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Permit
CITY OF TIGARD PLUMBING PERMIT C ,, Permit #: PLM2011 -00339 ,.., COMMUNITY DEVELOPMENT TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/13/2011 Parcel: 2S102AA00602 Jurisdiction: Tigard Site address: 11960 SW PACIFIC HWY Project: Tendercare Dental Subdivision: TIGARD HIGHWAY TRACTS Lot: 12 Project Description: Interior plumbing with medical gas. Contractor: VENNE PLUMBING Owner: AMAN, WALTER S CREDIT SHELTER TR 17678 SW GALEWOOD DRIVE 19217 SW 119TH AVE SHERWOOD, OR 97140 TUALATIN, OR 97062 PHONE: 503 - 624 -9309 PHONE. FAX: 503 - 684 -0940 FEES Quantity Description Date Amount 2 ea Fixture /Sewer Cap 12/13/2011 $50.04 Specifics: 1 ea Hose Bib 12/13/2011 $25.02 10 ea Sink 12/13/2011 $250.20 Type of Use: COM 1 ea Water Closet 12/13/2011 $25.02 Class of Work: ALT 1 ea Medical Gas 12/13/2011 $179.30 Type of Const: 1 Plan Review 12/13/2011 $132.40 Occupancy Grp: 1 12% State Surcharge - 12/13/2011 $63.55 Stories: Plumbing Total $725.53 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 que • C by calling 503.232.1987 or 1.800.332.2344. Issued :y: // 4 f/ Permittee Signature: 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. Plumbing Permit Application ;✓_,,) , _ dc) ((o , i . .4;1- Building Fixtures Fo12 OFFICE USE ONLY City of Tigard ® `� R Date/By: / 5 %i>I)<iI Permit No.: PLJ ezi /� 0033' v 13125 SW Hall Blvd., Tigard, OR 97223,.. � Plan Review , 5 : Phone: 503.718.2439 Fax: 503.598 90' „N ` i Other Permit No.: a ( r a� , - Inspection Line: 503.639.4175 Date/By: T l G A R D pectt ( 1, Date Ready/By: " , Jana: iii See Page 2 for Internet: www.tigard-or.gov 1s.. • �� e S Notified/Method: , v/I , ,7 Supplemental Information TYPE OF WORK \,\QA >'0,01w* FEE* SCHEDULE , "' ❑ New construction ❑ Demolnd`C r� ©� 1`" For special information use checklist ,�. `, `,�_ Description I Qty. 1 Ea. 1 Total ® Addition/alteration/replacement ❑ Otheti. ` \\ New 1- 2- family dwellings (includes 100 ft. for each utility connection) "` l SFR (1) bath 312.70 CATEGORY OF CONSTRUCTION ( ) ❑ 1- and 2- family dwelling 0 Commercial/mdustrial SFR (2) bath 437.78 ❑ Accessory building ❑ Multi- family SFR (3) bath 500.32 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: \ \ C ( p Q..) PAC l (C t �)N' Catch basin or area drain 18.76 Drywell, Tigard, OR � '1 2 "23 yR'ell, leach line, or trench drain 18.76 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Tendercare Dental 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.: Backflow preventer ' 31.27 DESCRIPTION OF WORK. Backwater valve 12.51 Clothes washer 25.02 New Dental Office Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 S'd Crti Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/ State/ZIP: Hose bib I 25.02 6157 ca, Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Venue Plumbing,LLC Medical gas (value $ Page 2 `'l Primer 12.51 Contact name: Ryan Venne Roof drain (commercial) 12.51 Address: 17678 SW Galewood Drive Sink/basin/lavatory t t 1p 25.02 2st). City/State/ZIP: Sherwood, Or 97140 Solar units (potable water) 62.54 Phone: ( ) Fax:: ( ) Tub /shower /shower pan 12.51 E -mail: Urinal . 25.02 CONTRACTOR Water closet t 25.02 a 51.6), Water heater 37.52 Business name: Venne Plumbing, LLC Water piping/DWV 56.29 Address: 17678 SW Galewood Drive Other: I 25.02 City/State/ZIP: Sherwood, Or 97140 Subtotal 9 , 5T Phone: (503) 6249309 Fax: (503) 6840940 Minimum permit fee: $72.50 CCB Lic.: 192949 i Plumbing Lic. no.: P11596 Plan review (25% of permit fee) ! a State surcharge (12% of permit fee) /„3 , Authorized signatur�s�a__� TOTAL PERMIT FE �% Print name: Lindsay Venue I Date: 10/31/11 ` This permit application expires if a permit is not obtained wi id180 days after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. Plumbing Permit Application - City of Tigard ' C - O'E.ii &We L Page 2 - Supplemental Information n ��\ n L _ Fee Schedule: ij �Lu r y 1 �� ' "t Residential Fire Suppression Systems: Site Utilities Qty. Fee (ca) Total Square Footage: Permit Fee: Footing drain - le 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' 3,601 to 7,200 $233.20 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: 51.00 to $5,000.00 Minimum fee 572.50 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 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 * . Quantl, by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped ' Added Relocate Plan review is required for any of the following. 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 J..Z 4° Isometric or Riser Diagram Car Wash Drain g 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/l.av - Non -food related . j C) - Bradley - Commercial- food related - Service r __- ---- Swimming Pool Filter ---' Note: If the fixt re work under this permit results in an Washer - Clothes �' Water Extractor Q'� r increase of sewer 1 DUs, a sewer permit will be issued and Water Closet - Toilet / f i l �) fees assessed for a sewer increase must be paid before the Urinal plumbing Other Fixtures: J 4 P g per can be issued. I - d 04.60 2utgwnld auuaA d0S:20 IT 60 oaa