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Permit CITY OF TIGARD PLUMBING PERMIT - COMMUNITY DEVELOPMENT Permit #: PLM2011 -00255 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/10/2011 T Parcel: 1 S126BC01506 Jurisdiction: Tigard Site address: 9020 SW WASHINGTON SQUARE RD 120 Project: Server Logic Subdivision: Lot: 0 Project Description: Relocate breakroom sink and dishwasher. No change in EDU's Contractor: GRIDLINE PLUMBING Owner: WISCO REAL ESTATE EQUITY 4343 SE 37TH 1501 SW TAYLOR STREET, SUITE 100 PORTLAND, OR 97202 PORTLAND, OR 97205 PHONE: 503 - 294 -0400 HONE: 503 - 771 -8790 FAX: FEES Quantity Description Date Amount 1 ea Dishwasher 08/10/2011 $25.02 Specifics: 1 ea Sink 08/10/2011 $25.02 1 12% State Surcharge - 08/10/2011 $8.70 Type of Use: COM Plumbing Class of Work: ALT 22 ea Minimum Fee Adjustment - 08/10/2011 $22.46 Plumbing Type of Const: Occupancy Grp: Stories: Total $81.20 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 la , • • will be done in accordance with approved plans. This permit will expire if work is not s , • -d within 180 days of issuanc =, or if work is su .z-nded for more the 180 days. ATTENTION: Oregon law requires you to folio rules adopt -q by the Oregon Utilit Notification Center. Th. e ul -s are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 ou may obtain a cbpy of the rules or 'erect questions to OUNC by c- ing 50 1 2.1987 or 1.800.332.2344. I - sued By: ( �- Permittee Signature: .40411 _AAA d Call 503.639.4175 by 7:00 a.m. for the next available ins ti•1'.a• This permit card shall be kept in a conspicuous place on the job site u it c• pie •n of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures . FOR OFFICE USE ONLY , City of Tigard Received Q O L �^ D / Jn :IR� `� g Date/By: o ii Permit No. 0( / W n 13125 SW Hall Blvd., Tigard,OR 97223 11111 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: T I G iA R D Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For stecial information use checklist Description Qty. Ea. I Total • dition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ❑ 1- and 2- family dwelling mercial/industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 4 02,,,0 �,l ( je Yd Catch basin or area drain 18.76 City /State /ZIP: i V/./ /, 3 Drywell, leach line, or trench dram 18.76 G Footing drain (no. linear ft.: ) Page 2 Suite/bldg./apt. no.. /2 Project name: j ejz r - Manufactured home utilities 50.03 Cross street/directions to job ite: Manholes 18.76 C / Rain drain connector 18.76 I 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.: • Backflow preventer 31.27 D SCRIPTION OF WORK Backwater valve 12.51 �i�1 Clothes washer 25.02 z / � _ - 'v � i �A- Dishwasher X / 25.02 L5 ' 8-2- Q 7 / � / Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PER SON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory e f.. 7 25.02 , 1 . 6 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 CONTRACTO • Water closet 25.02 Water heater 37.52 Business name "7 d //X___ i r Water tin DWV 56.29 p�p l� Address: 1-31 _ / Other: 25.02 City /State /ZIP: ,,./ a4Z / CC 972, - Subtotal 'Q. 14 Minimum permit fee: $72.50 72 0 Phone: ) /. A Fax: ) ©�5 _ . CCB Lic.: 9 Plumbs g Lie.. no. . ✓ Plan review (25% of permit fee) �� �,,?]gir'o �� State surcharge (12% of permit fee) g.0 Authorized signatur : 4111 , � j / TOTAL PERMIT FEE S1.216 Print name: �� i/ 4 ems Date: r -- / / This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1:\Building\ Permits \PLMU- PermitApp.doc 10/01/09 440- 4616TO 0 /02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: 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 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit.Fee: $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 P 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 * . Quantity by Fixture Type i Plan Review for Plumbing Installations FixtureType'for Replace/ Plan review is any required for of the following. Performed: Capped Added Relocate 9 y g Baptistry/Font Please check all that apply. 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 ❑ 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" 4 " Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings Garbage - Domestic-non -food g re q g 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 - 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: I:\ Building \Permits\PLMF - PermitApp.doc 02/24/2011 2