Permit � . _ � CITY OF TIGARD PLUMBING PERMIT
' ' - : . ' t . COMMUNITY DEVELOPMENT Permit #: PLM2012 -00019
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/07/2012
TIC'iARD g Parcel: 1 S136CD01002
Jurisdiction: Tigard
Site address: 7900 SW PFAFFLE ST
Project: Proforma Graphics Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: Plumbing fixtures for TI
Contractor: BEAVERTON PLUMBING INC Owner: E &S HOLDINGS LLC
13980 SW TV HWY 8020 SW PFAFFLE ST
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 643 -7619 PHONE:
FAX: 503 - 643 -7620
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 01/26/2012 $25.02
Specifics: 1 ea Primer 01/26/2012 $12.51
3 ea Lavatories 01/26/2012 $75.06
Type of Use: COM 1 ea Tub /Shower /Shower Pan 01/26/2012 $12.51
Class of Work: ALT 2 ea Water Closet 01/26/2012 $50.04
Type of Const: 1 ea Water Heater 01/26/2012 $37.52
Occupancy Grp: 1 12% State Surcharge - 01/26/2012 $25.52
Stories: Plumbing
Total $238.18
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 may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
r
Issued By� = +ftee-Signature: , / /I
Call 503.639.4175 by 7:00 a.m. for the next available in .ection . ate.
This permit card shall be kept in a conspicuous place on the job site un : pletion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures FOR OFFic F• . !.'SE. °N'IA
4 1 131 W , Na1l ' li l v d .,Tigard,OR A IT'p A .' 1 Plan Rcvic : ` earn,; e2(, �a?�Q0 /9 rJ
Phone: 503.718.2439 hex; 503,. 8.1 )6 t r l0 Dates : Other Permit N,��/4, A,7 -QdD /p
75 JPN ,� , Nat f ad /Method: 6 /Z :i /' see mr,tul information i 1 Ei i Inspection Line: 503.639.4175 J
Internet: www.tigard-or.gov
. i; � � zi wir rmation Q
Tl'I P a� Ioiig .(41, \ .` i � �' ,. r 1 ... �.I D 1 •
II FM' x ia1 i eh
LI New construction _.,.., ❑ n i � t! FM' .R�' � onnwalon use
DesCripliu L9ty. I Ha. I Total
❑ Di Cr; fl
New 1- 2 - family dwellings (includes 100 ft. for each utility connection) 1 1
El Addition/alteration/replacement a�t� 0 ll O J CCU � '
SFR (1) bath 31
- and H N : l ldia.i --
❑ 1 2- family dwelling ® Commercial /industrial SFR (2) bath m... 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
rr, k SI . )C TY
;r:..� 30 FA Q11T ANI1 x`O_ATNI,jG Site utilities:
Job site address• IOW PFAFFLE 7 9'() Catch basin or area drain 18.76
City /State/ZIP: 'I'IGARE, OR 97223 Drywall leach line, or trench drain 18,76
Footing drain (no. linear 11.: _) Page 2
Suite/bldg./apt. no.: Project name: PROFORMA CRAPIUCS
Manufactured home utilities SO.p;i
Cross streetld rcetions to job site: Manholes LL 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 fi.: ) Page 2
Subdivision: Lot no.: °
Fixlurr or item:
Tax map /parcel no.: /s/ 3 , Cry, O / ea ^z Backflow prevenler 31.27
. - N t : . ripe 77 . , Rack valve
$111? . R . . 12Sl • 1
. hI !, a `, Cl othes washer 25.02
INSTALL 2 TOI I .h,I'S, 2 WALL HUNG LAVATORIES, 1 BREAKROOM SINK ' - -
I)ishwashcr • 25.02
A WATER HEATER, FLOOR DRAIN, PRIMER, AND AN ADA SHOWER AND Drinking fountain 25.02
VALVE Ejectors/sump 25.02
t::'P rEwry O"/lr Flt' L( ; :. T VT Expansion tank 12.51
Name: Profurma Spectrom Printing Graphics Fixturr/scwercap 25.02
Floor drain/floor sink /huh 1 25.02 • 25.02
Address: 6745 SW Hampton, Ste. 101 _
Garbage disposal 25.02
City /Slale/ZTP: Portland, Oregon 97223 Hose bib 25.02 „ ~
Phone: (503)9245740 Fax: ( ) Ice maker 12.51
F I►11 ANT II interceptor/grease tru 2
11 u q ❑ :C(INTAt: W04046N P 5.02
Business name: BEAVERTON PLLIMBIN(i, INC Medical gas (value: $ ) Page 2
Contact name: CASEY
Primer 1 12.51 12,51
Roof drain (commercial) 1,2,51
Address: 13980 SW TUALATTN VALLEY IIWY M Sink/basin /lavatory 3 25.02 75.06
City /State/ZIP: BEAVERTON, OR 97005 Solar units (potable water) 62.54
Plume: (503) 643.7619 Tax: : (503) 643.7620 Tub /shower /shower part 1 12.51 12.51
E- mail: Sae(a benvertnnplumbing.com M1Urinal _ 25.02
Vp Water closet 2 25.02 50.04
Businessnatne <11IAOZ< ' ' GT jlj
" -- -- -- w hewer 1 37.52 :17.52
PLUMBING, INC - Water piping/DWV 56.29
Address: 13980 SWTUALATINVAT.T.RYH.WY Other: 25.02
w
City/State/ZIP: 1W OREGON 97005 Subtotal 212.66
Phone: (503) 643.7619 Fax: (503) 643.7620 Minimum permit fee: $72.50
CCB lie.: 12889 Plumbing Lie, no.: 34 -4PI3 Ulan review (25% of permit fee)
Stale surcharge (12% of permit fee) 25,52
Authorized signature:(', 3,(, I This crmrt application mm
TOTAL, PHRMI'.l' FEE 238.1
( _Print name :.SUSAN -DEAN- - - - - -- Date: 1/19/12 p pP ation- expires i a - permit is not obtained within IRO da ,
after It has been accepted us complete.
