Permit 1 R a CITY OF TIGARD PLUMBING PERMIT
11 a COMMUNITY DEVELOPMENT Permit #: PLM2009 -00079
Date Issued: 04/08/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S1010600500
Jurisdiction:
Site address: 12670 SW HALL BLVD BLDG 1
Subdivision: Lot: 0
Project: APEX INDUSTRIES
Project Description: TI
Owner: FEES
TCTPI LLC Quantity Description Date Amount
25977 SW CANYON CREEK RD #J 3 ea Lavatories 04/08/2009 $49.80
WILSONVILLE, OR 97070 1 ea Water Closet 04/08/2009 $16.60
PHONE: 1 12% State Surcharge - 04/08/2009 $8.70
Plumbing
Contractor: 6 ea Minimum Fee Adjustment 04/08/2009 $6.10
JAK NORTHWEST LLC - Plumbing
17114 NE 20TH ST. 1 12% State Surcharge - 04/08/2009 $8.70
VANCOUVER, WA 98684 Plumbing
PHONE: 360-772-0957 73 da Investigation Fee 04/08/2009 $72.50
FAX: 503 - 665 -6330
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $162.40
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 rules
Issued By: Da l\ Permittee Signature: n } { CCA( C)1\
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Apr 07 09 12:41p JAK Northwest LLC 503 - 665 -6330 p.1
Plambine Permit Application r .
Building Fixtures 1�.+'CE�� -+� I O R Uri lcl: t SE o r.�
Received
City of Tigard , � Lb permit No.:) 1 ► 17(J • 0 0 C; 9
• oh ' It 13125 SW Hall Blvd., Tigard, OR 97223 APR - 7 2009 Plan Review per Permit N . o.: Cf (�
B Phone: 503.639.4171 Fax: 503 598.1960 Date kp2i^ r1 "
q n n oti ® See Page 2 for 1
Inspection erne Line: 503.639.4175 "-a OF TIG Notified/Method: (1 1 ' C2 I Supplemental Information
T t .Ct: n Internet www.tigard -0r.gov
.TYPE -OF wo IPIDIVISION • � .
FEE* SCHEDUI :. .
. ❑D For special information checklist
❑ New construction Description Ea. I Total
Addition/alteration/replacement 0 Other: New 1 - 2- family dwellings (includes 10011: for each utility connection)
. CATEGORY • OF CONSTRUCTION ' . : .. SFR (1) bath 249.20
(2) � 350.00
0 i- and 2 -family dwelling ErCommercial usdusttia SFR l 350.00
SFR (3) bath
[] Accessory building ❑ Multi- family Each additional bailJkitchen 45
❑ Master builder 0 Other. Fire sprinkler ( sq. It) r Page 2
JOB S .6 ITE INFORMATION AND LOCATION Sit utilities
Job site address: I % C .S L° f , ,, l g `f 6 Catch basin or arca drain 1 16.60
City/State/ZIP: *1 Ll c, 9 7 2 2 . Bre t. leach Line, or trench drain 16.60
1 2 E5 . _ 1 Footing drain (no. linear ft: �) Page 2
Suite/bldg./apt. no.: ( Project Dame: AQE.X Tin :1 v..S4,r e.-i
ufactured home ankles 110.00
Cross street /directions to job site: '
• Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft: _,J Page 2
Stone sewer (no. linear ft: _ ) Page 2
Water service (no. linear fl.: ) Page 2
Subdivision: 1 Lot no.:
Fixture or item
Tax map/parcel no.: .
Absorption valve 16.60
. , • DESCRIPTION OF -WORK : • . . : Backtlow preventer Page 2
a ` ,.vt _( - r) / n - Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Q .. Drinking fountain 16.60
. ❑ PROPERTY OWNER .: Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
- ❑ APPLICANT . ❑ CONTACT PIERSON •
maker aker 16.60
Business name: -) A .44.,/,-ft. W - 5 /Lc_ Interceptor /grease trap 16.60
Contact name: � ec G Medical gas (value: $ ) Page 2
Address: / 71 / ( , tiL ..c)'''' 5f- Primer 16.60
City /State/ZIP: Vail Col i t/ r 1,a4- `� 6 ,� y` 7'747 _ Roof drain (commercial) 16.60
r Sink/basin/lavatory 3 16.60 y cj . ZO
Phone: ( VC) 7 2 --Z - C p -5' 2 Fax:: ( . 5 - C ' , 3 6 6 .6-_?30 Tub/shower /shower pan 16.60
E-mail: j cc& lto ," t it w.e S - (l- ea r:. c a 5 7. /lei Urinal 16.60
• • CONTRACTOR Water closet f 16.60 I to . (4,0
Business name: f4 K 4,4„ rr IV, r S t Z, L.0 Water heater 16.60
Address: ( 7 / / ! -7'4 St Other
City/State/ZIP: ih ti co Lt vgY IA? /I c / 6 70y Subtotal ( (, . y (;)
b9inimum permit fee: $72.50
Phone: ('160) 7 .7 a _ p y_ 2 Fax: (6 ‘C 6 Residential bacldlow minimum permit fee: $3625 7 2 ,S
CCB Lie.; 166 5'e7 Plumbing Lic. no.: 3 � - C f�P8 Plan review (25% of permit fee)
M State surcharge (12% of permit fee) 1 1 Q
Authorized signature: / = * � -
c TOTAL PERMIT FEE 1 ' L0
Print name: -.3";, . , k �4"ele_ I Date: o 41 - ?`e" This permit application expires ifa permit is not obtained within
180 days after it has been accepted as complete.
Apr 07 09 12:41p JAK Northwest LLC 503 -665 -6330 p.2
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' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,00! 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 Valuation: Permit Fee:
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
Fixture or Item Qty. Fee (ea) Tatal additional $100.00 or fraction thereof, to and
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 i
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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees ❑ Any new commercial building with water servi .e 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/ Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial •
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage -Domestic Comments ar
re din fixture work:
Disposal - Commercial regarding
- Industrial Cr(.G.,., e - to i 1'e f Fe 4. !J rsz rot.l'li id,
lee Mach./Refrig. Drains N^-0 U e /Le ✓ 1-0 Ct C Cc ••• ala re._ 4 ,5,f
Oil Separator (Gas Station) 7 L` e I, 7 41 - S ;11 k-
Rec. Vehicle Dump Station
Shower -Gang
` ; k S t' f/ p f t.t IM / ; .--G F $ 44.1-- ; K
-Stall i , tUcs v'-ek. -t,$ �_ /
Sink - Bar/Lavatory ? 1
- Bradley * Note: If the fixture work under this permit results in an
- 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
p lumbin permit can be issued.
Washer - Clothes _ g p
Water Extractor
Water Croset - Toilet j
Urinal
Other Fixtures: