Permit CITY OF TIGARD PLUMBING PERMIT
1 4 2 • COMMUNITY DEVELOPMENT Permit# PLM2012 -00273
Ti GARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued 09/19/2012
Parcel 2S101DCO3800
Jurisdiction Tigard
Site address 7190 SW SANDBURG ST 5
Project McCormack Properties TI Subdivision SALEM FREEWAY SUBDIVISION Lot 4
Project Description Reconfigure toilet room and breakroom Relocates only, no change in EDU's
Contractor DEAN WARREN PLUMBING & REMODELING INC Owner MCCORMACK PROPERTIES LP
PO BOX 14701 7190 SW SANDBURG ST
PORTLAND, OR 97293 TIGARD, OR 97223
PHONE 503 - 624 -4649
HONE 503 - 236 -4152
FAX 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 09/19/2012 $25 02
Specifics: 1 ea Primer 09/19/2012 $12 51
ea Sink 09/19/2012 $25 02
Type of Use COM 1 ea Lavatories 09/19/2012 $25 02
Class of Work ALT 1 ea Water Closet 09/19/2012 $25 02
Type of Const 1 ea Water Heater 09/19/2012 $37 52
Occupancy Grp 1 12% State Surcharge - 09/19/2012 $18 01
Stories Plumbing
Total $168 12
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 N. -lion - " -r Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or dir: questions to OU b g 503 232 1987 or 1 800 332 2344
Iss -d By / * Permittee Signature
kt
Call 503 639 4175 by 7 00 a m for the next available in • • ction date
This permit card shall be kept in a conspicuous place on the job site til completion of the project
Approved plans are required on the job site at the time of each inspection
Plumbing Permit Application
RECEIVED rolz or•r1cl: USE. o��L)
City of Tigard RECEI ' Received Permit No
14 is 13125 SW Hall Blvd , Tigard,OR 97223 Date/By 9 / 9�A L Q /g ooa ?3
0 Phone 503 718 2439 Fax 503 598 1S�0p 1 9 ) Date/By Other Permit No
l I G A R D Inspection Line 503 639 4175 Date Ready/By Juns VI See Page 2 for
Internet www tigard -or gov CT Y OFTIGARD Notified/Method Supplemental Information
TYPE OF 'MN DING DIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty I Ea I Total
( , 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 dwelling ❑ Commercial /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 -215' 0 S S a "db 5 S7--
Catch basin or area drain 18 76
City /State /ZIP
T ?..1- p Drywell, leach line, or trench drain 18 76
1'5 G - Footing drain (no linear ft ) Page 2
Suite/bldg /apt no Project name 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
A /r Clothes washer 25 02
'_ G co.-45 ca T ) //.-- f lo,, oc 04.-a i / Si< Dishwasher 25 02
Drinking fountain 25 02
Ejectors /sump 25 02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Name Fixture /sewer cap 25 02
Floor drain/floor sink/hub I 25 02 2 ,', o Z
Address
Garbage disposal 25 02
City /State /ZIP Hose bib 25 02
Phone ( ) Fax ( ) Ice maker 12 51
❑ APPLICANT ❑ CONTACT PERSON interceptor /grease trap 25 02
Business name 1 Y / /C�ra e(*-- / Medical gas (value $ ) Page 2
Contact name :3 A..) as Primer / 12 51 / 2. f - t
Roof drain (commercial) 12 51
Address P U 15 / y 7 o I Sink/basin/lavatory 2 25 02 ft/ c U
City /State /ZIP Po,-I/„2,4 ay/ _ 4 ? 3- 5'5 Solar units (potable water) 62 54
Phone (-. ) ) g c, - 19 8C Fax ((t." 3 ) 2 F c- s- 1/ Tub /shower /shower pan 12 51
E -mail Urinal 25 02
CONTRACTOR Water closet 1 25 02 2s. o Z
Water heater / 37 52 '3 7,J 2
Business name
Water piping/DW V 56 29
Address Other 25 02
City /State /ZIP Subtotal
Phone ( ) Fax ( ) Minimum permit fee $72 50
Plumbing Lic no Plan review (25% of permit fee)
CCB Lie
/ `r ii S/9 g 2 � 7 3 � ,7� State surcharge (12% of permit fee)
Authorized signature / /_ / 1 TOTAL PERMIT FEE if��e. /7
Print name 1 Y/ / � g L D This permit application expires if a permit is not obtained within 180 days
r�ji� / JcJ after it has been accepted as complete
*Fee methodology set by Tn -County Building Industry Service Board
I \Building\ PermitsWLMU- PermitApp doe 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 - 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
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62 54 $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
Q ty. Fee (ea) Total each additional $100 00 or fraction thereot, to
Other Inspections or Fees 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 ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following
accurately report fixtures could result in increased sewer fees * . 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 ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub /Shower as defined in OAR918- 780 -0040
- Jacuzzi/Whirlpool
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities
Dave Stall ❑ Any multipurpose fire sprinkler system
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 -780 -0040
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/smk - 2" ❑ Isometric or riser diagram is required for new buildings
3„ that meet the qualifications above
- 4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach /Refng Drains
Oil Separator (Gas Station)
Rec Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter 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