Permit CITY OF TIGARD PLUMBING PERMIT
II II
a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00219
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/02/2012
Parcel: 2S113AC00101
Jurisdiction: TIGARD
Site address: 16655 SW 72ND AVE 400
Project: Microlnterconnects Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 37
Project Description: Relocate breakroom (1) sink
Contractor: CASCADE PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES LP
2416 N HAYDEN ISLAND DR ATTN: N PIVEN
PORTLAND, OR 97217 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 289 -7095 PHONE:
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Sink 08/02/2012 $25.02
Specifics: 1 12% State Surcharge - 08/02/2012 $8.70
. Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 08/02/2012 $47.48
Plumbing
Class of Work: ALT
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. �r
Issued By: e � Permittee Signature: Q IQ ,4PP� cievr1 Q
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.
•
Plun Per mit APIlicaticRE E D
Building Fixtures
City of Tigard A Y r i n 1 2012 Received
13125 SW Hall Blvd.. Tigard OR 9 _ Dare/By: 91 Z i Z Permit No.: I D ( „b 1 2013...- 00- l
Phone; 503.639.4171 Fax. 503.5% J, OFTIGARD D a n By: Other Permit No8 o /a _ oo1 4,3
eciion Line; 503.639.4175 �� rr' DIVISION 1��
Date/By:
•ri(3A Inspection UCDIVISI ®N DateR
Internet: www.tigard -or.gov BUl><.� Ready/By: J t3 SeePage2
e rod
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.:. _ nk:; :rg Ol�`,�X3104, -. :. of f S pleme °tat laferm a
1EE•, :SCHEDULE
d New construction ❑ Demolition For - al In motion use checklist
ddition/altcration/replacement Ocscri lion Qty. Ea Total
Other: New 1 2- family dwetli , ; s (includes 100 ft. for each utility connection)
" • `CATEGORY .OF SFR (1) bath _ 312.70
❑ 1- and 2-family dwelling ommerciealrndustrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 50032
❑ Master builder - Each additional batl lkitchen 25.02
0 Other Fire sprinkler ( sq. ft) JOB Page 2
.` g
5i I'E: ;1{1H�'ORMATIQIY �D I.00A.TION • Site utilities: _
Job site address:
..021.1 , ...021.1 ii _ P� 1 T/J Catch basin or area drain _ 18.76
Cily /StatcZIP: 9 1 � +r �• DrywelL leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name: i aD , 113, Lnt7Q0 JS M anufactured home utilities
lY 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: _., J Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no. Fixture or item
Ta. map/parcel ap/parcel no.: Backflow preventer 31.27
.
•
Backwater valve • pp.SR[ONlr ' WORK . . 12.51
!/ 4 I _i......'.. 6J _ .. ..&• • as _ 'ilk- Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25 "02
; PROPERTY -O ![WNE . • • •• : Q" TENANT Expansion tank
1251
Name: Fixture/sewer cap 25.02
Address: Floor drain/fioorsink /hub 25.02
City /State/VP: Garbage disposal 25.02
Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51 • : :d APPLICANT .. , . 0 C01V' 40.: *P-ERSON. Interceptor /grease trap 25.02
- Business name: CASCADE PLUMBING COMPANY Medical gas (value: $ ) Page 2
Contact name: CRYSTAL JONES Primer 12.51
_Roof drain (commercial) 12.51
Address: 2630 N. HAYDEN ISLAND DRIVE #3 _ Sink/basin/lavatory I 25.02 r b
Ci(y /State2IP: PORTLAND, OR 97217
•
Solar units (potable water) 62.54
Phone: (503) 289.7095 I ` ax: (503) 283 -9514 Tub /shower /shower pan 12.51
t
E -mail: CASCADEPLIIM@YAHOp.COM Urinal 25.02
G`4yNI'Ri#CftSR ' Water closet _ 25.02
Water heater 37.52
Business name: CASCADE PLUMBING COMPANY
• Water piping/DWV 56.29
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Other: 25 "02
City /State/ZIP: PORTLAND, OR 97217 _ Subtotal
ne: (503) 289 -7095 (503) 283.9314 _ Minimum permit fee: $72.50 72,56
✓ CCB Lic.: 120893 Plumbing Lie. no.: 34 -412PB Plan review (25% of permit fee)
State surcharge ((2% of permit fee) o
Authorized signature: ,�,/a �} �a
�t (J'`�C 2.~ TOTAL PERMIT FEE i t 1, 10
[Print name: CRYSTAL J ES D ata: Tht permit application expires if a permit is not obtained within 180 days
L
after it has been accepted as complete.
