Permit jill o Q CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 00210
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06!27/2013
Parcel: 2S101AD02400
Jurisdiction: TIGARD
Site address: 12753 SW 68TH AVE
Project: George Fox University Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Move (1) lay and install (1) new lay in 2nd floor women's restroom.
Contractor: OWNER Owner: GEORGE FOX UNIVERSITY
GEORGE FOX UNIVERSITY ATTN: FINANCIAL AFFAIRS
1101 N VILLA RD 414 N MERIDIAN
NEWBERG, OR 97132 NEWBERG, OR 97132
PHONE: 503 - 554 -2010 PHONE
FAX
FEES
Quantity Description Date Amount
2 ea Lavatories 06/27/2013 $50.04
Specifics: 1 12% State Surcharge - 06/27/2013 $8.70
Plumbing
Type of Use: COM 22 ea Minimum Fee Adjustment - 06/27/2013 $22.46
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 ou o follow the rules adopted by the Oregon
Utility Notific tInn Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 95 001-00!1. You may obtain a copy of the rules
or direc uestions to . NC b calling 503.232 1987 or 1.800.332.2344
Issue B y: S , 4 ' Permittee Signature: I ler ,k„.4
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 FOR OFFICE USE ONLY
City of Tigard DateBy 4 .27 / .. OS Permit No t /3 00,02 0
II . a 13125 SW Hall Blvd , Tigard,OR 97223 Plan Review OG
Phone • 503 718.2439 Fax. 503 598 1960 Date/By Other Permit No 6,,,e.,,..10-t9 f,sr)
T I GARD Inspection Line' 503.639 4175 Date Ready/By. Juris ® See Page 2 for
Internet www tigard -or gov Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty 1 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 12753 SW 68 Ave Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Portland Or 97223 Footing drain (no linear ft ) Page 2
Suite /bldg. /apt. no.: I Project name: Manufactured home utilities 50 03
Cross street/directions to job site: Manholes 18 76
highway 99 Rain drain connector 18 76
Sanitary sewer (no linear ft.. ) Page 2
Storm sewer (no linear ft 1 Page 2
Water service (no. linear It ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: of i) (6 ( Al7O,-400 Backtow preventer 31.27
Backwater valve 12 51
DESCRIPTION OF WORK
Clothes washer 25 02
lav addition ,r FL.LJa2 LA'_ 0 1 3 2 t'itoo Dishwasher
/ 1-4-L) 25 02
&C 1) t Q) t. Al ° '— /,L)57 k-t— (�) Ai ' Drinking fountain 25 02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Fixture /sewer cap 25 02
Name: george fox university
Floor drain /floor sink/hub 25 02
Address: 1101 N Villa Rd Garbage disposal 25 02
City /State /ZIP: Newberg Ore 97132 Hose bib 25 02
Phone: (503 )554 2009 Fax: ( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor /grease trap 25 02
Medical gas (value $ ) Page 2
Business name: george fox
Primer 12.51
Contact name. Dwayne Hood Roof drain (commercial) 12 51
Address: 1101 N Villa Rd Sink/basin/lavatory O`, 25 02
City /State /ZIP: Newberg Ore 97132 Solar units (potable water) 62 54
Phone: (503) 347 5563 Fax• : (503 ) 347 5563 Tub /shower /shower pan 12 51
Urinal 25 02
E - mail: DHood @georgefox.edu
Water closet 25.02
CONTRACTOR
Water heater 37 52
Business name: george fox Water piping/DWV 56 29
Address 1101 N Villa rd Other 25.02
City /State /ZIP: 97132 Subtotal
Phone: (503) 554 2010 Fax: (503) 554 2009 Minimum permit fee $72 50 7'1 , 50
Plan review (25% of permit fee) �
CCB Lic.: "kis Plumbing Lic no�9184�'(�
Authorized signature: 0,71 a of permit fee) G
. 7d
`, / � State surcharge (12% p - . � ti l Y TOTAL PERMIT FEE K/. a°
Print name Dwayne Hoo Date: 06/26/13
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
I \Buddmg\Permns\PLMU- PermitApp doc 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 - I S 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
each additional $100.00 or fraction thereof
(minimum charge — 1/2 hour)
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 * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Please check all that apply.
Baptistry/Font
Bath - Tub /Shower ❑ Any new commercial building with water service 2" and
- Jacuzzi /Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ 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 ❑ Any complex structure as defined in OAR918 -780 -0040.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
- 3"
Isometric or Riser Diagram
Car Wash Dram ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic non - food
Disposal - Domestic - food related that meet the qualifications above.
- Commercial —food related
- Industrial -food related
Ice Mach./Refrig Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec Vehicle Dump Station I}i Elf,WASt E. Ltd At 121rAK4'NIISTALI 2L&1
Shower -Gang A W.0)UHi y Aft: ►h' :1Z.�61E'` Avii NNI'r6
-Stall A - 1. ZW 11 4) 0 "( via. LAN/ 1 Lf
Smk/Lav - Non -food related I I �13
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit 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
http : / /www.tigard- or.gov /city_hall /departments /cd /docs/PLM F -Perm itApp2doc