Permit n CITY OF TIGARD PLUMBING PERMIT
IIIIII
a COMMUNITY DEVELOPMENT Permit#: PLM2009 -00218
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/12/2009
Parcel: 2S 102AB04300
Jurisdiction: Tigard
Site address: 12400 SW MAIN ST
Subdivision: Lot: 0
Project: Sunshine Gallery
Project Description: Replace 120' of exterior water service, replace 60' of interior water pipe, replace existing fixtures
(1) sink, (1) lavatory, (1) water closet and (1) water heater.
Owner. FEES
TIGARD MAIN ST COMMERCIAL PROPER Quantity Description Date Amount
12488 SW AUTUMNVIEW ST
TIGARD, OR 97224 120 If Water Service 08/12/2009 $101.40
1 ea Sink 08/12/2009 $16.60
PHONE: 1 ea Lavatories 08/12/2009 $16.60
1 ea Water Closet 08/12/2009 $16.60
Contractor: 1 ea Water Heater 08/12/2009 $16.60
RELIANT PLUMBING & MECHANICAL 1 12% State Surcharge - 08/12/2009 $26.74
11575 SW PACIFIC HWY STE 219 Plumbing
TIGARD, OR 97223 55 da Additional Permit 08/12/2009 $55.00
PHONE: 503 - 246 -1201
FAX: 503 - 246 -1205
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $249.54
• 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
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: vtc (5 ,//' G , cif.: o
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.
08/12/2009 09:50 477 PAGE 01/03
Piumbin Permit ApplicationRE
',
Building Fixtures
g AUG 12 2009 rolz orrice•, 1.ISE ONLY
City of Tigard Daie / 0 , /9 .i Ayr-
Pc d
n 13125 SW [lull Blvd.. Tigard, OR 972 OFTIGARD °�'eBy, ° �'� /w`1a00 -- )5
■ Phone: 503.639.4171 Fax; 503.59�Y Plan Review
Inspection Line: 503,639.a175
T i 1LDING DIVISION Date/By: Other Permit Nei/ e 2 f r 9 DO/ yb
! : A r, o N
Internet; www.ti ardor, Notified/Method: ov ine Ready/By: .//,&-' Supplemental Pent lnfnrmn for tilyi � g tion
TYPE. WORK '11 SGHE
0 Ncw construction ❑ Demolition For special information use checkJsc
Description Qt E a. Total
❑ Addition/alteration/replacement ® Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
, .. , CA'fFGoRY '.OF ONS`i'RUG Ci0r 1,:? '-,:?,.;:',;:;ii SFR (1) bath 24920
❑ 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 350.00
❑ Acccsory building ❑ Multi family SFR (3) bath 399.00
❑ Master builder 1:1 Other Each additional hath/kitehcn 45.00
40B':SI't'E .INF`OitMATION AN 1, _ Fire sprinkler ( _� sq. R) _ Page 2
• -..,,•••• ; - Site utilities
Job site address: 12400 SW Main Street Catch basin or area drain 16,60
City/State/ZIP: Tigard, OR 97223 Drywcll, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: l Project name; 12400 SW Main St Tigard Footing drain (no. linear ft: ) - Page 2
Cross street /directions to job site: Burnham StiA/Sff/n/E �
G1.472y Manufactured home utilities 110,00
Manholes 1 6.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ,) Page 2
Sturm sewer (no. linear ft: ) Page 2
Subdivision: [ Lot no.: Water service (nn, linear ft.; 122) I PaRc 2 101.40
Fixture I
Tax map /parcel no.: 251024804300 ore or Item "�''0
on valve Ah�orpti 1 16.60
:•6.1 CRIt'TI'ON. D>c'W. .
