Permit •
. CITY OF TIGARD PLUMBING PERMIT
I N 3 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00071
- TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
Parcel: 2S110DC00500
Jurisdiction: Tigard
• Site address: 11455 SW SUMMERFIELD DR
Project: Schwindt Medical /Dental Office Subdivision: WILLOW -BROOK -FARM Lot: 17
Project Description: Site utilities for a new dental office. No water service on this permit.
•
Contractor: PHAIR CONSTRUCTION COMPANY Owner: CDBK PROPERTIES LLC
PO BOX 4722 11565 SW DURHAM RD BLDG F 100
SALEM, OR 97032 TIGARD, OR 97224 • •
PHONE: 503 - 545 -9583 PHONE:
FAX:
•
FEES •
•
Quantity ,Description Date Amount
1 ea Catch Basin or,Area Drain 06 /27/2012 $18.76
Specifics: 2 ea Rain Drain Connector 06/27/2012 $37.52
39 If Sewer Service . 06/27/2012 $62.54
Type of Use: COM 130 If Storm and Rain Drain 06/27/2012 $100.06
Class of Work: NEW 1 Plan Review 06/27/2012 $54.72
Type of Const: 5 ea Info Process /Archiving - Lg 06/27/2012 $10.00
•
Occupancy Grp: $2.00 (over 11x17)
Stories: 1 12% State Surcharge - 06/27/2012 $26:27
Plumbing
Total $309.87
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 B : '1 � o Permittee Signature:
C
? r
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.
•
•
Plumbing Permit Application
Site Utilities �10 FOR OFFICE USE ONLY
Received
City of Tigard Q? e Permit No.: /
n 131 SW Hall Blvd., Tigard, J7223 %NIL Date /By: 3� 1r L/n ...0 �7
' Plan Review ° iM Other Permit No.:
Phone: 503.718.2439 Fax: 503.598.0 y Date /By: , - __ ��
T I G A R D Inspection Line: 503.639.4175 't " G� Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov 6. OV 1: ♦ k /Y Notified/Method: 1r, Supplemental Information
TYPE OF WOO' � � FEE* SCHEDULE
❑ New construction emolition F 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
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
(1,1-15 JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 5W Summerfield Dr Catch basin or area drain I 18.76
Drywall, leach line, or trench drain 18.76
City /State /ZIP: Tigard Oregon, 97224
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Swhwindt Dental Office Manufactured home utilities 50.03
Cross street/directions to job site: SW Durham Rd Manholes 18.76
Rain drain connector 2 18.76 37.52
Sanitary sewer (no. linear ft.: 39) 2 Page 2 62.54
Storm sewer (no. linear ft.: 10) 2 Page 2 100.06
Water service (no. linear ft.: _ ) Page 2
Subdivision: I Lot no.: 500 Fixture or item:
Tax map /parcel no.: 2S1 W IODC Backflow preventer 31.27
DESCRIPTION OF WORK Bac water valve 12.51
Cloth- washer 1 25.02 25.02
Demolish existing building and construct new office. Construct parking lot,
Dishwas r 1 25.02 25.02
sidewalk, and swale. Drinking fo. ntain 25.
Ejectors/sump 02
J. 0 PROPERTY OWNER I ❑ TENANT Expansion tank 5., 12.51
Name: CDBK Properties LLC Fixture /sewer cap Q tT 25.02
Floor drain/floor sink/hu: 25.02 tv
Address: 11565 SW Durham Rd, Bldg F, Suite 100 V _
Garbage disposal 25.02
City /State /ZIP: Tigard OR 97219 Hose bib 25.02 It_V
Phone: (503)322 - 8450 Fax: ( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: KASA Architects Medical gas (value: $ 4,500) Page 2
Primer 12.51
Contact name: Kevin Saxton
Roof drain (commercia 12.51
Address: 4119 NE Cesar E Chavez Blvd Sink/basin/lavatory 11 25.02 275.22
City /State /ZIP: Portland, Oregon 97211 Solar units (pots. e water) 62.54
Phone: (503) 284 - 6917 Fax: : ( ) Tub /shower /s• war pan .51
E - mail: ksaxton @kasapdx.com Urinal 2 2
Water oset 2 25.0 50.04
CONTRACTOR
Wat. heater 37.5
Business name: Emmett - Phair Construction W. ter piping/DWV 56.29
Address: PO Box 4722 Other: 25.02
City /State /ZIP: Salem, Oregon 97032 Subtotal
Phone: (503) 545 - 9583 Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: 5•? y/�. Plumbing Lic. no.: _ Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: d A „ �[� TOTAL PERMIT FEE I
Print name: Kevin Sat n /(JV 1 � � Date: March 27, 2012 This permit application expires if a 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(10/02/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 - I' 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' I 62.54 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' 1 62.54 62.54 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 1 37.52 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 $1010,,000000.00.
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 * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Please check all that apply.
y
Baptistry/Font
Bath Tub /Shower ❑ Any new commercial building with water service 2"
- Jacuzzi /Whirlpool greater, except systems designed and st p d l}ydhen
Car Wash - Each Stall engineer.
- rive Thru ❑ New exterior plumbing site utilities anyomplek structure
Cuspidor /Water Asp ator " "�
Dishwasher Com ercial ® Medical gas and vacuum systems for health care facilities.
- Dourest • • ny mu tipurpose fire sprin er system.
Drinking Fountain ❑ Any complex structure as defined in OAR918 780 - 0040.
Eye Wash
Floor Drain/sink - 2" ' Submit 2 sets of plans with any of the above.
3„ Iic!inll
4 " I�r Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic- non -food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic -food related W r that meet the qualifications above.
- Commercial -food re .ted
- Industrial -food rel. ed ,
Ice Mach. /Refrig. Drains
Oil Se.arator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dum. Stati.,i`i --_
Shower -Gang -__
-Stall
Ele
Sink /Lav - Non -food related I
-Bra. ey
-Co mercial- food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes I
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet 2 1 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I: \KASA Projects Backup\201 1 \1105 Tigard Pediatric Dentist Office \D_C2des & Permitting \PLMU - PermitApp HHPR.doc