Permit CITY OF TIGARD PLUMBING PERMIT
`• .2 "- COMMUNITY DEVELOPMENT Permit #: PLM2011 -00362
TIG ARi?
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/2011
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 220
Project: Spec Space Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Add (1) sink & (1) dishwasher.
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
P
PHONE: 503 - 624 -6300
PHONE: 503 - 236 -4152
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Dishwasher 12/06/2011 $25.02
Specifics: 1 ea Sink 12/06/2011 $25.02
1 ea Water Heater 12/06/2011 $37.52
Type of Use: COM 1 12% State Surcharge - 12/06/2011 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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.; s!. . 44.
Issued By: Permittee Signature:
2
I . .I
Call 503.. by 7:00 a.m. for the next available insp. date.
This permit card shall be kept in a conspicuous place on the job site un completion 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 /
li City of Tigard RECEIVED Date/By: is ��_ Permit No.: a d�! -4,536 .
'I 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
. 2 Phone: 503.718.2439 Fax: 503.59 b 6 2011 Date/By: Other Permit No.: 4e4gd / / tn0/'64)
TI GA R D Inspection Line: 503.639.4175 Date Ready/By: orris. ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF MIMING DIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
ID 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 LOCATION Site utilities:
Job site address: � ,O�` Pc"
basin or area drain 18.76
5350 p n
� t /� Drywell, leach line, or trench drain 18.76
71,(91\0-0 City /State /ZIP: fin aac `
r � Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: ad) I Project name: „ .PLC. ,§P4 -C(_, 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: / Lot no.: Fixture or item:
p2�
Tax map /parcel no.: a ` d / ! /C) 0 / 490 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
DO ( StvvA- -,- ' � r5, 1 fw/ r5 H 4 re_ Dishwasher / 25.02 . :.° y
Drinking fountain 25.02
Ejectors /sump 25.02
214ROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Address: (5S5 ( , r ?u{ ,� �2, 0 Floor ge disposa l 25.02
sink/hub 25.02
n Garbage disposal
City/State/ZIP:-AA b A ( 0 "` D Lf Hose bib 25.02
Phone: (S --5) ( '2L.- co Fax: ( ) Ice maker 12.51
1 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
�,(� E, Medical gas (value: $ ) Page 2
Business name: 0 q•.- tt�1�)
Contact name: Primer 12.51
�� �` Roof drain (commercial) 12.51
Address: el' Sink/basin/lavatory ' 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater I 37.52 3 7, .5
Business name: DE,-* I, (}fa K {() (1k m 0aj
Water piping/DWV 56.29
Address: p ,/,_ kl..n_Q p .>• i , r. oht , _ 1 t 1 % Other: 25.02
City /State /ZIP: O0PrLWLx Subtotal g 7, 56
` Minimum permit fee: $72.50
Phone: (j � "3) '19 - �C��� Fax: ( ) f _
CCB Lic.: l'5f -I 6t Plumbing Lic. no.: a(;t /SO fl3 review (25% of mit fee) )
State Plan surcharge (12% of permit per fee To l
Authorized signature: 9 �/
L M FEE g, tJ `Y
Print name: Ze , e,,,,, Date: _ vii This permit application expires if a permit TOTA is not PER obtai ned within 180 days
( /11 1 after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building\Permits\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 - l' 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 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
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 Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font
El Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuzzi /Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918- 780 -0040.
Cuspidor /Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR918- 780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain /sink: - 2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non - food that meet the qualifications above.
Disposal: - Domestic food related •
- Commercial food related
- Industrial food related
Ice Mach. /Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay /Bar non -food related
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I: \Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15350 SW SEQUOIA PKWY 220, TIGARD, OR,
97224
Commercial - Plumbing
399 Plumbing final
2014-01-17 (null)
PLM2011-00362
PASS - No C of O
Violation Summary:
Inspector Contractor