r Hackflow prevcntcr Page 2
•
Backwater valve 16,60
Clothes washer 16.60
Dishwasher 16.60
.. ®. •PRO►E1tre• -it A R .. .. - fountain mn
A1V't. :
Ejcctors/sump 16.60
Name: Chris Cach Expansion tank 16,60
Address: 12400 SW Main fixture /sewer cap 16.60
Cily /State/71P: Tigard, OR Floor drain/floor sink/hub 16,60
Phone: (,503)807 -1387 Fax: ( . ) Garbage disposal 16.60
�. • a4PPt1614T
, : d CUPITACC:rf!1y:1)zSpN' ":'. . 11osc bib 16.60
ice maker 16.60
Business name; Reliant Plumbing & Mechanical
_ Interceptor/grease trap 16.60 •
Contact name: Amanda • Medical gas (value: $ ) Page 2
Address: 11575 SW Pacific Hwy #219 Primer 16.60 _
' City/State2UP: Tigard, OR 97233 Roof drain (commercial) 16.60
Phone: (503) 246 -1201 Fax: : (503) 246 -1205 Sink/basin/lavatory 2 16.60 33,20
Tub /shower /shower pan 16.60
rr
E -mail: amandaOreliantplumhing.cm
Urinal
CONTRACTO1it '
w ater closet 1 16,60 16.60
Business name: Reliant Plumbing & Mechanical Water heater 1 16.60 16.60
Address: 11575 SW Pacific 13wy #219 Other: OOft water plp / �o� A S
City /Statc/Z1P: Tigard, OR 97233 l `L t/ ✓mil/ /LFd Subtotal ...14,115
Phone: (503) 246-120.1 7a r1-/ Minimum permit ftc: $72.50
( ) Fax: (503) 246 -1205 Residential backflow minimum fee: $36.25 p? as ,1'0
CCB Lic.: 169844 lambing Lic. no.: PB117 Plan review (25% of permit fee)
Authorized si a •Ire: � State surcharge (12% of permit fcc) A G� 7L/
`' r r �' -
TOTAL PERMiT FEE Rtl'
Print name: Amin a R: , Date; 08/10/09 This permit application expires if a permit is not obtained within
672A// E - y7/ -'5b '/4,�� 180 days after it has been accepted as rnmplete. a l sy
7 •Fee methodology act by Tri- County Building Industr service Boar •
1;1BuItdlna\rermialPt rtP.PermhAPD.doc 12/27/06 4 /02/COMfW R) .60K74-
08/12/2009 09:50 477 PAGE 02/03
•
Plumbing Permit Application - City of Tigard
r � Page 2 - Supplemental information
Fee Schedule: .. e Suppression Systems:
:Utlilitlie ie::
e-gti en
Footing drain -1" 100' 55.00 0 to 2,000 $115.00
y Footing drain - each additional 100' 46.40 2.001 to 3,60(1 $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' L 55,00 55.06
Water Service - each additional 100' 1 46.40 46.40 Medical Gas Systems:.
Storm & Rain Drain - 1st 1.00' 55.00 'rrll#idi> .;; g'r'1I'jdl1 Ci:
$1.00 to 55,000.00 Minimum fee $72.50
Storm & Rain Drain - cach additional 100' 46.40 55.001.00 to 510.000.00 $72.50 far the first 55.000.00 and 51.52 for each
'>(�ttYl)f : OI' teln< Qty. Fet:( ',7oial additional $100,00 or fraction thereof, to and
. LL including $10,000.00.
Commercial Back Flow Prevention Device 46.40 510,001.00 to 525,000.00 5148.50 for the first $10,000.00 and 51.54 for
Residential I ackflow Prevention Device - each additional 5100.00 or fraction thereof, to
(minimum permit fee $36.25) 27,55 and including 525,000.00.
Rain Drain, single family dwelling 65,25 525,001.00 to 550.000,00 $379,50 for the first $25,000.00 and 51.45 for
Inspection of existing plumbing or each additional $100,00 or fraction thereof, to
s ecia requested inspections - per hour 72.50 and including first 0.00.
Subtotal: $50.001.00 and up 5742.00 for the e f fiirst 550,000.00 and 51.20 for
/if Li each additional $100.00 or fraction thereof.
,, f ' 9-r / — l gat) / SS. ,z) sr .
/5 , Yo
Commercial Fixture Work:
Are you capping, adding or replacing fixtur it' "yes ", Plan review is required for any of the foliowing.
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 service 2" and
Qaatttity (Fixture) Work.fier greater, except systems designed and stamped by licensed
. Fixtirre.'I'ype. ' ' .Rt,plarc ' engineer.
. .. .• •,Pr implied , ;: ddi41:/ • _ i.ixlatl j.. ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font
as defined in OAR918- 780- 0044.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
-7acu zi/Whirlpool ❑ Any multipurpose fire sprinitler system,
/�
Car Wash -Each Stall . {� ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru t`'
Cuspidor/Watcr Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Dom
Drinking Fountain . " • �t .. , sera • W l�t1►`:.,:'. ::' .; : <
E Wash 0 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 regarding fixture work:
Disposal - Commercial b'
- industrial
ice Mach,/Refrig. brains
Oil Separator (Gas Station)
Roc. Vehicle Dump Station _
$hnwcr - Gang
-Stall ..
Sink -8 ..avat r + 1
- Brad ey *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
rvj� Yes 1
fees assessed for the sewer increase must be paid before the
Swimming Pool Filter
plumbing permit can be issued.
Washer • Clothes p g P
Water Fzfr
l t Closet = Toilet_ ' y� �
,r Ply A �t�
Other Fixtures:
•
_ /� mil n
.: 43uildir .\Pt,M -Permit App.doc 12/27/ta .0 4---.
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