Permit CITY OF TIGARD PLUMBING PERMIT
B • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00344
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/26/2012
Parcel: 1 S 134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 400
Project: Spec Space Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: B
Project Description: (1) sink cap in breakroom
Contractor: JAMES ROOD PLUMBING INC Owner: ROBINSON, CONSTANCE A
125 S 1ST AVE #542 BY KILLIAN PACIFIC LLC
HILLSBORO, OR 97123 500 EAST BROADWAY, STE 110
VANCOUVER, WA 98660
PHONE: 503 - 648 -3907 PHONE:
FAX: 503 - 681 -2196
FEES
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 11/26/2012 $25.02
Specifics: 1 12% State Surcharge - 11/26/2012 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 11/26/2012 $47.48
Type of Use: COM 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.
Issued By: JA L At ��� Permittee Signature: � A PPLr C /�
� D&L
� �C.(Ail �
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 ApplicatiollECciur a
Building Fixtures !VC/
FOR OFFI LiSF ONLY
City of Tigard • NO V ' 2 6 2012 g iv: /4 f l a , s, P crmitN o. P ,i.o f -
13125 SW Hall Blvd., Tigard, OR 97223
Date/By v l ( iP Dpi ARD 1111 111 : �� Plan Revie
Phone: 503.7182439 Fax: 503.598. Other Penult No.:
D a t e JB y:
T I c; A [l T] inspection Line: 503.639 p� I f p g��
Internet: www.tigard- or.gov �7VI�Q � Notified See Page 2 for
o d �7 "iL So Soo .lemental Information
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❑ New construction ❑ Demolition For special information use checklist
Descriptio I Q ty. I Ea. I Tota]
rx Addition /alteration/replacement ❑ Other New 1- 2- family dwellings (includes 100 ft. for each utility connection)
1iF4 LiSstt` 6�s 7. lth ,t `. i, G !' . i '� i N�i'.r`, 1 t" ; 7 i = n� ; ! 1y � r+ :r 724:11%:! ri! i0 ', 1 , 4 3 , i SFR (I) bath 312.70
❑ 1- and 2- family dwelling IX Commercial /industrial SFR (2) bath 437.78
['Accessory building SFR (3) bath 500.32
❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) I Page 2
t_t a , ir .,. , _ sr� ><+u i '];;nii inl� a V454 n �'3S li 3 ' L �,t�t,'f t Site utilities: .
1 r ,? .tiG' . .-tiai!ErJSnst.t.t'cii.l±., :1stritrins L...: _ sw. ��1I il.. iiii,z .L
Job site address: 1 b / I s S w h I1'1 0 Catch basin or area drain 18.76
City /State/ZIP: Drywell, leach line, or trench drain 18.76
`'i - Footing drain (no. linear ft.: ) Page 2
ult ldg. /apt. no.: 5Db Project name: S q„ to S/Q a 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.:� 3 g^� Bacicf1ow preventer 31.27
'0. a .y. {11 g Il ` 2 l 1 tx iF '�iiiiglip l ;-` ): 0 r 1
5;, e I f�J n ) R H t 4 1 1 5 :'girl ° �.4 -R:4 l :7 1 �i 1 , ,r 1, t f° $ Backwater valve • 12.51
ii r .r , ,t/ "A.., ? {111r.H.C. r ,1,'. �.±-;: ,` -� . .. 11:'�.1 i..[ Lt ftglm l ;� e.W L,.S :W.: I ��iH. t:.ct
' Clothes washer 25.02
a p 1 b re0. A ii' .ail% Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
l
Ntl p i�f. rwl�y rf, v tR est i 6,rr t , 4g7p s7+ X } l
( N � fir 3, n 1 1, a V: ,1,} �, nin Z al't di i 'r l .k; ,r 1 I "si:. �k, Expansion tank ]2.51
1 kt' 3:1 , rue..,, &3'1� ."11'rfi�.,, ., . T .ar..,.,..a.ti;, :• , { 3l1 � :_i„l�#a. .,..LIr s. .
Name: Fixture /sewer cap 1 25.02 J S O Z
Floor drain /boor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
-
a ^s e.rYm i. •,YI1 Ci , .: n o , uC , .h , ' 1 11 ��- t� 4 11 l m� r s r'.7 1 . Illr t� g f wr z,;,, iK.l 7rAr�.��� t3;,� Ill
`fr44 " Tl.ii i i'It 2 it 9 . ,-f,.N Is '' l ' ' r [ d 1,i'T LIPR � ' intercepter /grease trap 25.02
� ` a{�TFin:l "n3JSliP .::.,:. -:r �x: , 3^it7i.....ti.�..Cr� t J t. ,.
