Permit n CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit# PLM2012 -00272
Date Issued 09/18/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S112AC01500
Jurisdiction Tigard
Site address 7319 SW KABLE LN 500
Project Quality Custom Distribution Services Inc Subdivision FANNO CREEK ACRE TRACTS Lot 23, PT 2
Project Description Rough -in and install (1) water closet, (1) lay, (1) 2" floor drain & (2) urinals
Contractor ADDISON PLUMBING LLC Owner PACIFIC REALTY ASSOCIATES
27425 S BEAVERCREEK RD ATTN N PIVEN
MULINO, OR 97042 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE 503 - 740 -8116 PHONE
FAX 503 - 632 -1168
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 09/18/2012 $25 02
Specifics 1 ea Primer 09/18/2012 $12 51
1 ea Lavatories 09/18/2012 $25 02
Type of Use COM 2 ea Urinal 09/18/2012 $50 04
Class of Work ALT 1 ea Water Closet 09/18/2012 $25 02
Type of Const 1 12% State Surcharge - 09/18/2012 $16 51
Occupancy Grp Plumbing
Stories
Total $154 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 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 dire suestion . OUNC • calling 503 232 1987 or 1 800 332 2344
Issue. By I I' I!/ , PermitteeSigna re
.//•
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 Application
RECEIVED OFFICE USE ONE)
City of Tigard Date/By cived j� ! �MI Permit No I t WW D/a — 002.7,2
14 i3 13125 SW Hall Blvd ,Tigard, OR 97223 1 8 212 Plan Review
Date
Phone 503 718 2439 Fax 503 598 1960 Other Permit No 6 ,04 ( 90/A -00/96
Inspection Line 503 639 4175
T I G A R D Internet www ti aril -or gov CITY OF *T Date Ready/By lung 63 See Page 2 for
g g llIG VISIOtV Notified/Method Supplemental Information
TYPE O li SY FEE* SCHEDULE
ID 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 It for each utility connection) -
CATEGORY OF CONSTRUCTION SFR (1) bath 312 70 l(
❑ 1- and 2- family dwelling {,� Commerciallindustnal SFR (2) bath 437 78
building SFR (3) bath 500 32
❑ Accessory
ry g ❑Multi -family
Each additional bath/krtchen 25 02
❑ Master builder ❑ Other Fire sprinkler (_ sq ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address •7 3 ( 9 54.1 f�a.6le 10›.-4- Catch basin or area drain 18 76
Drywell, leach line, or trench drain 18 76
City /State /ZIP -r 3ar,� de.
3 Footing drain (no linear ft _) Page 2
Suite/bldg /apt no cad I Project name Q c_1) 7e „AA.- '
w t �iw Manufactured home utilities 50 03
Cross street/directions to job site 4uotL /Ty d ieyrb %Jr5 -e/t6lgrrO1V Manholes 18 76
etQ, 4 0.1-6 / /JCe a. 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 a s_ 2 4Co /5-nc) Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12 51
Clothes washer 25 02
P- ,..s i ■ w1/4. $ i .-S +o .\ / ' Li C - I 1 /a..l t / / t) i Z G..�, ,,.0-1 Dishwasher 25 02
Drinking fountain 25 02
Ejectors /sump 25 02
la PROPERTY OWNER I 0 TENANT Expansion tank 12 51
Fixture /sewer cap 25 02
Name 1 ,0 c( ts.e«I 1 ASSa (Floor dram)loorsink/hub / 2502 QS,o?
Address 15'.;$ 'L c li Pkwy rX) Garbage disposal 25 02
City /State /ZIP (bei kj, OrZ- Hose bib 25 02
Phone (5o3 ) G 244 6 it to Fax ( ) Ice maker 12 51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
Business name Medical gas (value $ ) Page 2
Contact name Primer / 1251 /2,57
Roof drain (commercial) 12 51
Address Sink/basinfe ato ( 25 02 ab.(
City/State /ZIP Solar units (potable water) 62 54
Phone ( ) Fax ( ) Tub /shower /shower pan 12 51
E -mail Urinal . 25 02 ,:;..
CONTRACTOR Water closet / 25 02 f .0A
Water heater 37 52
Business name & i ;ct,„. Pi.> -k...- /.r9 Lt - ` Water piping/DW V 56 29
Address 2.74z. s- S• B 1 , eir-cAr -ee_1� �rc3 Other I 25 02
City/State /ZIP 11/4), pp 47ov-}z Subtotal /5 7h'/
Phone (S03 )6sL . fG 37 Fax (ca ) GYZ - /16$ Minimum permit fee $72 50 —^
CCB Lie /S(7 - i, 4(1 rl y Plumbing Lic no S - y.4.9 r fr.. Plan review (25% of permit fee) �'
State surcharge (12% of permit fee) !(OS/
Authonzed signature \ TOTAL PERMIT FEE "5ci. /2
Pnnt name 3 ci Q.Aao■ •Q Date 7 - 18 " (-7_ This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete
*Fee methodology set by Tn- County Building Industry Service Board
m
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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
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 thereof, 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
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040
- Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities
Drive tall ❑ 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 Dra sink i ❑ Isometric or riser diagram is required for new buildings
4 „ that meet the qualifications above
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach /Refrig Drains
Oil Separator (Gas Station)
Rec Vehicle Dump Station
Shower -Gang
-Stall
Sink -B. i ava o
- 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 I
Urinal Z
Other Fixtures
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