Permit CITY OF TIGARD PLUMBING PERMIT
11111 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00183
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012
. Parcel: 2S 113AB01201
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 120
Project: Phoenix Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 30
Project Description: Add (1) non -food related sink in break room.
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 236 -4152 PHONE:
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Sink 06/28/2012 $25.02
Specifics: 1 ea Water Heater 06/28/2012 $37.52
1 12% State Surcharge - 06/28/2012 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment - 06/28/2012 $9.96
Plumbing
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: f,,
Call 503.639.4175 by 7:00 a.m. for the next available Insp: on 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
CE D l Oli (),,,,,.: ii.: OiNl,l
tl Y.� ived
City of Tigard Rec Dat / � Z Permit N y0 �/ _DD / (f3
a . 13125 SW Hall Blvd., Tigard, OR 972 ^^II G 8 2012 Plan Review
' 0 Phone: 503.718.2439 Fax: 503.598:)180 Date/By: � ` Other Permit ,eD /3L
Inspection Line: 503.639,4175 D ate Read B Ju ® See Page 2 for
TIGARD I Y Y :• g
Internet: www.tigard C ® Notified/Method: ' /' ( Supplemental Information
TYPE OF �VR l� stt� 1SiON FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
, Description I Qty. I .Ea. I Total
Addition/alteration/replacement ❑ 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 LOCATION Site utilities:
Job site address: / ). ,00 5 4 , 6 g‘...._ Ar4 4 / Catch basin or area drain 18.76
TtF r Drywell, leach line, or trench drain 18.76
City /State /Z1P:
S'�°j' on ` g ›j-)-Y Footing drain (no. linear ft.: ) Page 2 -
Suite/bldg. /apt. no.: - I Project name: Ape,,,0" Manufactured home utilities 50.03
Cross street/directions to job site: Manholes . 18.76
47‘e- !1-c -FS 7li crQ / as 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.: Backftow preyenter 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/ ', L/ Clothes washer 25:02
Ae(d I €r°9.4 Sri ' Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12:51
Name: A 7fy / - Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: ' / w S•
)� 3 - S So-ot� / "rZ� "/ Garbage disposal 25.02
City/State /ZIP: 1 - y5 .4 - on. 9 »a - L• Hose bib 25.02
Phone: (y-i ) x y V _ C ?co Fax: ( ) Ice; maker 12.51 •
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 '
Business name: Medical gas (value: $ ) Page 2
Dear ( ., /-/l e1../
Primer 12.51
Contact name: J
Roof drain (commercial) 12.51
Address: 7 e % /4'7c / Sink/basin/lavatory / 25:02 25) oL._
City/State /ZIP: ,'•7` . p/Z - Si 7 Solar units (potable water) 62.54.
Phone: ( S - = - 7 ) I Fax: : ({- ) )56 - --/ - 1, g Tub /shower /shower pan 12.51
E -mail: "28 G- 9"(Pc
Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater / 37.52 3 7
Business name:
Water P€/
r P m DWV 56.29
Address: Other: 25.02 '
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( )
Minimum permit fee: $72.50 32, . f
CCB Lie.: / .5 9/) Plumbing Lic. no.:16 - 71,t: PIS Plan review (25 % of permit fee)
State surcharge (12% of permit fee) 4' r 7d
Authorized signature /.1 TOTAL PERMIT FEE f ,
Print name: ,,,,LA Date: ( ).�. _� Z_ /if
permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
'Fee methodology set by Tri -County Building Industiy Service Board.
t7 r
.1 :\ Building \Permits\PLMU- PermitApp.d°c 10/01/09 440- 46I6T(IO /02/COM/WEB) :
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Scheduler Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l' 100' 50.03 0 to 2,000 $121.90
. Footing drain - each additional 100' _ 37.52 2,001 to 3,600 $169.69
Sewer - 1st 100' 62.54 3,601 to 7,200 "$233.20
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
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: '
$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
p . and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for thefirsf$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 indi 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.
Quantity 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
. Tub /S 12 New exterior plumbing site utilities for any complex structure
Bath - hower
Tub/S owerrlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ 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 'qua
4" lifications above.
.
Car Wash Drain - .
Garbage - Domestic. _
Disposal - Commercial - - '
- Industrial -- • Comments regarding fixture work:'
Ice MachiRefrig. Drains . ' • ,
Oil Separator (Gas Station) -
Rec., Vehicle Dump Station
•
Shower -Gang •
-Stall •
Sink Bar/Lavatory / . . .
,,tJ , - Bradley.
/ - Commercial *Note: If the fixture work under this permit results in an
t - 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
Water Extractor plumbing permit can be issued. . •
Water Closet - Toilet' . . _
Urinal •
Other Fixtures: . •
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