Permit •
CITY OF TIGARD PLUMBING PERMIT
° ►'� t COMMUNITY DEVELOPMENT Permit #: PLM2012 -00164
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2012
Parcel: 1 S136DA02300
Jurisdiction: Tigard
Site address: 6900 SW ATLANTA ST 100
Project: OME Subdivision: FRUITLAND ACRES Lot: 5
Project Description: Add (1) non -food related sink in break room for TI (same tenant, in suites: 100, 110, 120 & 200)
Contractor: D & F PLUMBING Owner: OREGON EDUCATION ASSN
4636 N ALBINA AVE 6900 SW ATLANTA ST
PORTLAND, OR 97217 TIGARD, OR 97223
P
PHONE: 503 - 684 -3300
PHONE: 503 - 282 -0993
FAX: 503 - 288 -0604
FEES
Quantity Description Date Amount
1 ea Sink 06/07/2012 $25.02
Specifics: 1 12% State Surcharge - 06/07/2012 $8.70
Plumbing
Type of Use COM 47 ea Minimum Fee Adjustment - 06/07/2012 $47.48
Plumbing
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
eAl /97 e — i %o
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.
Jun 0512 03:40p D & F PLUMBING CO 5032880604 p.2
Plumbing Permit Application RECPiV
Building Fixtures FOR OFFICE USE ONLY
JUN 0 5 2014 Received �, �/
City of Tigard D,re By: 7 /It �•• , Permit Ao�L� / ^D /h>� (/Q /(oy
e 13125 SW Hall B:vd.. Tigard. OR 97223 CITY OF TIGA=�DPIac Re+ Oil= Permit � /ed0 %�-����y O
Phone: 5C 3.718.2435 Fax: 503.598.1960 r DatcBy:
• TIGARD Inspection Line: 503.639.4175 BUILDING DIVISIO / ay: % //a '�J tuns ®SecP nCc2ror
Internet: www.tigard- or.gov Notdied/Method:`f' �`� , 1 I . Supplemental Information
TYPE OF WORK / /j(ay FEE* SCHEDULE I
❑ N ew construction ❑ Demolition For special information use checklist %
Description 1 Qty. I Ea. I Total \O
Additiotialte .-dtion /replacertient El Other: Nett I- 2•family deellings (includes 100 ft. for each utility co:tncction)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
cs;;) l- 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. 11.) Page 2
. JOB SITE INFORMATION AND LOCATION Site utilities: '
Job site address: 0 v c iA ., A T�t4('r Pk Catch basin or a ea drain 18.76
Drywell, leach line, or trench drain 18.76
City /Slatc2 :P: " fl c) .,,,...,.., • (9 - 77- ✓ Footing drain (no. linear IL: ) Page 2 I
Suite /bldg. /apt. no.: I Project name: 1:).,6.-71- ; tz: i ; - %1 Manufactured home utilities 50.03
Cross street /directions to job site: 10/46 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear R.: ) Page 2
• Storm sewer (no. linear R.: ) Page 2
Water service (no. linear ft.: Page 2
Subdivision: I Lot r. o.: Fixture or Item:
f,
Tax map /parcel no: `s/3 to 0 310 a Bacicflow preventer 31.27
• Backwater valve 12.51
DESCRIPTION OF WORK •
j Clothes washer 25.02
�hrg : t. ri,ri;(VI 5: 1 - eso= C� �• i v- I Dishwasher 25.02: .
Drinking fountain 25.02
Ejxtorsrs<tmp 25.02 I
• ❑ PROPERTY OWNER • ❑ TENANT Expansion tank 12.51
U `I- yy►► Fixture /sewer cap 25.02
Name: PT•6inrt GCIr)c:Chfl 4 f? : -/ r/D • h 2
/[ Floor drain/floor sink!hub 25.02
Address: • Garbage disposal 25.02
City/State/ZIP: Hose bin 25.02
51 12.