Business name: Medical gas (value: $ ) Page 2
• Primer 12.51
Contact name:
Roof drain (conunercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State/ZiP: Solar units (potable water) 62.54
Phone: ( ) I Fax :: ( ) _ Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
t/Ti w # i J wt i f G, 41f i 1 'I t i M1 i � , ti u li ' t 1 t t{ ?' . r Water closet 25.02
'c: s �' ` � i , i + ' +�l�iF , tt 75 a i 1 11 Y 7 �(1�,I'� r �
:C 1� i'tI?RiiiliVrl e ilai.lfy.'..i,i; 41.^MI1 � . r:_f: A71 ?ff'T.. C,ta1 ::,il � iili i 9'taz 1 ' ^'` °',;ip ,{`,
Wetex heater 37.52
$usiness name: pi.p t 1 Water P tP in 8/p WV 56.29 ~
Address: /, S 5- /sue a # 5 Other. 25.02
City /State/Zip: f;/4 44OD pi,. i ' /2, 3 e Subtotal ? S0I,
Phone: (Tet) 4 .- 39 o`) Fax: (Sb j) 411.. .2, 04 Minimu permit fee: $72.50 7 . 50
CCB Lic.: / kW) O ) Plumbing Lie. no.: P/3 SS''� Plan r charg (25% of permit fee)
State surcharge (12% of permit fee) y 7 0
Authorized signature: ' / TOTAL PERMIT FEE 0 /• 7 .O
Print name' �t'� p � Date: / / /�f�� his pennant appilcad n expirre if a permit n not obtained within 180 days
/// afte it has been accepted a! complete
"Fee methodology set by Tri -County Building industry Service Board.
1:1 Bui !dinggPermits1PLMU- PermitApp.da 10/01/09 440- 4616T(M1OM2/COM/WEa)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: - Residential Fire Su • • cession S stems:
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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 $23320
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 S stems:
Water Service - each additional 100' 37.52 I r i 5s"•: pi' ,+'Tiff r e, 1 �, � f ^ � ? 7t -
v . r t, yli1 �'tt N r4 ;� m. v. - ? ,1- , , w kT r' +,.: ;:- : -
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
� .r. , ', 1 ui3s?7 If..4 fig �;;,F, -Fi a +,� � ' f ill. r, ' '• i, each additional $100.00 or fraction thereof, to
, A J :tl 4. ,mite B1c c` nynatmii a�:Y,r 3 b i. 1 . M'Ai11 i rmrs ...�, t..;. +.0 ¢ .1IIii :dlle.:.' 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 $120 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 ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
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2j ' r ° '' ` MYR n ' '. ..IN PO' �' � y .. �1 ,, i 14. Y om , � T 1l $� I . q .., ,'- Plan review is required for any of the following.
rl' 6 tres r ... ... .... .., , ..,.X.,l .:...:..>a Please check all that apply.
Baptistry/Font
Bath -Tub/Shower W ❑ Any new commercial building with water service 2" and
lacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thni ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic, ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918- 780 -0040-
Eye Wash
Floor Drain/sink - 2" Submit a sets of plans with any of the above.
..3^
- 4" I� i y1 a: . 1 ` ,ic' �� t W ell n i L r n , , i , L lo'1 , � ' :
. N
, 4
Car Wash Drain /1' "I� � - (11 � 6t., e( 5 9 y �Y, a rF
h(} 1 ,k0.as�lx;, . ,., �Tr-, '.r r,,h ,.,r L r i 1 11 a43:I.
Garbage - Domestic -non -food ❑ Isometric or riser diagram is require for new buildings
Disposal - Domestio-food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice MachiRefrig. Drains
Oil Separator (Gas Station) Comments rear g fixture work:
Rec. Vehicle Dump Station (C p 1 41.447 �$j Iy� i
. Shower -Gang - 9 '
- Stall
ink/Lav - Non -food related _
- Bradley
- Commercial -food related'
- Service 1
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer perlutit.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: \Users\jim1AppData \Local \Temp\PLMF- PermitApp.doc 2