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Permit CITY OF TIGARD PLUMBING PERMIT a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00115 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012 TIGARD g Parcel: 2S115BA02600 Jurisdiction: Tigard Site address: 16230 SW PACIFIC HWY 140 Project: Shell Subdivision: 2004 -015 PARTITION PLAT Lot: 2 Project Description: Install (1) 2" floor drain, (2) lays, (2) water closets (1) water heater. Contractor: GRIDLINE PLUMBING Owner: SN PROPERTIES PARTNERSHIP 4343 SE 37TH 1121 SW SALMON ST PORTLAND, OR 97202 PORTLAND, OR 97205 PHONE: 503 - 771 -8790 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Floor Drain /Floor Sink/Hub 05/14/2012 $25.02 Specifics: 2 ea Lavatories 05/14/2012 $50.04 2 ea Water Closet 05/14/2012 $50.04 Type of Use: COM 1 ea Water Heater 05/14/2012 $37.52 Class of Work: ALT 1 12% State Surcharge - 05/14/2012 $19.51 Type of Const: Plumbing Occupancy Grp: Stories: Total $182.13 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 I • . ork will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuan , or if work is so , •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Util' Notification Center. T use rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or sired questions to OUNC by c- • $3. 32.1987 or 1.800.332.2344. Is ed By: �Jj � Permittee Sign: f Call 503.639.4175 by 7:00 a.m. for the next available inspect' • n 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. Plumbing Permit Application RECEIVED City -o at 95-- Building Fixtures 1,1 CI of Tigard MA Y 4 Received Permit No.: h' g 1 21 Dat S f a- LN/�O/�Gb�� q 13125 SW Hall Blvd., Tigard, OR 972 Plan Review Permit N r P Other Phone: 503.718.2439 Fax: 503.598.1 eeo.: C n p OGb a Inspection Line: 503.639.4175 �frY OF TIGARD Date/By: p� �daa O TIGARD p Date ReadyBy: luris: RI See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method" YW /.. Supplemental Information TYPE OF WORK tI4 4 FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use check list Description I Qty. I Ea. I Total )::r Add1t1on/al ter ati on/re p lace ment ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ❑ 1- and 2- family dwelling Commercial/industrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOC ION Site utilities: Job site address: !Z2 Z ; /r% S r� tnr � Catch basin or area drain 18.76 t Drywell, leach line, or\trench drain 18.76 City/State /ZIP: Ti (0 - 97�� / i Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: / Project name: ll 6l't' f L.L. I I Manufactured home utilities 50.03 Cross street/directions to job site: 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: I Lot no.: Fixture or item: Tax map /parcel no.: g a( /5 - 694 60 Backflow preventer 31.27 DESC PTION OF ORK Backwater valve 12.51 / /_ �� C�� l Clothes washer 25.02 / - /�� 7 �/ Dishwasher 25.02 7 � /� Clrc�G1 - � Drinking fountain 25.02 - P ©Q/�- 5 a , z /( �/ Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub X / 25.02•" j 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: Medical gas (value: $ ) Page 2 Primer( 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory X Z 25.02 50• G y City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 Water closet X r. 25.02 50 . CONTRACTOR � % �/% ater heater x / 37.52 3 S7. Business name: J7� v/ / Al A g Water piping/DWV 56.29 Address: #3 r �v / 7/ tz C� Other:. 25.02 City/State /ZIP: Ar ( / 0J!- 97?-0--- Subtotal. j69,? 4 - �n2 Phone: �/ ) 77/ - • 6)--790 Fax: ( -�//� / j5$ 77/ _/ Minimum permit fee: $72.50 n CCB Lic.: 7¢/0. Plan review (25% of permit fee) 5 tubin Lic no.: g Lic. . l s State surcharge (12% of permit fee) /q Authorized signature: i f - TOTAL PERMIT FEE f32. 13 Print name: MAW Date :∎+6 / This permit application expires if at permit is not obtained within 180 days � ��� ` � / after it has been accepted as complete *Fee methodology set by Tri- County Building Industry Service Board. I :\ Building \Permits\PLMU- PermitApp.doc 10 /01/09 440 4616T(l0 /02/COM/WEB) 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 - 1st 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 Q ty. Fee (ea) Total each additional $100.00 or fraction thereof, to Other Inspections or Fees 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 ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. • Fixture Type for Replace Please check all that.apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2" and greater, except systems designed and stamped by licensed Bath: - Tub /Shower - engineer. - Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918- 780 -0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918 -780 -0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: - 2" 1 - 3" Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non -food that meet the qualifications above. Disposal: - Domestic food related - Commercial food related - Industrial food related Ice Mach/Refrig. Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec. Vehicle Dump Station \, Shower: -Gang ' -Stall ' Sink: - Lav/Bar non -food related 1 - Bradley • . - Com/Serv/Util food related - Service ' *Note: If the fixture work under this permit results in an Swimming Pool Filter 9 increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes �- fees assessed for the sewer increase must be paid before the Water Extractor • ' Water Closet - Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF - PermitApp.doc 08/04/2011 2