Phone:( 1 Fax:( ) Ice maker
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
• Medical gas (value: $ _) Page 2
Business name: Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory j 25.02
Ci :ylStnte /ZIP: Solar units (potable water) 62.54
Phone: t I Fax: : ( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: Water closet 25.2 •
CONTRACTOR Water heater 37.52
Bu;incas name: i' r r ,,�t,+. IfJrV Water piping/DWV 56.29
Address: s
`tL rV Au ?;�ti� Other: 2502
City /State/ZIP: 'y!r -#4,,k �) rL- c i p 7 Subtotal
Phone: ty, ) t� Fax ) •'2.3% � 060V Minimum permit fee: $72.50 ' 2_ .
�� lei ax : $ 7 Plan review (25% of permit fee)
�CB Lie.: s Plumbing Lie, no.: 7Z, - 2 p b State surcharge (12% of permit fee) c ,• 7cr V
Authorized signature: fl , g,tio
X)
TOTAL PERMIT FEE k/. .
t� Date: /•' This permit application expires if a permit i9 not obtained within 180 days
Print name: .4N!/ I f ' i i/F c - .y - i' after it has been accepted us complete_
`Fee methodology as by Tri•Counry Building Industry Service Baud.
• 1"13uildi.+yW_r irirsU'LMUPer mit App.duc IO,DLO9 440- 4616T(lo :sScONAVEn)
ViivCE Z F PL nt n 6-
Jun 0512 03:40p D & F PLUMBING CO 5032880604 p.3
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: -
Fontirg dra:n - 1° 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2 2,001 to 3,600 $169.69
2.601 to 7,200 $233 .20
Sewer- 1st 100' 62.54 7.201 and grater $32754
Sewer - eac :r additional 100' - 37.52
I
Water Service -1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' I 37.52 Valuation • Permit Fee: •
S'u rm & Rain Drain - 1st l00' f o $1.00 to $5.000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 . $5,001.00 to $10,000.00 572.50 for the first 55,000.00 and $1.52 I'or
Q ty. Fee (ea) 'total each additional S I OO.00 or fraction thereof; to
Other Inspections or Fees and including 510.000.00.
Inspection of exist.ng plumbing or for 510,001.00 to $25,000 00 $148.50 for the first 510,000.00 and $1.54 for
which no fee is specifically inticatec 9C.001hr each additio.•ial $100.00 or fraction thereof, to
(nin:mun charge - 1,2 hour) and includins $25.000.00.
Inspect ions outside of normal business 9C.00!hr - $25,001,00 to 550,00000 5779.50 for the first $25,000.00 and $1.45 for
hours (minimum car e - 2 hours) each additional $100.00 or traction thereof. to
R_inspectio: Fees 90.00 /hr and including $50,000.00.
Additional plan review fcr revisions - ' 90.00 /hr ' $50,001.00 and up S742.00 for the first $50,000.00 and S1.20 for
each additional 3I C0.00 or fraction thereof.
(minimum charge - 1 hear) ,
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
' Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Itepm "r Plan review is required for any of the following.
Work Performed: . Capped Added Relocate
Please check all that apply.
BaptistrdfFont ❑ Any new commercial building with water service 2" and
Bath - T:cb/Shmver greater, b ed an
)' except systems desi ed and stamped licensed
-Jaci zifWhirlpool p " e°tf p by
engineer.
Car Wash -Each Stall
-Drive Tlin' ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
Cuspidor /Water Aspirator
Dishwater - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system. •
Drinkinc Fountair I ❑ Any complex structure as defined in OAR918 -780 -0040.
Eve Wash
Floor Drainisink - 2-' Submit 2 sets of plans with any of the above.
3"
- a° Isometric or Riser Diagram
Car Wash Drain - ❑ Isometric or riser diagram is required for new buildings
Garbage - Dotr.esrc - food .
Disposvl - Dotnesdc - food related that meet the qualifications above.
- Commercial-food related
- Industrial -food related
Ice Maci.IRefrg. Drains
Oil Seperator(Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang '
-Stall
Sinkil-av - Non -food related P
- Bradley
-Comme via: -food related
- Service
s..'imir.:nC 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 fees assessed for the sewer increase must be paid before the
Jtrinut _ plumbing permit can be issued.
Other F:.xtures:
C: 1L: serslrandyWppData ∎Localvfemp\PLMF- Permit.App.doc 2
•
w