Permit •
CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit #: PLM2009 -00070
T [GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/01/2009
Parcel: 1 S135BD00100
Jurisdiction:
Site address: 9600 SW OAK ST 400
Subdivision: Lot: 0
Project: EVEREST INSTITUTE
Project Description: TI
Owner: FEES
PLAZA WEST LLC Quantity Description Date Amount
BY NORRIS BEGGS & SIMPSON, 121 SW 2 ea Lavatories 04 /15/2009 $33.20
MORRISON ST STE 200 2 ea Water Heater 04/15/2009 $33.20
PHONE: 1 12% State Surcharge - 04/15/2009 $8.70
Plumbing
Contractor: 6 ea Minimum Fee Adjustment 04 /15/2009 $6.10
DETEMPLE COMPANY INC - Plumbing
1951 NW OVERTON ST
PORTLAND, OR 97209
PHONE: 503- 227 -2641
FAX: 503- 274 -7686
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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: t, I - %_■.I Permittee Signature: < 1/4\
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 /01/2009/WED 08:00 AM DETEMPLE FAX No, 5032747686 P. 002
Plumbing Permit Application FOR OrrI('r t SF ONLY
q lh E iCR PermitNo.: 1 .; - 00011
13125 SW Hall Blvd., Tigard, OR 7 P
..: • Phone; 503.639.4171 Fax 503. 8 -1960 Other Permit No. r 1
Inspection Line: 503.639.4175 11°
DetelB 1 • . • r Q ��
1'1C;At:ll PR DataReadyBy: Jig 1E1 SeaPage
Internet: www.tigard or.gov _ Notified/Method: (. Supplemental information
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., . , \ i ,.. 1 r • Forspedci Information use checklist
❑ New construction � � '�•
Description I Qty. I Ea. I Total
IX Addition/alteration/replacement ❑ Other. New 1 - 2- family dwellings (includes 100 ft for each utility connection)
(�e ,TtBG`U 0 ;O ,.... 24920
... '.a: '•i >.f. "���`Ia`�,wnla, -, .�.•- ,�i+��, ,:1��JS-�''�'��'t:;t:�i; `if SFR(1) 24 9
0 1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath 350.00
0 Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
'. .:•a• r I ,�:1X L'%.1 \] R. .1•.;', '.2 x r 9'; v.4.. )_ti a , .,, Fire sprinkler ( sq. ft) Page 2
L ; t;ee�� yo-' ' r,.I p ; .`SITE ,.:.-- a Ul7 4; ' 1e `i.;:::.s, , G.,`� . ''" �p ! Site utilities
Job site address: q Lead 4 o , ee r Catch basin or area drain 16.60
City/State/ZIP: Ti Qa ra o q12 2 .? V Drywall, leach line, or trench drain 16,60
Suite/bldg./apt. no.: 4 /00 t Project name: piaja Wit Footing drain (no linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: •
Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.: ) Page 2
• Storm sewer (no. linear ft: ) Page 2
Subdivision; I Lot no.: Water service (no. linear ft.; _) Page 2
Tax map /parcel no.: / f J + 547,30 C) 0 / CO Fixture or item
, �„ Absorption valve 16.60
°..r.'t ti Ail ' r• .. , :yam w eilt. r , } AA..1t......r„v .Y(P..i: Bardlow preventer Page t
/1 h z _ l// 4/ )(tz4rrJ : 2 sJii2Y,..s are A' Backwater valve 16.60
2 V1int !., Cr e t-eJ^ Clothes washer 16.60
t^ C Dishwasher 16.60
g :i �: *ry �.1:1 h l�A, A'.':.4 Drinking fountain 16.60
.11Y�� 0 P ,I ;V!,:i � i 1 W .> c °: Ej ectors /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
l <11. ;. �1 b S r - r. � :• �, Hose bib 16.60
., r. " I-IC. . .. r4 s8i � ;,r OP A �ER Or " U` ",'
.. .. ° . t %d• -�• awl -• ..h. J .. ,ri: ��. ,w a v.• ' ..I:v::.::1:11.1
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: • Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax :: ( ) Sink/basin/lavatory 1 16.60 3 3 ZO
Tub /shower /shower pan 16.60
E -mail:
r ,���a . ,,. r4 L,; 'il ,yS. 7- .v °�a: _ _ Urinal 16.60
11 /% r. W e A:; 'A''' ,, r-. pj - T,I , :k " { ...V. ,�, 4: ' , Wate closet
.,r A i.: i '.:-\ . ' '.4 ` '' ' .:411 4 .:..• ,• a 'f' lz .P.. 'r �:, Yr. .:•_ ' :14... 15nr? acs 16.60
Business name: r DeTemlple Company Water heater 2- 16.60 3 a,2,0
Address: _ 1951 NW Overton St OthCr
City /StateritF: Portland, OR 97209 Subtotal Lott . 4/O
Phone: ( ) P #503- 227 -2641 F #503- 274 -7686 Minimum permit fee; $72.50
Residential bacldlow minimum permit fee: $36.25 72.
