Permit ,i CITY OF TIGARD f ' PLUMBING PERMIT
'IN COMMUNITY DEVELOPMENT (474/11 Permit#: PLM2011-00297
T I C;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/28/2011
Parcel: 25113AA00300
Jurisdiction: Tigard
Site address: 16330 SW 72ND AVE B3
Project: A Cut Above Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: Interior plumbing for restroom addition:Adding(2)water closets and(2)sinks.10/11/11,reprinted to add 2"floor
drain. 10/13/11,reprinted to add(1)relocated sink.
Contractor: ADDISON PLUMBING Owner: PACIFIC REALTY ASSOCIATES
27425 S BEAVERCREEK RD ATTN: N PIVEN
MULINO, OR 97042 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-740-8116 PHONE:
FAX: 503-632-1168
FEES
Quantity Description Date Amount
2 ea Sink 09/28/2011 $50.04
Specifics: 2 ea Water Closet 09/28/2011 $50.04
1 12%State Surcharge- 09/28/2011 $12.01
Type of Use: COM Plumbing
Class of Work: ALT 1 ea Floor Drain/Floor Sink/Hub 10/11/2011 $25.02
Type of Const: 3 12%State Surcharge- 10/11/2011 $3.00
Occupancy Grp: Plumbing(manual)
1 ea Sink 10/13/2011 $25.02
Stories:
3 12%State Surcharge- 10/13/2011 $3.00
Plumbing(manual)
Total $168.13
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
applicabl- - . ork will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issu. •-, or if work is - spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Ut. ty Notification Center. ose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
o direct questions to OUNC by ■- ng 0 32.1987 or 1.800.332.2344.
Is ued By: ■ / Permittee Sig
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.
CITY OF TIGARD ( PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit#: PLM2011-00297
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/28/2011
Parcel: 2S113AA00300
Jurisdiction: Tigard
Site address: 16330 SW 72ND AVE B3
Project: A Cut Above Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: Interior plumbing for restroom addition:Adding(2)water closets and(2)sinks. 10/11/11,reprinted to add 2"floor
drain.
Contractor: ADDISON PLUMBING Owner: PACIFIC REALTY ASSOCIATES
27425 S BEAVERCREEK RD ATTN: N PIVEN
MULINO, OR 97042 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-740-8116 PHONE:
FAX: 503-632-1168
FEES
Quantity Description Date Amount
2 ea Sink 09/28/2011 $50.04
Specifics: 2 ea Water Closet 09/28/2011 $50.04
1 12%State Surcharge- 09/28/2011 $12.01
Type of Use: COM Plumbing
Class of Work: ALT 1 ea Floor Drain/Floor Sink/Hub 10/11/2011 $25.02
Type of Const: 3 12%State Surcharge- 10/11/2011 $3.00
Plumbing(manual)
Occupancy Grp:
Stories:
Total $140.11
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
applicabl- .w. All wo ,'II be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuan•-, or if work is susp-•ded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Tho-- r -s are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or di ect ques'+.ns to OUNC by cal g 503.232.1987 or 1.800.332.2344.
Issu:. By: — /et Permittee'-ignature:
Call 503.639.4175 by 7:00 a.m.for the next available I . =ction 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.
CITY OF TIGARD PLUMBING PERMIT
7 1 ' COM MUNITY DEVELOPMENT Per mit #: PLM2011 00297
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 09/28/2011
Parcel: 2S113AA00300
Jurisdiction: Tigard
Site address: 16330 SW 72ND AVE B3
Project: A Cut Above Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: Interior plumbing for restroom addition: Adding (2) water closets and (2) sinks
Contractor: ADDISON PLUMBING Owner: PACIFIC REALTY ASSOCIATES
27425 S BEAVERCREEK RD ATTN• N PIVEN
MULINO, OR 97042 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE 503 - 740 -8116 PHONE:
FAX. 503 -632 -1168
FEES
Quantity Description Date Amount
2 ea Sink 09/28/2011 $50.04
Specifics: 2 ea Water Closet 09/28/2011 $50.04
1 12% State Surcharge - 09/28/2011 $12.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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. ou m ain a c. .y of the rules
or direct questions to OUNC by calling 503 23 • .::: 2344.
