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Permit CITY OF TIGARD PLUMBING PERMIT o • COMMUNITY DEVELOPMENT Permit 4: PLM2012 -00132 T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/11/2012 Parcel: 2S110DC00500 Jurisdiction: Tigard Site address: 11455 SW SUMMERFIELD DR Project: Schwindt Medical /Dental Office Subdivision: WILLOW- BROOK -FARM Lot: 17 Project Description: Medical gas Contractor: CASCADE PLUMBING CO Owner: CDBK PROPERTIES LLC 2416 N HAYDEN ISLAND DR 11565 SW DURHAM RD BLDG F 100 PORTLAND, OR 97217 TIGARD, OR 97224 PHONE: 503 - 289 -7095 PHONE: FAX: 503- 283 -9514 • FEES Quantity Description Date Amount 1 ea Medical Gas 07/11/2012 $339.46 Specifics: 1 Plan Review 07/11/2012 $84.87 1 12% State Surcharge - 07/11/2012 $40.74 Type of Use: COM Plumbing Class of Work: ALT • Type of Const: Occupancy Grp: Stories: Total $465.07 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 • work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility . 'cation Cen - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or d' - Ct questions to OUN 4 • calling 503.232.1987 or 1.800.332.2344: I -ued By: � Permittee Signatu 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 + ;�, old o0p ,0 Building Fixtures CEt'V�E� FOR OFFICE USE ONLY City of Tigard MAY 17 2012 Received �J ©�� w_,w� - q 13125 SW Hall Blvd.. Tigard, OR 972� y 11 �► d/ - C.U71� - Phone: 503.639.4171 Fax: 503.5 8.}}c9J�0 OFTIG }}D Date II /By: Plan Review 7 -./n �� / Other Permit No.: T I G n R D Inspection Line: 503.639.4175 BUILDING DIV ©N D ate Readyley: / lulls: 0 See Page 2 for Internet: www.tigard-or.gov Noti ed/Method: / �� Supplemental Information • TYPE OF WORK i' / ► Ao 1r34-. SCHEDULE ❑ New construction ❑ Demolition r speck use checklist. Description I Qty. I Ea. I Total ddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 ❑ I- and 2- family dwelling ,commercial /industrial SFR (2) bath 437.78 ❑ Accessory building ❑ Multi- family SFR (3) bath 500.32 ❑ Master builder Each additional bath/kitchen 25.02 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND. LOCATION Site utilities: Job site address: l 5' 5 sW Su ill me, ti.eA4 C D t atch basin or area drain 1 City /State / %IP: well, leach line, or trench drain 188.76 .76 l 1 (I � a, 0 12 Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: Project name: e. . Sep, wi nct-1" Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18 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.: Backflow preventer 31.27 /� DESCRIPTION OF WORK Backwater valve 12.51 �/ o7 i/o , oil l r. h rI ls l b a 1„ , , Clothes h e r 25.02 � - v�-+' l W t (J1 p4p4rua___ U (y[U LIJ�� Dishwasher 25.02 O . r� 9 �� Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Address: Floor drain /floor sink/hub 25.02 Garbage disposal 25.02 City /State/ZIP: Bose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON _ Interceptor /grease trap 25.02 Business name: CASCADE PLUMBING COMPANY Medical gas (value: $.i 4)4 Page 2 - 10.41r . Contact name: CRYSTAL JONES Primer 12.51 Roof drain (commercial) 12.51 Address: 2630 N. HAYDEN ISLAND DRIVE #3 Sink/basin/lavatory 25.02 • City /State /ZIP: PORTLAND, OR 97217 Solar units (potable water) 62.54 Phone: (503) 289 -7095 Fax: : (503) 283 -9514 Tub /shower /shower pan 12.51 E -mail: CASCADEPLUM @YAJIOO.COM Urinal 25.02 CONTRACTOR ' Water closet 25.02 • Water heater 37.52 • Business name: CASCADE PLUMBING COMPANY Waterpiping/DWV 56.29 Address: 2630 N. HAYDEN ISLAND DRIVE #3 Other: 25.02 4 0. City/State/ZIP: PORTLAND, OR 97217 Subtotal Phone: (503) 289 -7095 Fax: (503) 283 -9514 Minimum permit fee: $72.50 APPT CCB I.ic.: 120893 Plumbing Lic. no.: 34 -412PB Plan review (25 % of permit fee) Authorized signature: t State surcharge (12% of permit fee) 4061 PJ TOTAL PERMIT FEE Print name: CRYSTAL ON Date: 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 Boar I\Building \Permits \PLMU- PermitApp.doc 10/01/09 440 4616T( /OJCOM/WEB) i a 5�Ji ... Plumbing Permit Application - City of Tigard Page 2- Supplemental Information • Fee Schedule: Residential Fire Suppression Systems: Site Vtilitieti ..' -..:..,:-•,-: :•-•:•::: :".., ...::.....-' '..---' - :•'-:i' , 9! 3 ':::' Fee (eli , ' 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 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 addifional 100' 37.52 stomi& Rain Drain - 1st 100' 6234 $1.00 to $5,000.00 Minimum fee Sn30 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 :.! ;: 4 :,, , ,... :_.-:F•ecr(!lo - 70.,1, each additional $100.00 or fraction thereof, to and includini$10,000.00. Inspection of existing phunbing 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 $0,000.00. Inspections outside of normal business 90.00/In $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/In $50,001.00 and up $742.00 for the first $50,000.00 and $120 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 (Nanny by Fixture Type :.. Plitie. Retie* fOr•Pliiinbint Installations Elzture Type for Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Ba.ptistry/Font Please check all that apply. Bath - Tub/Shower 0 Any new commercial building with water service 2" and -Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall ' engineer. . -Drive Thru 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher - Commercial 'eLP-' - Medical gas and vacuum systems for health care facilities. - Domestic 0 Any multipurpose fire sprinkler system. Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit a sets of plans with any of the above: -3" .... Car Wash Drain . r; .s: • ' . : ISiinietrieor Riser•Diagram : • Garbage -Domestic-non-food R Isometric or riser diagram is required for new buildings Disposal -Domestic-food related , that meet the qualifications above. , -Commercit-food related -Industrial-food related Ice Mech./Retie,. Drains Oil Separator (Gas Station) • Comments regarding fixture work: Rec. Vehicle Dump Station . - r■ ,. Shower -Gang -Stall . Sink/Lav -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter . *Note: If the fixture work under this permit results in an Washer - Clothes Water Extractor increase of sewer EDT's, a sewer permit will be issued and water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: CAUsers\Randy \AppData\LocalMorosofti Windows \ Temporary Internet 121es\ContentOutlook\IC1XX3V971PLMF-PermitApp.doc .