Permit CITY OF TIGARD PLUMBING PERMIT
1111
s COMMUNITY DEVELOPMENT Permit #: PLM2012 -00122
T [GA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2012
Parcel: 25103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: Fowler Middle School Subdivision:)0 SUPPLEMENTAL PLAT NO.1: ANNE Lot: 7 -6
Project Description: Science classroom upgrades, add (4) emergency eye washes to existing sinks. Relocating (1) sink. No EDU
increase.
Contractor: CASCADE MECHANICAL SYSTEMS INC Owner: TIGARD - TUALATIN SCHOOL DISTRICT
PO BOX 399 ATTN: BONITA MAPLETHORPE
ESTACADA, OR 97023 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE 503 - 630 -4492
PHONE: 503 - 431 -4000
FAX: 503 - 630 -5510
FEES
Quantity Description Date Amount
100 Misc Other Fee 07/17/2012 $100.08
Specifics: 1 12% State Surcharge - 07/17/2012 $12.01
Plumbing
Type of Use: COM 1 ea Sink 07/17/2012 $25.02 '
Class of Work: ALT 0 12% State Surcharge - 07/17/2012 $3.00
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $140.11
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 NoJ ifira'.. 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 ' ct questions to a - : calling 503.232.1987 or 1.800.332.2344.
ssued By • 44,04_41-1_, .
P ermittee S • nature: AO I
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 Applicati
Building Fixtures ,
M AY 1 5 2012 Received Pa
go of Tigard Dat S / g Ix Permit No.: L.•[ go /42...rj01a7
a 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.S0L��OOF TIG?►RD Date/By: Other Permit No.:
T G A K D Inspection Line: 503.639 B DIVISION Date Ready/By: Juris: 65 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
10 Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) 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 R. Other: geiver 6, Fire sprinkler (___ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: `0 P 5 ` SGj) LW9 UT� Catch basin or area drain 18.76
•
City/State /ZIP: 7 �� 97 Z 3 Drywall, leach line, or trench drain 18.76
Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: I / Project name: POWLeg, t/ "0 L J Q(,b OOt Manufactured home utilities 50.03
Cross street/directions to job site: "��" 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.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
5C/L r"C,r /��� € �/ �, *26 Dishwasher 25.02
• .¢,D,o C4-� � - YG' ZG��I� Drinking fountain 25.02
c_e-) SWe Ejectors/sump 25.02
gl PROPERTY OWNER ❑ TENANT Expansion tank 12.51
U l . ame: MAW 7T 9 - n,�r� f' �/ 1O fcr Fixture /sewer cap 25.02
Address: ` ' T �/� Floor drain/floor sink/hub 25.02
�D96O d y, /g/ X �'� Garbage disposal 25.02
City/State /ZIP: '& p 9 Z 2 3 Hose bib 25.02
Phone: (5t5 3) 43 / - 4 OA" Fax: ( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor /grease trap 25.02
Business name: D�r - f 5/ 9 /e�� Medical gas (value: $ ) Page 2
� /� Primer 12.51
Contact name: /Slzz Z .9OY
12.51
/' Roof drain (commercial)
Address: 9G 3-4) � k $T Sink/basin/lavatory / 25.02 A509" 62.54
City /State /ZIP: / rz1/Up /D►4, 9 S ` Solar units (potable water)
� Phone: (S ) 2.2 c --& fi Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: �� //. rj „_ 7 ad Ja -' I2 pry ail+, Urinal 25.02
"" 6 ` ' ^ Water closet 25.02
CONTRACTOR <7317 Water heater 37.52
C( ' . Business name: Cqecro,A - t) L t 6y 5 rt./7,6 fix. • Water piping/DW V 56.29
Address: _ Other: F4 , 4 0- 60 .9.50,
L4 25.02 406, d 9 • City /State /ZIP: f, �►ITA.C. 4.-T) IVAi a � 1 Subtotal A,2,6 I
\ I: 3/ Phone: ( ) K 5 = ( ) --- Minimum permit fee: $72.50 •
CCB Lic.: /0.7 9, Plumbing Lic. no.: 4, '{t0 Plan review (25% of permit fee)
State surcharge (12% of permit fee) / � 0(
Authorized signature: TOTAL PERMIT FEE /q0,4
Print name: 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 Board.
