Permit � __ ; ; CITY OF TIGARD PLUMBING PERMIT
YF COMMUNITY DEVELOPMENT Permit #: PLM2009-00250 13125 SW Hall Blvd. Tigard OR 97223 503.639.4171 Date Issued: 09/15/2009
T'�� Parcel: 1 S 1356B00500
Jurisdiction: Tigard
Site address: 10487 SW CASCADE AVE
Subdivision: Lot: 0
Project: More Furniture for Less
Project Description: TI - Adding additional fixtures, no caps, no relocates.
Owner: FEES
RAM /CASCADE CENTER LLC Quantity Description Date Amount
BY ELLIOTT ASSOCIATES INC, 901 NE GLISAN
ST 1 ea Expansion Tank 09/15/2009 $16.60
PHONE. 4 ea Floor Drain /Floor Sink/Hub 09/15/2009 $66.40
2 ea Sink 09/15/2009 $33.20
1 ea Water Heater 09/15/2009 $16.60
Contractor: 1 12% State Surcharge - 09/15/2009 $15.94
NW PLUMBING SPECIALTIES INC Plumbing
PO BOX 535
EAGLE CREEK, OR 97022
PHONE: 503 - 432 -9664
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $148.74
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 -0100. You may obtain a copy of the rul
or direc ion UNC by calling 503.246.6699 or 1.800.332.2344.
Is ued By: Permittee Signature: / Allicridp
.
Call 503.639.4175 by 7:00 a.m. for an inspecti busin• -s day. aligb
This permit card shall be kept in a conspicuous place on the job site un ' completion of the pr
Approved plans are required on the job site at the Um- • each inspection.
Plumbing Permit Applicat'ri VED . CE! FOR - OFFICE USE ONLY
Received /// �� / �� 9 ,_,,,,
,
( e ive Permit No.:
N 13125 SW Hall Blvd., Tigard, OR 9722 D Re Re 1 1 2009 Plan Review p
11 Phone: 503.639.4171 Fax: 503. 1960 Date /By: Other Permit No. �..G�7rs'
T IGAR D Inspection Line: 503.639.4175 tl 1Y OF TIGARD Date Ready/By: Juris El See Page 2 for
Internet. www. tigard -ocgov BUILDING Notified/Method: 9 Supplemental Information • - • x ' is "; :"' 4 „''4`::; :' x r% t. r. cam.: £=^ Tfla r;,
36 i f i . :s, .g . �!.,- s.,, =,�,r - k �,-. EER, :. S SHED : :, , ,„ - . •s - - ; TXPE� . r. OR �:';_�:��" : � • � r- ; . - �� , _, s> t . G T1 L - fi
r,'v<�.+�`,�r�,�.z:: �'� n:� �'�`��'� ;''� ... -_ -.f :a+�.,c.a+.-'.".dS^ than .a =s�^a?^� t�...ez . �w.: - �,a. � °' r . ' ...,.'';' �S:r..�,:.� �: ,_ a.: :..� >k��w��z.��s,s�... +r.�m.: � ...a: _ :3.: a C>�£xi; y:. >,., � .
ID New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
rsx a F } i g u . , i , CATEG®R�X OF, CO1V3,TRL C;TIONf a r. . is SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
. rm;a- �t;�'b.;:.,;.:.�,<,z,,; *cr� av, i ia�'�;x.:: <_ =:,= nsr t -��? -s c.�,.w;u�µ:;.,,;:., -- :h �`v'�,,.`-K�
" = RO 3ekRgT. 3 x INF ®RMkTIONN AND ft5FCITFON >� P, ,I „-
'4,4a " ,• -:: < .:e,,34, 'M. ° cre.:. . A ._ <t,, *: , ,& 5,.a . a . . ,usx� s,.:, 0 _ .A., S lte utllltleS
Job site address: l 0(4 % 7 om A E. (40 Catch basin or area drain 16.60
City /State /ZIP: . Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Hoek g cru r,92 Footing drain (nu. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: j - i 35 6 SZDo Fixture or item
' r ,,y: ,. r , . emu , : .; t._ =.- n ,, . , x v , , -. >.. ;<,,, Absorption valve 16.60
O W ,,, l,',....,,,,,' 4 013 1 S O �VO -.
