Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00037
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/23/2012
Parcel: 2S112DC00100
Jurisdiction: Tigard
Site address: 15605 SW 72ND AVE
Project: Consumer Cellular Subdivision:HERN PACIFIC TIGARD INDUSTRIAL I Lot: 1 -2
Project Description: Replace fixtures on existing rough -in.
Contractor: CASCADE PLUMBING CO Owner: PACTRUST
2630 N HAYDEN ISLAND DR #3 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97217 PORTLAND, OR 97224
PHONE: 503 - 624 -6300
HONE: 503 - 289 -7095
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 02/23/2012 $25.02
Specifics: 1 ea Hose Bib 02/23/2012 $25.02
8 ea Lavatories 02/23/2012 $200.16
Type of Use: COM 2 ea Urinal 02/23/2012 $50.04
Class of Work: ALT 7 ea Water Closet 02/23/2012 $175.14
Type of Const: 1 12% State Surcharge - 02/23/2012 $57.05
Occupancy Grp: Plumbing
Stories:
Total $532.43
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 quest OUNC b (ling 503.232.1987 or 1.800.332.2344.
Issued By: 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.
Pin/Ohm Pin/Ohm Permit Application
USE Fixtures `
Building xtur �'� 1 U1�f'1t�1� USE ONLY Ci 'L��� ��_"',
G 1 t' PermitNo.•
r 131 of Tigard
SW Hall Blvd., Tigard, OR � �, Other Permit No.:
� ,0 � � z. � l� o .3
. C Phone: 503.639.4171 Fax: 503.59 I960 0 r Review
C� �v� � ,1 DatelBY•
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IC; .n N n Inspection Line: 503.639.4175 S' ��
Internet www.tig Ready/ By: >vri Supplemental men tal for
• www.tigard.or.gov
�.. ... _ .. WORK \�Q
.
. . . :.; s�F.Dlutltr � .
❑ N construction
❑ Uemoli For special Lnformarioj, use cJjecfJlsi •
Addition/alteration/replacement Other: Description J Qty, I Ea. I Total
. ,...; New 1- 2-family ell ngs (includes ft, for utility connection)
C ATEGORY ° OF;.CONSFRUCTION ..:..' ' ; - • SFR (1) bat
i in es t 00 each
�• 127
❑ I- and 2- family dwelling eleksImmerciaVindustrial SFR (2) bath 437.78 .
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
-- Each additional bath/kitchen 25.02
❑ Master builder ❑ Other
sq. ) Page 2
JOB ... WE .INFOj=kATlON-AND
Fire sprinkler ( . ft. P e
... _ Site utilities:
Job site address: I5°0 05 1 awned Catch basin or area drain 18.76
City /State/ZIP: r is _ a, Drywell, leach line, or trench drain 18.76
"rte` 1 /��,, � �� - Footing drain (no. linear R: page z
Suite/bldgjapt. no.: Project name: t Iarn . e.l - C p Manufactured home utilities
50.03
Cross street/directions to job site: Manholes 18.76
- Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _J Page 2
- Storm sewer (no. linear ft.; _ ) Page 2 Water service (no. linear R: ___) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
. >ES LRIP LI O
.. .•, . D O . = l QBdC
A� _ , rho 4/4 . •. a Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
ro 4.124.1 Drinking fountain 25.02
Ejectors/sump 25.02
❑• PROPERTY - 1 :Q TENAI�IT . Expansion tank 12,51
Name: - Fixture/sewer cap 25.02
Address; Floor drain/floor sink/hub . l - 25.02 d S. co 2.
- . Garbage disposal 25.02
Cily/State21P: Hose bib 25.02 „V5_ p 2.
Phone: ( ) Fax: ( ) Ice maker 12.51
0 APPLICkiiii ;.,. ` :.:... ' •
• . I' ❑ C ONTACT PERSON . r lnterccptorJgrt:aserrap 25.02
Business name: CASCADE PLUMBING COMPANY Medical gas (value: $ ) Page 2
Contact name: CRYSTAL JONES Primer 12.51
Roof drain (commercial) 12.5I
Address: 2630 N, HAYDEN ISLAND DRIVE 113 _ Sinkibasi avatory g 25.02 aOO, t
City /State/ZIP: PORTLAND, OR 97217 Solar units (potable water) _ 62.54
Phone: (503) 289 -7095 Fax: : (503) 283 -9514 Tub /shower /shower pan 12.51
E -mail: CASCADEPLUM @YAHOO.COM Urinal
°'7 j
:C ONTRACTOR:.:. _ 5 Jy_
25.02
W 2s oz
Wader heater 37.52
Business name: CASCADE PLUMBING COMPANY
Water piping/UWV 5629
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Other: 25.02
City /State/ZIP: PORTLAND, OR 97217 Subtotal :/75 i}
Phone: (503) 289 -7095 Fax: (503) 283-9514 Minimum permit fee: 572.50
CCB Lie.: 120893 Plumbing Lie, no.: 34.412P8 Plan review (25% of permit f>'e)
State surcharge (12% of permit fee) Afy,
Authorized signature: / C EE
V / J TOTAL, PERMIT FEE r32.q
Print name; CRYSTAL JONES ' Date This permit application expires if a permit is not obtained within 180 days {- /
after 4leis been accepted 24 complete. t►
_„-.p 1 4 a • , L , .}r (��(� 44 "Fee methodology sot by Tn -County Building Industry Service Board
I:18vildinglPermitaLLMMV- Permit doe 10/01 ' /i+s -^ 44o.461
ZO /t0 30tid 3GVDSVO bt96E8ZE09 b9 :0t ZZOZ /tZ /Z0
Plumbing Permit Application - City of Tigard .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
`'SiteUtihttes, ' -J,., :Yf . Qh'; .- '' , , c) • . _ . Squar 1Aotage: . P mi., Fee ;_ . , , ; ,,. _. £4 ' .,
Footing drain - 1' 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 ; V'affMtio, Per;ii rRte " " '-' `•
Storm & Rain Drain - 1st 100' 62.54 $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 S1.52 for
iii. each additional $100.00 or fraction thereof, to
Otkra ispectio`rs � ti'r. y ees: y,, Q Fee (eat = .: otal 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
each additional $100.00 or fraction thereof.
(minimum charge - 1/2 hour)
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 * .
- •..M
' Y - ,s,:- - .Qua'ntityby:Fixture ype' ": _ Plan . for,Eluiribingtbs_talrtafions i =-_, Fiituretypef0t:
` 4 ,: :if!1X,: ; '.z ,`.. ' :: ay �Re lace) .�
;'• ,; � `' `4� <:. ?,. Plan review is required for any of the following.
!V1'tirk Performed: '; a. Capped? ad '= .Ifelurate'
Please check all that apply.
Baptistry/Font ❑ Any new commercial building with water service 2" and
Bath -Tub/Shower greater, except systems designed and stamped by licensed
-Jacuzzi/Whirlpool
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 "
'I -f'':; . - ;' - someticvorAINgr.'Di xapu "". 1.
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food ,
Disposal - Domestic-food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice MachiRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station •
Shower -Gang
-Stall
Sink/Lav - Non -food related S
- Bradley
- Commercial -food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor ,
Water Closet - Toilet 7 fees assessed for the sewer increase must be paid before the
Urinal 2 plumbing permit can be issued.
Other Fixtures:
C: \Documents and Settings \Cascade Plumbing\My Documents \DownloadyLMF- PermitApp.doc