Fee Mel h<xioloty set by Tri- County Building Industry Service Board.
I: V3uildinteParmitslPLh111- YprenhAN.J 10/01/09 440- 4616rp0 /02/COMMWL13)
■
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fe Schedule: Residential Fire Su • ression Systems:
siitiiiiii4 !.::....4J! :.:,::• • :,:•,:rotil . i S, ire Footage :: •, . ermi : . ee,::J . . .: ::f :. : .,
Footing drain - l 100' 50.03 (1 to 2,000 $121.90
-- .
Footing drain - each additional 100' - 37.52 2.001 to 3 600 $169.69
- 3,601 to 7 200
7,200 $233,20
Sewer. 1st 100' 62.54 7,20i and greater $327.54
Sewer - each additional 100' 37_52
Water Service. 1st 100' 62.54 Medical Gas S stems:
Water Service - each additional 100' 37.52 '''Vititatioiiii::. • :,.: • -,.i :: :jyk piy ..:,:: • . . • .. .
Storm & Ruin Drain - 1st 100' 62.54
'
$1.00 to $5,000.00 Minimum fee $72,50
Storm & Rain DraM - each additional 100' 37. $5,001.00 to $10,000.00 $72.50 kir the first $5,000.00 mid $1.52 for
each additional $100.00 or fraction thereof, to
°01,eit.:•16010elitiiiikbr:T:e0' '.:::. : I N , 0 0!N , f. 'OP. ...: •., , :! II,
••......: • • and including $10,000,00.
Inspection of existing plumbing or f o r $10,001.06ii, $25,000.00 $148.50 for the first $10,000.00 and $ 1 ,541 ter
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge -1/2 hour)
_ and includin! $25,000.00.
..,
Inspections outside of normal business 90.00/hr V5,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge .2 hour!)
each additional $100.00 or fraction thereof, to
,
Reinspeetion 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 kb:titre Type — ' . • ,:•1,1 .ilIkteY,WW.•,for.:Piumhong:Ins otations:::•:,:::;!:441,..
•Fixture:Type:for . • ' • , ,• ' , "Replace/
of the following.
Work Peiformici: • . .. • • :. Added •L,: Relocate Plan review is required for any ohe
.
Baptisuy/Funt - Please check all that apply.
Bath -Tub/Shower
0 Any new commercial building with water service 2" and
-.Iaeuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
__
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water _ ter Aspirator as defined in OAR9 18-780-0040.
1 Dishwasher -Commercial 1=1 Medical gas and vacuum systems for health care facilities.
-Domestic El Any multipurpose fire sprinkler system.
•
Drinking Fountain rj Any complex structure as defined in 0AR918-780-0040.
Eve Wash
- '
Floor Drain/sink - 2" 1 Submit 2 sets of plans with any of the above.
C ar Wash Drain • ,:. • .: .11;g0.1tietrit•:e ,,", 00.: thgram..: ..•.:,. : !..., . ..
Garbage -Domestic-nn-food .
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-tbod related that meet the qualifications above.
- Commercial -food related ..,
- Industrial-food related
lee Mach./Refrig, Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
_
-Stall 1 —_____________
Sink/Lay -Non-food related 3
-Bradley
—
-Commercial-food related - . ________---
-Sery ice
.
Swimming Pool Filter
Washer. Clothes ' — *Note; If the fixture work under this permit results in an
' .
Water Extractor — increase of sewer EDUs, a sewer permit will be issued and
.
Water Closet - Toilet — 2 fees assessed for the sewer increase must be paid before the
_
—
Urinal - - - - . plumbing pent be issued. _ •
Other Fixtures:
http://www,tigard-or.gov/city_htill/dcpartments/cd/does/PLMF-PermitApi2doe