Permit - •
CITY OF TIGARD PLUMBING PERMIT
' a COMMUNITY DEVELOPMENT Permit#: PLM2010 -00003
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/06/2010
Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15875 SW 72ND AVE
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project: Spec Space
Project Description: Add (1) breakroom sink.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Sink 01/06/2010 $25.02
1 12% State Surcharge - 01/06/2010 $8.70
PHONE: 503 - 624 -6300 Plumbing
47 ea Minimum Fee Adjustment - 01/06/2010 $47.48
Contractor:
Plumbing
DEAN WARREN PLUMBING & REMODELING
INC
PO BOX 14701
PHONE: 503 - 236 -4152
FAX: 503- 296 -2218
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. am' l /� p
/
Issued By: �y G L /� 1 n Q n n Permittee Signature: /�� . _ 1C
Call 503.639.4175 by 7:00 a.m. for an inspection that b i ss day. `�' —
This permit card shall be kept in a conspicuous place on the job site un it completion of the project.
Approved plans are required on the job site at the time of each inspection.
1
Plumbing Permit Application
Building Fixtures RECEIV FOR OFFICE USE ONLY
CI Of TI and Received ' p (� t - OOO •
3
1111 City g ate i,/, /1 Permit No : 1 'U I 1 2 Q uvlT.
Y 13125 SW Hall Blvd., Tigard, OR 97223 JAN 0 6 201 ���LLL���"'
Ian Review
Phone: 503 639.4171 Fax: 503.598.1960 DateBy: Other Permit No.: rn10 g q -00li2
Inspection Line: 503.639.4175
T I G A R D CITY OF TIGAR�te Read /B lur' 63 See Page 2 for
Internet: www.t igard- or.gov edT4et T Supplemental Information
TYPE OF WORK BUILDING DIVISI�9 FEE* SC
❑ New construction ❑ Demolition For special information use check /is[
Description I Qty. I Ea. I Total
gl Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399 00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. fi) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / rJ' 7 y S , mil- gr., a- Catch basin or area drain 16.60
City /State /ZIP: r5 .),-f pi„ c 7 - 1 ))1-1 ,4± U Drvwell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
n Manufactured home utilities 110.00
Cross street/directions directions to job site: /d . 2./ . 5 -- 5 S, c, ..,_ ... Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
11 / DESCRIPTION OF WORK Backflow preventcr Page 2
m'c' el Ar' 4 ren,cl f / I Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
•
• ❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Pd r t-vsf Expansion tank 16.60
Address: / n . 5 - 0 5 4., Se5 / /O- - A �1-/ Fixture /sewer cap 16.60
City /State /ZIP: / ,( GL c) 7ZZ11 'Floor drain/floor sink/hub 16.60
Phone: (S ) �i�ii_ 6 3 0c , Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone:( ) Fax::( )
Sink/basin/lavatory 16.60 /C...&
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 1 ,, 0,47/0, Plt,415 DeQ.r y r QC / Water heater 16.60
Address: P. 0 , 6„,_ 7
1N0( Other:
City /State /ZIP: p�i on_ 715 3 Minimum permit fee $72.50
Phone: (re, ) 7$ 0 - 9 h b C Fax: (cc? ) ). 9 C- 21/ $ Residential backflow minimum permit fee: $36.25
CCB Lie.: Plumbin Lie. no.: Plan review (25% of permit fee)
/s'y9/9 g �6 -73ceo
Authorized signature: State surcharge (8% of permit fee)
/r, TOTAL PERMIT FEE ff l .26 _
Print name: cm. Aa. J Date: ) -6- 64 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Permits\PLMF- PcrmiIApp doc 12/27/06 440- 4616T(IO/02/COPt /WEB) l D . /^
1/ 0
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' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3.601 to 7,200 $220.00
Sewer - 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:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - 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 Back 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 Backflow 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 72.50 $50,001.00 and up $742.00 for he first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry /Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose tire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water 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 - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley *Note: If the fixture work under 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.\Building\Pc: mils \PLM.PermnApp doc 12/27/06
CITY OF TIGARDj PI0V2d-7/0 �/�
3
BUILDING DIVISION PERMIT #: aavU
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 !..ia''�iu�ii� L
l" ��
Inspection Requests (24 Hrs.): (503) 639 -4175 '=''.
INSPECTION WORKSHEET FOR DATE: 31Z�jd TIM : PAGE:
SITE ADDRESS: j$'P7 — 2a CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: Q
OWNER: 1 (�.1.� !�-� PHONE .:q C6 - a
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date f-- ® Pour Time:
Code # Inspection Description onfir • Contact # Message
"3g C plx.4....vt„,
Corrections /Comments /Instructions:
/D9 e ra b—r.<_6‘3,
PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
I I FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � Date: 3/ 6 Phone #: (503) 718 - �Z