_
CCB Liu.: ., Lie# 26 -25PB CCB# 2510 Plan review (25% of permit fee) � -
State surcharge (12% of permit fee) 8. 70
Authorized signature: � 11 r/ Ir � J TOTAL PERMIT FEE g / , 2A
Print name; /� Date: N- 1- Q y This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1: 1Buildin5WPermiu\PLM- PmnlNpp.doc 06/26/06 440-46I6T(10102/COM/WEB)
stkv 930.00
APR /01 /2009 /WED 08:00 AM DETEMPLE FAX No.5032747686 P.003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Suppression Systems:
1}.'P#i: c eg %Tel c z
f� v tiYu r ; ' �„ .O •._ • � ,.: ti A", '
Footing drain - 1 8 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer 1st 100' 55.00 3,601 to 7,200 $220.00
7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 s : lf
55.00 'IYY ; i$ ,w "y, • :t;� Y • re ;1 � !1; 3
Storm & Rain Drain - 1st 100' $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
r; , . n r..
ieItei>tT`� "` `' 1;,Qty ir e� s i ee ri:s -
additional $100.00 or fraction thereof, to and
;� ; s� k'' i�%? � .. ; s : . • - � � •, %%'k : 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
Residential Backflow Prevention Device each additional $100.00 or fraction thereof+ to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rein 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including
specially requested inspections - per hour 72.50 first
Subtotal: $50,001.00 and up $742.00 for the e 0.00.
first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
. � : t L'X,9�•�.7.IZi 14AT� 1 fAi � w D>' tl 'y' lr. -4y0f' f
Fixture Work: 'a''ynZeevrorriDE?.iAiaa4Q5:' 'ir
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. 0 Any new commercial building with water service 2" and
''t!r uce�r r; ° t'', a':�v+fC46�: ?1?el fdi mt;`d greater, except systems designed and stamped by licensed
w iiik • , . i MA, ggev� _ s , c "..1. +dj4j%; : `�. wog engineer.
y.''. {.�.. ::t•1'�4+ i ` y !'•'� P
l A I Ti e1k4a it U (tied •.; q �a y � i ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ My multipurpose fire sprinkler system.
- Jacuzzi/Whirlpool ❑ My complex structure as defined in OAR918 -780 -0040.
Car Wash -Each Stall
-Drive Thru Submit I sets of plans with any of the above.
Cuspidor/Water Aspirator
Dishwasher -Commercial :; C Yi4 bS j'4 WE `V:11,, ux/m�. r- t
-Domestic
r,; ' �:l :1 39 :ekri de $ .a • ,
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain/sink - 2"
3r, Comments regarding fixture work:
-4"
Car Wash Drain •
Garbage - Domestic
Disposal -Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower - Gang *Note: if the fixture work under this permit results in an
-Stall increase of sewer 1JDUs, a sewer permit will be issued and
Sink - Bar/Lavatory 'Z fees assessed for the sewer increase must be paid before the
- Bradley
omme plumbing permit can be issued.
-Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures, WI)-•l 1
is tAppdoo 09/22/16