Permit CITY OF'TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00353
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012
Parcel: 2S 101 AB00100
Jurisdiction: TIGARD
Site address: 12017 SW 70TH AVE
Project: Dr. Sepehri Subdivision: Lot:
Project Description: Medical gas.
Contractor: CASCADE PLUMBING CO Owner: RED ROCK BUSINESS ASSOCIATES LLC
2630 N HAYDEN ISLAND DR #3 23077 SW NEWLAND RD
PORTLAND, OR 97217 WILSONVILLE, OR 97070
PHONE: 503 - 289 -7095 PHONE:
FAX: 503 - 283 -9514
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FEES
Quantity Description Date Amount
1 ea Medical Gas 04/10/2012 $72.50
Specifics: 1 12% State Surcharge 04/10/2012 $8.70
Plumbing
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 Notific- '• • enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direc • estions to O by .fling 503.232.1987 or 1.800.332.2344.
Issu - • 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.
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Plumbing Permit Application
Building Fixtures . . , . '' 'r FOR OFFICE USE ONLY
ill M1 r.
V r (l 677__ a 13125 SW I fall Blvd., Tigard, OR 972
City of Tigard t Received f y� ii Q Permit No.: l j, 5'
: Date /By: ) p� L. � �� r �
3 (J 9 ,...‘i . ' �
Phone: 503.639.4171 Fax: 503.598.1960 Ov 2 Plan Rewe
Other Permit No.: /
N Date/By // 1 i `< ' /U �/� Zr 4
Inspection Line: 503.639.4175 V{
T I G A R D r° �c �`, t Qq�} Dateeady /By: lad 1i1 See Page 2 for
Internet: www.tigard- or.gov
CI ,-•. (- / ' 'Ltd/Method: 7 1:276 Supplemental Information
TYPE OF WORK r •
tt •"' - ,
•-•,a I tOV FEE* SCHEDULE
For special information use checklist
[New construction ❑ Demolition .
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I- and 2- family dwelling [,Commercial /industrial SFR (2) bath 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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / la ?tom A - Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: I Got , `
Footing drain (no. linear ft.: _) Page 2
Suite /bldg. /apt. no.: Project name: °
i • LG / ' fS4 Cil r Manufactured home utilities 50.03
Cross street/directions to job site: ii��`"' Manholes 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 ft.: _) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27)
DESCRIPTION OF WORK Backwater valve 12.51
, 0 (� Clothes washer 25.02
h s ! !` + !r'C - Chao S Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
None: Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: CASCADE PLUMBING COMPANY Medical gas (value: $ I9[3m Page 2 1..), St7
Primer 12.51
Contact name: CRYSTAL JONES
Roof drain (commercial) 12.51
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Sink/basin/lavatory 25.02
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 @YAFIOO.COM Urinal 25.02
Water closet 25.02
CONTRACTOR -
Water heater 37.52
Business name: CASCADE PLUMBING COMPANY Water piping/DWV 56.29
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Other: 25.02
City /State /ZIP: PORTLAND, OR 97217 Subtotal
Phone: (503) 289 -7095 Fax: (503) 283 -9514 Minimum permit fee: $72.50 - iar slj
Plan review (25% of permit fee)
CCI3 Lie.: 120893 Plumbing Lic. no.: 34 -412PB
SState surcharge (12% of permit fee r -�
Authorized signature: l/ _ �����/� / TOTAL PERMIT FE fi ;
Print name: _ •S ncI ne Date: -a l- I , This permit application expires if a permit is not obtained within 180 days
1 after it has been accepted as complete.
F `--I e *Fee methodology set by Tri- County Building Industry Service Board.
I \nuilding \Permits \PLMU- PermitApp doe 10/01/09 440- 4616T(I0 /02 /COM/WEI)
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 - 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 - Ist 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
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 $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
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
(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 ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quanti by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace • greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer,
Baptistry/Font
f
Se ❑ New exterior plumbing site utilities for any complex structure
Bath = 'rub /how
ub/ howerrlpool as defined in OAR918 780 - 0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash • Isometric or Riser Diagram
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
- 4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) •
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer Clothes
xr plumbing permit can be issued.
Water Extractor P g P
Water Closet - Toilet •
Urinal
Other Fixtures:
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