I c S G FAX pe J�C FA e I J M 7 a `Fee methodology set by Tri -County Building Industry Service Board.
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Plumbing Permit Application -. City of Tigard
Page 2 - Supplemental Information
Fee stems:
l
Schedue: _ Residential Fire ore Suppression Systems:
' =i . °e "•'mil su > .z ,.
. .pootutgdrair -1 °100' I z. ,..w ,.� :?�► -• _ - @��• ^ :'i$`.`�.Aerd�.�` �:�y��;�� - • _ , ,.. ......
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 700 s233.20
7 .201 and greaser $327.54
Sewer.
each additional 100' 37.52
Water Service - 1st 100' 62.54
Water Service _ each additional lam Medical Gas S stems:
37.52 ,,.p
Storm & Rain Dram - I st 100' 62.54 y;:,,4�;:,, . :,e - ..x'6 .,
Storm & Rain Drain - each additional 100' S 1.00 to $5,000.00 Minimum fee $72.50
5;151, 37.52 $5,001.00 to $10,000.00 $72.50 fbr the Erse , `0$5 000 0 and 51.52 for
', 6 i • , ..,,,,,11.:„1 s:. � ` L ?'- v� ° , � e� (raj ' each additional $100.00 or faction thereof, to
.e,... and including 510,000,00.
Inspection of existing ing �m, � $10.001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is 90.00/hr
(minimum e . _ : _ -12 hour) each additional 5100.00 or fraction thereof, to
Inspections outside of normal business 90 00 and . $25.000-00.
hours (minimum c • •: _ e - 2 hours 525,001.00 to 550,000.00 5379.50 for the fast $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof to
Reinspedion Fees 90A0/hr
_ and including $50,000.00.
Additional plan review for revisions 90.00/br 550,001.00 and up $742.00 for the first $50,000.00 and $110 for
(minimum c • . : e -12 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 resort fixtures could result in increased sewer fees *.
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r,. " . ;; '..... • • ;.. a Momma, ,, a te w - s
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°'GVoi�lt'Pdt ornae& f ..:° .;'t+t f it f ! camp 1 Plan review for any f the following
. t�. -. �.:. A�ee. ;_ " , is required f y o
Baptistry/Font Please check all that apply.
Bath - Tub/Shower ❑ Any new commercial building with water service 2" and
dactmd/Wh,irlpool greater, except systems designed and stamped by licensed
Car Wash - Each Stall engineer.
- Drive T ru 0 New exterior plumbing site utilities for any complex structure
Cus�idor/Water Aspirator as defined in OAR918- 780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in 0A1t918 -780 -0040.
Eye Wash
Floor Drain/sink - 2,. Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain wno . -
'.�-�.. . Ise ..`C': / ��... ',. •
:ts4 "''.:.. k yN Yy .F..
Garbage - Domestic -non -food _ Isometric or riser diagram is required for new buildings
Disposal - Domestic - food related that meet the qualifications above.
-Commercial-food related
- Industrial -food related
Ice Maeh/Refiig. Drains
Oil Separator' (Gas Station) Comments regarding fixture work:
Rea Vehicle Dump Station
Shower -Gang
-Stall
Sink/lav -Non -food related 1
- Bradley '
- Commercial- food related
- Service '
Swimming Pool Rte.
washer - clothes *Note: If the future work under this permit results in an
water Extractor increase of sewer EDUs, 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:
C :1Docurnents and Settings\Cascade PlumbinglMy Documents \Downloadgpl,MU- PermitApp.doc
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08/01/2012 11:15
=== COVER PAGE = ==
TO:
FROM: CASCADE
FAX: 5032839514
TEL:
COMMENT: