Permit CITY OF TIGARD PLUMBING PERMIT
•
: COMMUNITY DEVELOPMENT Permit #: PLM2013 -00142
1 3125 SW H all Blvd., Ti Date Issued: 05/07/2013
Tigard OR 97223 503 718.2439
TFGARD 9
Parcel: 2S 113AD01900
Jurisdiction: Tigard
Site address: 16640 SW 72ND AVE B10
Project: Veris Industries Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Cap (1) RP device
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 ATTN. N PIVEN
PORTLAND, OR 97293 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
P
PHONE: 503 - 624 -6300
PHONE: 503 - 236 -4152
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 05/07/2013 $25.02
Specifics: 1 12% State Surcharge - 05/07/2013 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 05/07/2013 $47 48
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 ' . Ica ion = Ater Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or rect questions to OU • by calling 503.232.1987 or 1 800 332 2344.
1 ued By: / / Permittee Signature:
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
Building Fixtures RECEIVED
City of Tigard Received Date/By 5- 7 3 Permit No: t_17: 3- 00 ,z,
v 1 3125 SW Hall Blvd., Tigard, OR 97223 nn Plan Review
1114 I . Phone: 503.718.2439 Fax: 503 598 19 6Oi AY O 7 2013
3 Date/By Other Permit No
T I G A R D Inspection Line: 503 639.4175 Date Ready/By tuns ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARDs� Notified/Method Supplemental Information
wow OF G 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: ( (.Q (Q {O (., R- ZI'.)--° Catch basin or area drain 18.76
Drywell, leach line, or trench drain
City /State /ZIP: 71 0 2 c -za(A D
Footing drain (no. linear ft.' ) Page age 2 2
Suite/bldg. /apt.no.: I Project name: Ueri5 13es'- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
�� CDC Rain drain connector 18.76
`,�� ��'� h 1p 1 n � DC _ � w � T" num.)
Sanitary sewer (no. linear ft.. ) Page 2
000 Z OK) `3 t� C 'E_ Kt-` Storm sewer (no. linear ft.• ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
(� Clothes washer 25.02
ea p R, P oc-)'�- -A- OGt� Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Vf}L - TR.l1�S`� Fixture /sewer cap 25.02
Address: 1 5 350 5w S a ,0 I Floor ge disposal sink/hub 25.02
- _-1 ��11 Garbage disposal 25.02
City /State /ZIP: -,---,,,,w,0 , d Q 0 1.9-D., � -\ Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12 51
9 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: 0e3 LAi+�-FE� 0,0„.btu Medical gas (value: $ ) Page 2
Contact name: ` Primer 12.51
Address: ��
��� Roof drain (commercial) 12.51
Li - 3 36 \ Sink/basin/lavatory 25.02
City/State /ZIP: Pb on-pt 02_ 9?-Aq 9?-A 3 Solar units (potable water) 62.54
Phone: (51j3) TN - CtL Lp Fax:: ( ) _ Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: G A 3 (j..) R,(, cr.) )IVJ b1IJ_ Water piping/DWV 56.29
Address: Po �k ) L. { -9.. 0k t � Other. 25.02
City/State /ZIP: PQ,v-rj„, ) g Ab 1- q -*aC�`3 Subtotal
Phone: (533) 1 AO ett-g C Fax: ( ) Minimum permit fee: $72.50
149 t9 Plumbing �'7�_ 73 1;fj Plan review (25% of permit fee)
CCB Lie.:
5 Plumbin Lic. no.: odC ll
State surcharge (12% of permit fee)
Authorized signature C TOTAL PERMIT FEE
Print name: Co � Date: This permit appli expires if a permit is not obtained within 180 days
R ( C I - it IL r 5- - 7 - 1 72_ after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
1 \Building\Permits'PLMU- PermuApp 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 - 1 100' 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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100 00 or fraction thereof, to
l� 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 ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath. - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR9I8- 780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink. - 2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
- Car Wash Drain
Garbage Domestic non - food that meet the qualifications above.
Disposal - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink: - Lav/Bar non -food related
- Bradley
- Com/Serv/Utd food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I: \ Building \Permits\PLMF- PermitApp.doc 08/04/2011 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16640 SW 72ND AVE B10, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
05/30/2013 00:00
PLM2013-00142
PASS - No C of O
1/2" RP Cap-off ok
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16640 SW 72ND AVE B10, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
05/30/2013 00:00
PLM2013-00142
PASS - No C of O
1/2" RP Cap-off ok
Violation Summary:
Inspector Contractor