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Permit p CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2012 -00180 T t G AR. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012 Parcel: 2S103DD00800 Jurisdiction: Tigard Site address: 13815 SW PACIFIC HWY 40 Project: Spec Space Subdivision: MELROSE Lot: 7 -8 Project Description: Reset existing fixtures, no increase in EDU's. Contractor: MP PLUMBING CO Owner: D W SIVERS CO PO BOX 393 4730 SW MACADAM AVE #101 CLACKAMAS, OR 97015 PORTLAND, OR 97239 PHONE: 503 - 655 -9161 PHONE: FAX: 503 - 655 -1726 FEES Quantity Description Date Amount 1 ea Expansion Tank 06/27/2012 $12.51 Specifics: 2 ea Lavatories 06/27/2012 $50.04 2 ea Water Closet 06/27/2012 $50.04 Type of Use: COM 1 ea Water Heater 06/27/2012 $37.52 Class of Work: ALT 1 12% State Surcharge - 06/27/2012 $18.01 Type of Const: Plumbing Occupancy Grp: Stories: Total $168.12 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: 6 e V eLots.6w k r 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. C0 Plumbing Permit ApplicationRECEIVED Building Fixtures City of Tigard JUN 2 5 2012 Le m 6 0/6-- / Permit No.: al/0040/ g0 III 13125 Sw Him Er d., Tigard, OR 97223 Plan Review a . Phone: 503.718.2439 Fax: 503.598.M p Other Permit No.: - Inspection Line: 503,639.4175 Ll a x 'J� T'�i.`� D ' ' '' Internet: www,tigard-or,gov BUILDING DIVISION N : r"". 1 iii See age 2 re. i- ,.. Vat .. ,t �. � � �11�l 'tw'i: 'h. i., /4'r , i . n`k. Y - ' r �. roS °�, ,r�3C+' A:; ;,, .,: f.. $:'ii'-+ '. _pL •,. �'•'t /!T..i,'.r� tN� 4"N!:}6i�1.'.1f „E .,,, 1.: 'e::2•14,4r- ;.4(;4Y:,41.':e. ,.., -.., iFL..9 f �; .:.t :c O ❑ New construction ❑ Demolition For apetsd infonnmlvn use dtecklist Dentition �Addition/aheration/replacaocnt 0 Other on Qty. I Ea. Total New 1.2 family dwellings (includes 100 ft. for each utility connection) 1 .. t o 7 .+ i - -v.. 11. ��S • iM���,gA�, mac t yy i (1) bath 312,70 - �' ' Y�:•rr�:tFinvi's'T�;u. • 2isz•si:..yvm� i�h ixar� . � ��hy'd>�rV 4``•'Zr;'�1.`Y ?� SFR ❑ 1- and 2- family dwelling f Commercial/ndustrial SFR (2) bath 437.78 0 Accessory building 0 Multi- family SFR (3) bath 50032 Each ark itionul hints/kitchen 25.02 © Master builder ❑ Outer: Fire sprinkler ( N. fl Page 2 E T IMEttfl.: ^.,,4::i...thi crea� ` e,) '' : • : '' ' Ss! ' ..,,ero!i). :§11..4/:,t•$s:« Site utilities: Job site address: 41 S 4111kingtir � .r Catch basin or ar>ar drain 18.76 City/State/ZIP: , , i es...: Drywall. leach line, or trench drain 18.76 _ i+ Footing drain (no. linear ft.: ) Page 2 Suite/bldg./apt. /apt. no.: 0 Pmjcct name: 4 ,•1t► • .v: 6. Manufactured home utilities 50.03 (miss street/directions to job site: . 1 e _ 'Ad L. 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.: _J Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Bacltfiow preventer 31,27 EM -H:',. 4 , , ., Ir . ..."41 7777 777 .77 W , .M t a• r, Backwater valve 12,51 IFIrm Clothes washer 25.02 a._ ./,_ wile .r_ ., • _41 I' . ' 11 Al 0 A Dishwasher 25.02 i 1 Drinking fountain 25.02 Ejectors/Amp 25.02 E+,',: \�J:.. T rw . < . , :.. .N.. b y :l D Wro. a Cxu. 7 - a� , :6i ". • . a:. bxpansion rank y L . ' �u..:: �:::,: ;�...,�,•a.r.•x�tx, =:� :.,r, - 1251 Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone�::y�( ) Fax ( ) Ice maker 12.51 o ,::,> ': 0 `x .` 7. L .,/1,43114M ,( ±s.-77vpw.nN {,. , `s eP r ) ,v Interceptor/grease trap 25.02 Business name: A Medical gas (value: S _ ) Page 2 Contact name: • ►, • " - Primer 12.51 Roof drain (commercial) 12.51 A "yD Siok/basin/Iavatory I.. 25.02 o Li City/State/ZIP: Solar units (mashie watt.) 62.54 Phone: ( i ) , - � Fax: : (C, ) ID 172,E Tub/showcr /shower pan 12.51 E -mail: • n Urinal 25.02 si kip ►i kt ..� . �� , ..,.: ,,v. ,.. Water CIO= 7 25.02 Cp 0(.1 Water heater 37.52 A 1 , Sa Business name: 7 -'1.