Permit CITY OF TIGARD PLUMBING PERMIT
5 - COMMUNITY DEVELOPMENT Permit #: PLM2009 -00272
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2009
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15495 SW SEQUOIA PKWY 100
Subdivision: Lot: 0
Project: Columbia Soft
Project Description: Replace breakroom sink and install w /h.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300 9 d 12% State Surcharge - 09/30/2009 $8.70
PORTLAND, OR 97224 Plumbing (manual)
PHONE: 503 -624 -6300 73 da Additional Permit 09/30/2009 $72.50
Contractor:
PMSI LLC
21195 NW EVERGREEN PKWY #204
HILLSBORO, OR 97124
PHONE: 503 -466 -2222
FAX: 503- 466 -2211
•
Type of Use: COM
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: j i
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
•
• • Frbm: 09/28/2009 13:42 #034 P.001 /003
Plumbinz Permit Application RECEIVED
Building Fixtures SEP 2 9 2009 FOE OFFICE I. SE O\L1
City of Tigard IP 4 Permit No.: Pt n,1200 0 i . 0 0 o z:
13125 SW Hall Blvd, Tigard, OR 97223 CITY OF TIGARD Plan Review
' - Phone:. 503.639.4171 Far .&1
503s98 LD1NG DIVISIO. Other _
TIC A R D Inspection Line: 503.639.4175 Br a See l'agezror
Internet wwwird- or.gov , Noafad/Method: 1 i suppbmenta Information
TYPE OF WORK • FEE* SCHEDULE
❑ New construction ❑ Demolition For special information are checklist
® Addition/alteration/replacement ❑ Other.
Description I Qtv. ) Ea. I Total
� l h New 1- 2-family dwellings (nidudes 100 R for each utility connection)
. CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
❑ 1- and 2 -family dwelling ® Commercialfmdustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
El Master builder Other Each additional bat /kitchen 45.00
Fire sprinkler (_ sq. it) Page 2
. JOB SITE INFORMATION AND LOCATION • Site trinities
Job site address: 15495 SW Sequoia Pkwy Catch basin or area drain 16.60
City/State/ZIP: Portland, OR 97224 Drywell, leach line, or trench drain 16.60
Suite/bldgiapt no.: 100 I project name: CobmrbiaSoft Footing drain (no_ linear R: _J Page 2
. Manufactured home utilities 110.00
Cross street/directions to job site: 16.60
Manholes Rain drain contactor 16.60
Sanitary sewer (no. linear R: __) Page 2
■
• Storm sewer (no. linear R: ) Page 2
Subdivision Lot Water service (no. linear R: ) Page 2
•
Tax map/parcel no.: Fixture or Item
Absorption valve 16.60
DFSCRIPZION OF WORK Badhtlow pm- venter Page 2
Replace break sink and install water heater Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinki
:: ❑ PROPERTY ; OWNER I ❑ TENANT • S fountain 16.60 .
Ejectors/sump 16.60
Name
Expansion tank 16.60
Address: Fixture/sewn cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60 •
'Phone: ( ) • I Fax: ( ) .. 16.60 .
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name:
Interceptor/grease trap 16.60
Contact name: Medical gas (value. 1 ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof dram (commercial) 16.60
Phone: ( ) Fax : ( )
Sink/basin/lavatory 1 16.60 16.60
7
E-mail: ublahowe lshower pan 16.60
Urinal • 16.60
CONTRACTOR Water closet 16.60
Business name: PMSI LLC Water heater 1 16.60 16.60
Address: 21195 NW Evergreen Pkwy Suite 204 Other.
City/State/ZIP: Hillsboro, OR 97124 Subtotal
Minimum permit fee: $72.50
Phone: (503) 466 -2222 Fax ( 503) 466 -2211 Residential baddlow minimum permit fee: $36.25
CCB Lie.: 158286 Plumbing Lic. no.: 34-434PB Plan review (25% of permit fee)
Authorized signature: State surcharge (12% of permit fee) 8.70
TOTAL PERMIT FEE 81.20
Print name: Lanell Robinson I Date: 9/25/09 ( This permit application expires We permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri.Connty Buidmg Industry Service Board.
L lMF-Pareileop.doo 12/27/06 440 MTh 0102/COM/WEB)
R ut_ SS t 0 S)-e rS 1 r .
•� Frbm: 09/28/2009 13:42 #034 P.002/003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • WY* Fee (r Tom Square Footage: Permit Fee:
Footing drain -1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 4640 2,001 to 3,600 $160.00
Sewer 3,601 to 7,200 $220.00
ewer -1st 100' 55.00
7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Swan 8 Rain Drain -1st loo• 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Dram - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof to and
including $10,000.00.
Commercial Bads Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Beddow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 7230 $50,001.00 and up $742.00 for the fast $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Qiumfitx by (Pixtu e) work Performed greater, excel systems designed and stamped by licensed
Fixture
Previous Capped . added E Replace engineer.
diting ❑ New exterior plumbing site utilities for any complex structure
Bapti.stry/Fent as defined in OAR.918 -780 -0040.
Bath - Tu&Shower ❑ Medical gas and vacuum systems for health care facilities.
Pool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918 -780 -0040.
-Drive Thm •
CuspidorlWrder Aspirator Submit 2 sets of plans with any of the above.
Dishwasher -Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2° that meet the qualifications above.
- 3"
- 4^
Car Wash Drain
Garbage -mac Comments regarding fixture work:
Disposal -Commercial
-Inds
Ice MachfRefrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -fang
- Stall
Sink -Bar/Lavatory 1
- Bradley *Note: If the fixture work snider this permit results in an
- commercial increase of sewer EDUs, a sewer permit will be issued and
-Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:1&u'1 1Pe®biP1.M- Per®tApp.doo 12!27/06