Permit CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit #: PLM2013 -00198
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/24/2013
Parcel: 1S 136DA00100
Jurisdiction: Tigard
Site address: 11308 SW 68TH PKWY
Project: Comcast Tech Ops West Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: Replace (1) catch basin and install (1) additional catch basin.
Contractor: LEASE CRUTCHER LEWIS Owner: BENENSON 68TH PARKWAY KEY LLC, T
550 SW 12TH AVENUE BY PROVIDENCE HEALTH SYSTEM
PORTLAND, OR 97205 ATTN: PROPERTY MANAGEMENT
1235 NE 47TH STE 160
PORTLAND, OR 97213
PHONE 503 - 223 -0500 PHONE:
FAX: 503 - 223 -2874
FEES
Quantity Description Date Amount
2 ea Catch Basin or Area Drain 06/24/2013 $37 52
Specifics: 1 12% State Surcharge - 06/24/2013 $8 70
Plumbing
Type of Use: COM 35 ea Minimum Fee Adjustment - 06/24/2013 $34 98
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 rul- adop •d by the Oregon
Utility Notif . - • - r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. Yo %ai . .py of the rules
or direc suestions to OUN .y ' g 503.232.1987 or 1.800.332.2344
Issue. By: Permittee Signature: j3�
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
Site Utilities RECEIVED / ,.-0,z Dine[: lisi: ()Nix
City of Tigard Rece /By [� / Permit No.: 4 AD /3 •�!ff.
a 13125 SW Hall Blvd., Tigard,OR 9722A I 2 4 2013 Plan Review
C Phone: 503.718.2439 Fax • 503.598.)9`60 Date/By Other Permit No.
T I G n R D Inspection Line. 503.639.4175 CITY OFTIGARD Date Ready/By inns El See Page 2 for
Internet www.tlgard or.gov Notified/Method Supplemental Information
TYPE OF »JDING DIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea I Total
❑ Addition/alteration/replacement ❑ Other: New I- 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: 1 #E �JV� C� n(14-17 Catch basin or area drain 18.76
City /State /ZIP: �(A� '7220 Footing drain line, trench drain ag 2
1 � �� Footing dram (no. linear ft • ) Page 2
Suite/bldg. /apt. no.: I Project name: c,G' t T Ira (.3 )ts/ 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.: Backflow preventer 31.27
`•,DESCRIPTION OF WORK `i Backwater valve 12.51
,�rA 1.'�� $� �+� r � ' I Clothes washer 25.02
t�� -'sT� I N) t d-- r V F (fE �-�✓nJ,vl IO 1� 1 Dishwasher 25 02
OroRM GEVJ(� 1ER Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPER OW NER ❑ TENANT Expansion tank 12.51
Name: � j� f� ` �" L-L /' Fixture /sewer cap 25.02
r`" `} �� E b +-° V Floor drain floor sink/hub 25 02
Address: I 41t;
Garbage disposal 25.02
City /State /ZIP: 1pi t L Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
Business name: � M. � },� j, Medical gas (value. $ ) Page 2
Contact name: / r ` t • I ` N Primer 12 51
19:11- Roof drain (commercial) 12.51
*_�
Address: { ✓�D Sink/basin/lavatory 25.02
f
City /State /ZIP: TTL ►D) 120 b Solar units (potable water) 62.54
Phone: '23 - I Fax:: ( ) Tub /shower /shower pan 12 51
E -mail: r,. ,6OTT• j ( 1 1 W1S1301.- DSuGaf i Urinal 25.02
Water closet 25 02
CONTRACTOR
�p� ,.��� ( i Water heater 37.52
Business name: �� C) `U 1�--i� 1+ ,' Water piping/DW V 56 29
Address: I ize A.,\". Other: 25.02
City /State /ZIP: CVIV*1) BO ' — Subtotal
Phone: M3 . .Q ) Fax: • xj 4 Minimum permit fee: $72.50 2 .60
Plan review (25% of permit fee)
CCB Lie.: 1� P i . ing . no.:
State surcharge (12% of permit fee) Fr. 7v
■ Authorized signature: p/' TOTAL PERMIT FEE
Print name: 0{-1.(
■ ` I N Date: CO . 24 . 1".1 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
I \Budding\Permits\PLMU- PermitApp doc 10/01/09 440-46 1 6T( 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 & Ram Drain - 1st 100' 62 54
$1.00 to $5,000 00 Minimum fee $72.50
Storm & Ram 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
P 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
Quantity by Fixture Type • Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following. Performed: Capped Added Relocate q y g'
Baptistry/Font Please check all that apply.
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 s
diagram is required for new buildings - Domestic non - food g q g
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach /Refng Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial- food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures.
I: \Building\Permits\PLMU- PermitApp.doc 2
Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
T.IGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS - Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
1.\ Building\Permits\PLMF- PertnitApp doc 12/30/05