Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00249
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/27/2012
Parcel: 2S112DD00701
Jurisdiction: Tigard
Site address: 15808 SW UPPER BOONES FERRY RD
Project: Lamar Company Subdivision: 1994 -006 PARTITION PLAT Lot: 2
Project Description: Reset (1) lay and replace (1) water closet
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY TRUST
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 236 -4152 PHONE:
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Lavatories 08/27/2012 $25.02
Specifics: 1 ea Water Closet 08/27/2012 $25.02
1 12% State Surcharge - 08/27/2012 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment - 08/27/2012 $22.46
Type of Const: Plumbing
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.
Issued By: . � `��` Permittee Signature: / /
Call 503.639.4175 by 7:00 a.m. for the next available ' spection 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
R eceived
UPI City of Tigard y j�7 42 Permit Noh,i _ de, li,9
0 13125 SW Hall Blvd., Tigard,OR 97223 Pla R
C Ph one: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No $(�/�a0/ s'
D a t e/By: o? -eQ / e
Inspection Line: 503.639.4175 Date Ready/By: ,m ® See Pa e 2 for
I' I G n K D Internet: www.tigard -or.gov Notified/Method: / �� Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklisx
Description I Qty. I Ea. I Total
1S 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 dwellingommercial/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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / Q / Catch basin or area drain 18.76
J`� 8 S u, t✓i �omel grip r
City/State /ZIP: f ',/ / Drywell, leach line, or trench drain 18.76
7�1Y°L �' S )2 `�/ Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: I Project name: 1....,,),,ac2f 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
Ae Se f - / , i - e Lr -- / - C•.-(._ Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Pc r Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 16- 3 ser ( (!. Seylior y�,, / ‘,ay Garbage disposal 25.02
City /State /ZIP: 0 / -9 S' )..1r Hose bib 25.02
Phone: ( ,3) G 2.-k/ --C 3'Q Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
_ Medical gas (value: $ ) Page 2
Business name: `n �1 k ,, +��` y44, 4, e_e (
Primer 12.51
Contact name:, Roof drain (commercial) 12.51
Address: r,62._ r,62._ R a� I 4 x I Sink/bas veto � I 25.02 .2
City /State /ZIP: P 1-- Oft_ 9) 2.9) Solar units (potable water) 62.54
Phone: (5-er3) 720 _ cj y 8 G Fax: : (g^-3) 1 54 _ 1 s,q Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet / 25.02 5 �
2 OL
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal U tf _
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 72, 5o
CCB Lic.: / S/ / Plumbing Lic. no.: _6'- Plan review (25% of permit fee)
�z, State surcharge (12% of permit fee) p, 70
Authorized signature � TOTAL PERMIT FEE d', as
ay I Date: 7 _ L This permit application expires if a permit is not obtained within 180 days
Print name: 3c.,€ R
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 - 1st 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 replacin fixtures? I s ", Plan Review for Plumbing Installations
please indicate work performed fixture. Failure to Plan review is required for any of the following.
accurately report fixtures &A id result in increased sewer s * . Please check all that apply.
,Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: / Replace greater, except systems designed and stamped by licensed
/ Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower
of \ as defined in OAR9I8- 780 -0040.
Car Wash Each Stall `0 Medical gas and vacuum systems for health care facilities.
Drive tall 0 Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator 0 Any complex structure as defined in OAR918 -780 -0040.
Dishwasher - Commercial
Doomestic Submit 2 sets of plans with any of the above.
Drinking Fountain f
Eye Wash / Isometric or Riser Diagram
Floor Drain/sink - 2" ❑I Isometric or riser diagram is required for new buildings
I that meet the qualifications above.
4 "
Car Wash Drain
Garbage - Domestic s
Disposal - Commercial
- Industrial C mments regarding fixture work:
Ice Mach./Refrid. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
/
Shower -Gang -
- Stall _
Sink B avatory
-Bra
- Com ercial *Note: If the fixture work under this permit results in an
- Servile increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool FilOe fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLM - PermitApp.doc 2
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00249
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/27/2012
Parcel: 2S112DD00701
Jurisdiction: Tigard
Site address: 15808 SW UPPER BOONES FERRY RD
Project: Lamar Company Subdivision: 1994 -006 PARTITION PLAT Lot: 2
Project Description: Reset (1) lay and replace (1) water closet
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY TRUST
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 236 -4152 PHONE:
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Lavatories 08/27/2012 $25.02
Specifics: 1 ea Water Closet 08/27/2012 $25.02
1 12% State Surcharge - 08/27/2012 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment - 08/27/2012 $22.46
Type of Const: Plumbing
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.
Issued By: . � `��` Permittee Signature: / /
Call 503.639.4175 by 7:00 a.m. for the next available ' spection 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.