( ( 5I) Water pipinn DWV 56.29 Address: i t ■ • w • Other: 25.02 City /State/ZIP: / ' J L y rt _ Subtotal ISM. I II `a j1�j - Fax: (7) ) , Ilk,„..- . Minimum permit fee: $72.50 Plan review (25% of permit fee) • I �� � ,� Plumbing Liu no.: - (� State surcharge (12% of permit fce) I .R,D Authorized signature: // � - .... /, / - TOTAL PERMIT FEE I ID E, t Print name: ; Oh ./ �- 'g / 17 Date: I0 :'.AVM pennn applica It pi es if a ampted n tampMe while 180 - days This *Fee mc,hndoing . Bet hy Tri- County Building Industry Service Board. I.\ BuildinaWermitr 'PLMU- PmoitApp.doc t0/1)t/U 140.4616T(I0/02/COM!Wm) Z d LZ0b8Z8OCSTN /LZ :Ol•1S /8Z :01 ZIOZ SZ Nllf 6uigwnld dW NOMA Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su ' i ression Szstems: ' it .' _ : T''P , r 7 ti6S +5. 1r . , . `, . `.,' : ' iry •I ;r :1 °:. „ ,. , .....�....... :1.;.....: �L'SIu, d. ek i els..�.45a r '` t2 .,�, .: ,. r .1.f.., i�14 .L.Sf��:.' a?'.X.•1•?.rl•N'y`.'• : o:.ii•.. Footing drain -1' 100' 50.03 U to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 S169.69 3,601 to 7,200 523320 Sewer - 1st 100' 62,54 7,201 and neater - - $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas S stems: Water Service - each additional 100' 37,52 ',. r� - & Drain , t�J�+�'�`.'liu >< > :'� Storm _ 62.54 n 0 Y a .,f >..]r . i . :' $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain • each additional 100' 37.52 MI $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for ;.. �41.. - . r • , ,• , r. ii °'y-, ,; r'rc-!r: .r 7 .7" :+ . each additional $ 100.00 or fraction thercot: to . : . 4. :.i- :..� :., ' : rr l'k,'"y, c omer" and including $10,000.00. Inspection ofexisting plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $ 10,000.00 and $ 1.54 for which no ftc is specifically indicated ■ 90.00/hr ■ each additional $100.00 or fraction thereof, to minimum -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 fur the first $25,000.00 and $1.45 fur hours minimum . , . y - 2 hours each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including 550,000.00. Additional plan review for revisions - 90.00/hr - $50,001.01 and up $742.00 for the first $50,000.00 and $1.20 for minimum -.:, _ -1/2 hour _ each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: -.n� 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 * . L ft9 L til.. sjs M:. iWit:'t^,: 3u4, .1....':: r • k "��viip :''"l - `.: :-� 1 04 "�• . " . :•:l.' ` ' ` t, Plan review is required for my of the following. Retptistry/Font Please check all that apply. Bath - Tub/3hovrer ❑ Any now commercial building with water service 2" and ,1saizzi Whirlpool - greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thu ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918- 780 -0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic - ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918- 780-0040. Eye Wash Floor Drain/sink - 2" Suhmit 2 sets of plans with any of the above. -4^ : e y ,F'/Y pyf v , 4 oW(,P�sA •( J • ;� ■ Car Wash Drain its :,4 4- aka ReOrli #� 7•. '` ...,.. - Dca�tir�on -food 0 Isometric or riser diagram is required for new buildings Driftage Disposal -Domcstio-food related that meet the qualifications above. -Commercial-food related - Industrial-food related Ice MachAtefrig. Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower fining -Stall _ Sink/Lev -Nun-food minted - Bradley _ - Commercial -food related service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes Water Extractor of sewer EDUs, a sewer permit will be issued and Water closet - Toilet P.- fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: http: / /www. tigard- or.gov /city -hal I /depnrtments/cd /docs/PLMP -Penn itAppldnc C d LZOb6ZSOOS'oN /LZ:O1'1S /8Z :01 ZIOZ SZ Nilf 6ulqunld dW WOa.