1:\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' 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
Storm & Rain Drain - I st 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 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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ . Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
- Jacuzzi/Whirlpool
Car Wash: Each Stall ❑. New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918- 780 -0040. •
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for healthcare facilities. '
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. •
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
• - 3" Isometric or Riser Diagram
4 ' ❑ Isometric or riser diagram, is required for new buildings
-Car Wash Drain •
° Garbage Domestic non -food that meet the qualifications above
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice MachiRefrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station) '
Rec. Vehicle Dump Station : F
Shower: -Gang _ .
-Stall . • . . - - -
••. , Sink: . -LavBar non -food related ,
- - Bradley • , '
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
washer - Clothes fees assessed for the sewer increase must be paid before the
• Water Extractor
WaterCloset - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1: \Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
Jul. 11. 2012 3:03PM No. 8064 P. 1/2
Plumbing Permit Applicati P ECEIV p
I�Uft t;)PDIC:C 1!51: ONLY Building Fixtures JUL 1 1 2012 neecived �. �,_o�'� —��
City of Tigard Dele/ay:
lill
a 13125 SW Hall Blvd., Tigard, OR 9722 OF TIGARD other Permit No.:
la Phone: 503.639.4171 L
Inspection Line: 503.639.4175 8 DIVISIO Fax: 5o3•S � g .639.4175 Dale R _:., A lu� y RI See Page 2 far
- 16A ft n Internet www.Iigard-or.gov Sa piemeolel lnrormalion
'TYPE OP WORK FEE' SCHEDULE
•
• ' For s / eclat hiornielloirrrsechecklist
❑New construction Demolilion D eScri , lion Qt . Ea. Total
❑ Other: N ew 1- 2- family dwellings (includes 10011. for each utility connection)
1
CATEGORY i CONSTRUCTION
■ 11
r 1 ' 1
■ ■ Other: Page 2
4011 SITE 1NFOR1�tATION AND LOCATION
811c utilities
Job site address: a s, • 16.60
D D 16.60
Suite/bldg• /apt no.: Project name: Y iilr 110.00
Cross street/directions to job site: 16.60
r 16.60
• - 1[ • p r. 1. ►i i
r ` - • e s, as Iv � C :' � Page 2 J, Page 2 7 Sabiqny sewer (no, linear fl.: ,___)
Slbm. sorer (no. linear II: � g
4 + 1 �'� _ �" �t' • ` Wall! service (no. linear A.: Page 2 Subdivision: -
Fls[llre or Item
Tax map/parcel no.: A lion valve 16.60
Imo/HYMN OF e D; . ow premier Page 2
DaelkWater valve 16.60
Clothes washer _
Dish rasher 16.60
e _ fountain 16.60
PROPERTY owNER ❑ TENANT r 0
1 Expansion lank 16.60
s, _r
FiinJrelsewor cap 16.60
Flat/ drain/floor sink/hub 16.60
Fax: ( )
Garl age disposal 16.60
� 16.60
ID APPLICANT ❑CONTACT PERSON 16.60
ice taker Business name: 16.60
Contact name: czEr222TIMEM
Page 2
IMM IMM.1111 16.60
Roo 16.60
SinlJbasinfiavatory 1 L640- 5 1 ) - .
16.60
Uri al 16.60
CONTRACTOR 16.60
Ala er heater 16•60 r _ -
�. �" � —� Qlbl:r ��' t?1f�G ION 6. �� s_ _
Address: 1 J ..4, *. Subtotal
'� M inimum permitfcc. 572.50 l - 1- •
• F l ) tv /b Residential bar-know minimum permit fee: $3625 —
Phone: y e (, m� Plan review (25% of permit tie)
m Plumbing I.ic.no.: 6— 2�p • State stirctmargc(12 %of permit fee) 45,0it; .,
Authorized signature: ■ TOTAL PERMIT FEE Print name 1 4' / , ^ . .
f Dale: 7,..I I_` . In permit application expires If• permit is nisi oblaineu • . �mm r• r
I 1,80 days after i1 has been accepted as complete.
* .I a methodology se b ` untyBuilding Industry Service Guar.
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