.
Issued By: I Permittee Signature:
i
Call 51 .• •.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 11' 4 % ■ A - a.tj — a A
Building Fixtures RECEIVED FOR OFFICE USE ONLY -
City of Tigard RECEIVED Received ei al
n
i i 672 No . pin �)1 / -UoD 1 7
13125 SW Hall Blvd , Tigard, OR 97223 c
I p q
Phone: 503 718 2439 Fax: 503.598.196Y- p 8 ?011 Date/By Plan Review Other Permit No. /12,070 /
l
DatDate/By Oth P ( f oWO
TIGARD ' Inspection Line 503.639.4175 Date Ready/By Juris BI See Page 2 for
Internet www.tigard -or gov CITY OF TIGARD Notified/Method Supplemental Information
TYPE OF w&4IC3LDING DIVISION FEE* SCHEDULE
ID New construction 0 Demolition For special information use checklist.
Description Qty. I Ea. I Total
R Addition /aiteration/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 Commercial /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 {/V LOCATION Site utilities:
Job site address: / kr 3 30 t, „ 1l "� ij T A at� Catch basin or area drain 18 76
City /State /ZIP: - / T . D 7......2... Drywell, leach line, or trench drain 18 76
/ Footing drain (no linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name: A C /, 04 i/ to - 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: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12 51
J d 1 Clothes washer 25 02
T .X. 0.. I BN` Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: 174_G�ru Fixture /sewer cap 25 02
5-19/.., Floor drain/floor sink/hub 25 02
Address: / i , ' r��( / ��( 9 C u2_ kt: /) f ki 7136) 0 Garbage disposal 25.02
City /State /ZIP: et " e 9 2 - 2 l Hose bib 25.02
Phone: 5-63) 6 a 1.I 6 A Fax: (503) 6 a `t'__ F .Fs5- Ice maker 12 51
14 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
t% Medical gas (value: $ ) Page 2
Business name: 1.A.V l.(. !� ,1 L ('
Contact name: �T ��Vr _/ . 1/..e C s Primer 12.51
Roof drain (commercial) 12 51
Address: lj 1:3� GL� " ` f •� 'C ��
- zs t � Sink/basin/lavatory 2— 25 02 S' ) _ ail City /State /ZIP: La v `? � ie pt Q� ?'4Z 1935- Solar units (potable water) 62.54
Phone: 503) 3p d ` 6 Q / Fax: : 533) , f i./...i./...._ . 1 f y tI Tub /shower /shower pan 12.51
E -mail: 51 -I ate U‘ ik e G D N1 v Urinal 25.02
CONTRACTOR Water closet a 25.02 57)
Water heater 37 52
Business name: ,/� �d T �d'�l _ Water piping/DWV 56 29
Address: 9. 7 'r2 S ^ vr..�Z•°- �; �/ Other 25.02
City /State /ZIP: /Ph ) U ii2 1 ".7 6 (1)- ` C Subtotal
!) y Minimum permit fee: $72.50 WO vl'�j
Phone ( jJ3 ) 7iiv ,_ 3 . 7 I ce Fax: (c, I ) 6, • �_ //6
CCB Lie.: / 74 / 7 f Plumbing Lic. no.: 3 iii-o-A3 Plan review (25% of permit fee)
State surcharge (12% of permit fee) I �. , U
Authorized signature: TOTAL PERMIT FEE // i
Print name: D ate: �y / Th is permit applicatio expires if a permit is not obtained within 180 days
/ / +�� after it has been accepted as complete.
�� ®/ i *Fee methodology set by Tn- County Building Industry Service Board.
LlBuilding rmts.PLMU- PermitApp doe 10/01/09 440- 4616T(10 /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 s` 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 &Ram Drain - 1st 100' 62.54 Valuation: Permit Fee:
$ 1 00 to $5,000 00 Minimum fee $72.50
Storm & Ram 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 ec
Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspections 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
Remspection 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 Plan Review for Plumbing Installations
Fixture Type 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"
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic non -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/Lay -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
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