 50.03
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 ft.: ) Page 2
Subdivision: I Lot no.: Fixture or Item:
Tax map /parcel no.: IIaclrflow preventer 31.27
--5 ,••�s:>ti w . .,�.� •_` "- ��:_..,_...,...._ - . l?actwatcrvalve
"�' -•: 12.51
:;id =- _ L 1 t:.. �� -` .__ _t'
-- :- _- :_- :- .::::- ..,.ti.a:•: > -.:s .,�,u,:, ., u•.F_�:..::,... ::...-:.. -:�- .. ::,,:.:.x:::_:,_:� -.x Clothes washer 25.02
rmbing for tenant improvement/remodel - relocate fixtures Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
F QyLVJ�i�= - QS'1:A' = - Expansion tank 12.51
Name: Fixture /sewer cap 2S.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /Stale/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
t .:. _,. CI �I' -_ - =- =- :_ : - -= C `p>& Interceptor/grease trap 25.02
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Bu3ine3S name: - - Y x _ � _ Medical gas (value: $ _) Page 2
- Primer 12,51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 4 25.02 100.08
City /State/ZIP: Solar unils (potable water) 62,54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E-mail: Urinal 25.02
:.:_ __._:._.__� =ma , � : o ti ..t, . �A Water closet 2 25.02 50.04
T: -- _ - ,z
r. ...... Water heater 1 37.52 37.52
Business name: PMSI LLC Water pipinglDWV 56.29
Address: 21195 NW Evergreen Plcwy Suite 204 Other: 25.02
City /State/ZIP: Hillsboro, OR 97124 Subtotal 187.64
Phone: (503) 466 -2222 Fax: (503) 466 -2211 Minimum pemut fee: 572.50
.B Lic.:158286 / Numbing Lie. no.: 34 -434PB
Plan review (25% of permit fee)
L `/
/, , � /) -L /J� � l/ " State surcharge (12% of permit fee) 22.52
Authorized signature: (�/i/1 (• ' �V(, `(.i,.∎ TOTAL PERMIT PEE 210.16
Print name: Lonell Robinson I Date: 6/28/11 I This permit application expires if a permit is not obtafhed 01tlhin 180 days
after It has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I: ItaildiAglPennin■PLMu- PermitApp.doc 10/01/09 440 -i616T(10/02/COMME6)
Jun. 29. 2011 1:36PM No. 3616 P. 3
, Plumbing Permit Application - City of Tigard
Page 2 -+ Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
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_ __ ;: _............__- ..,.,:- .- _ -_,.= 1�'.�; 1� �i- wil4,r._i•
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
Sewer - 1st 100' 62.54 3,601 to 7,200 $23320
7,201 and greater $32
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas S stems:
Water Service - each additional 100' 37.52 . +� _ " A -.7 t_ -- . :r ,_;_'
•.... %.... '$ - t-7•. -: �r..l_l ] e :, ; "7- ..r; r .K fft: -
Slorrn & Rain Drain - 1st 100' - 62.54 ` - t `
_ $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
x ? :.a te - _ -_ "- - __= -_ - each additional $100.00 or fraction thereof, to
gi ' -:= e a_a]-. 1`utglnQ
�lr�las .] 1 - :�1t.#annts4�'_� _ P�e�R� =. T- y. - = - - _- ._ - - - -._ �� � and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the that $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 90.00/11r $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 horns) 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 aud,$1.20 for
(ntiaintum 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
'ceurately report fixtures could result in increased sewer fees".
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^ '- • _ • �- • ; . t _ ;� F W ,y i:', :< Plan review is required any of the following.
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Baptistry/font Please check all that apply.
Bath Tub /Shower 0l Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool granter, 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 ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ My 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 1 metric sk RM ••- -- -- =---_-
Garbage - Domestic - aon - food 1J 1SOmetric or riser diagram is required for new buildings
Disposal - Domestic - food related i 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 - A 1 " L,,f If
- Bradley I f ?r,
- Commercial -food related / �
- Service 7- --
tvimming Pool Filter
,ti'asher - Clothes Note; If the fixture work under this permit results In an
Water Extractor increase of sewer OW, a sewer permit will be issued and
Water Closet - Toilet 2 fees assessed fair the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
hltp: / /www. tigard- or.gov/ city_ hnll/departments /cd/docs/PLMF- PermitApp2doc