. A .'.E .ti. ,,, ,, .rx.: >� ' .. :��::; . : B ac kfl owpreventer Paget
- 1 / Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
>.wm , ,_; i r ,,. ,a ,,.,.:,- .m,,u:; ^ ,,,,...,:;-,-R.,<: -.� • . -ra :.....,, -.; <, Drinking fountain 16.60
K - A , Pi RR , P ?RT1 OWNER ,v, W40 x '+T ENANT € , g
„ oa: w. #. a��r.� �... M... <s #A.4�..i.eGa <. r.,�X.. ta.,., h ?,,�;'� „...# , ,...... -.
Ejectors /sump 16.60
Name:
Expansion tank ( 16.60 /( .ted
Address: Fixture /sewer cap 16.60 •
City /State /ZIP: Floor drain /floor sink/hub .•e-/ 16.60 ie6, 0
Phone: ( ) Fax: ( ) Garbage disposal 1 16.60
Off _ tc n p.. � : I I5ikx :�TaJC``%r. E "7 s,7 , •.;f ;; g;s w; .. t;. Hose bib 16.60
•:a » s i`f. `:,A- 1,4z,C t Iw.,a- I :14 ' •` . „- ',it,, 4 ACT *A1V12,SQ ,
�� ) p L 1 Ice maker 16.60
Business name: 4 a / M Interceptor /grease trap 16.60 .
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
(-S
Phone: ( ) Fax: : ( ) i4/basin/lavatory 4 16.60 3 6 . 2.,p
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
.' - ': Y,: �aY,, `,F`^Wvxi:.x.:Za�X' �I ���� 4;' ; `- di:- .v"33P:m;.::> " _,• ,�,�'= 3:F`"'a. .ems ^°"xa "' _
il : = kk � t CONiT7RAAv R r : ' .. y , ,:; � k
v�;� �.:�._...r „� =,� �� . -� �. >����° •r'`�e .,.����t.��. � �� �s ,.,.� V .._ Water closet 16.60
Business name: fl a ) n ..0 , 4 3 t st� C ,,( / /,r 5 j_ Water heater 1 16.60 / (p. 4'C
Address: ��� t l3�� 5 3 `J 9 Other:
!D / Subtotal
City /State /ZIP: -Q ( (- E /L or ? 7o0Z a
Minimum permit fee: $72.50 � /� ^ • go
Phone: ( 3) /../3a 76,6, Fax: ( ) Residential backflow minimum permit fee: $36.25 „J of
CCB Lie.: q'1( a a Plumbing Lic. no. 6 5-a Plan review (25% of permit fee) -
- ,1
g / / .
Authorized signature: Ill l q State surcharge (12% of permit fee) / 5 7
nature: `�'
�f �� � TOTAL PERMIT FEE $ 7t/
Print name: 6 frt 7- D ate:? / / /!a 5, This permit application expires if a permit is not obtai a within
/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I :\Budding\ Permits\PLM- PermitApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
,.. >.' Qty., if ea
41 ota1 _ . , w< e
SrteiTt><t><es j .y SquareF N. �er ri>it
Footing drain - 1S 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00
7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46 40 :..., r° ., ,
aluation: 'er t�FRe :4:A , Ate;
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
- g e = fs g; ' 14 ; 30 '` " "' Seeti ti ` T otal =''- additional $100.00 or fraction thereof, to and
F1Xt rr E ' Yte v . <
nl _ v fgy .. gg ,tg,.... .� . -:_x hg including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", P1a11Reyle�WfO p111Emb711gI2StaRlIAi`OI15, , a
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
+ +°.;= uanti°'" bs < iriturowo ottarath di ❑ Any new commercial building with water service 2" and
FtxtureType � � , , u Replace greater, except systems designed and stamped by licensed
':a'to'"�'�.,gw��,,; �$- ��� .4.' . 44vio A ppe -d t4ddedO gE P':
engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash ' ISOIIL @tr1C15e� I`dI[l
Floor Drain /sink 2" [t ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
*Note: If the fixture work under this permit results in an
-Bradley
- Commercial � increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor -
Water Closet - Toilet
Urinal •
Other Fixtures:
c\Building\Permits\PLM- PermitApp.doc 12/27/06