Permit q CITY OF TIGARD PLUMBING PERMIT
:Fl a COMMUNITY DEVELOPMENT Pe rmit #: PLM2013 00264
Ti G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/01/2013
Parcel: 2S 101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 120
Project: Precoa Subdivision: VARNS ACRES Lot: 9
Project Description: Add (1) breakroom sink, (1) hub drain, (1) primer and (1) water heater.
Contractor: GRIDLINE PLUMBING Owner: GK TRIANGLE CORPORATE PARK III L
4343 SE 37TH BY THOMSON REUTERS INC
PORTLAND, OR 97202 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 503 - 771 -8790 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 07/31/2013 $25.02
Specifics: 1 ea Primer 07/31/2013 $12.51
1 ea Sink 07/31/2013 $25.02
Type of Use: COM 1 ea Water Heater 07/31/2013 $37.52
Class of Work: ALT 1 12% State Surcharge - 07/31/2013 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.08
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 i . Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection .ate.
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 IV ` FOR OFFICE USE ONLY
City of Tigard Received
ill DateBy: 7 l3/ /3 �[� 1 J Permit No.: . /� /0/ - �o ,2 4L/
q 13125 SW Hall Blvd., Tigard, OR 97223 JUL 3 1 2013 /
C Plan Review n 90/.3 , ao' 7/
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.: IL
Other
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: lurk: El See Page 2 for
Internet: www.tigard Notified/Method: Supplemental Informatio •
. TYP • OF WO R I� DILDf�IG DIVISION . .FEE* SCHEDULE •
❑ New construction El Demolition For special information use checklist:
Description I Qty. I Ea. I Total Z
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 `�1.ommercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32 W
❑ Accessory building ❑ Multi- family t
Each additional bath/kitchen 25.02
❑ Master builder 0 Other: Q
Fire sprinkler (___ sq. ft.) Page 2 UU
''' , ' - JOB SITE INFORMATION AND LOCATION • ' .. Site utilities:
Job site address: / 59 .i..<3 C-P . I ��W y Catch basin or area drain 18.76
J Drywell, leach line, or trench drain 18.76
'77t. City /State /ZIP: 77i. �-// / t9y Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: l I Project name: r c Q / /..4.- ` Manufactured home utilities 50.03
Cross stre-t/direction to job site: Manholes 18.76
A iled ,' ‘4 5 t /�e ae fes 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 • Backwater valve 12.51
Clothes washer 25.02
IaD ^ / i C j C loo .� Dishwasher 25.02
/ '.- //I !/ �/�Qv Y�� Drinking fountain 25.02
/ Atia / � Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Address: Floor drain/floor sink/hub Y / 25.02 c;; ;95:02
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer )e / 12.51 /2. 51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory )( / 25.02 Q�
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51
•
E -mail: Urinal 25.02
. Water closet 25.02
CONTRACT R Water heater X / 37.52 377 5-'2... Business name: &- /`D /`✓l Q h7 /// Water piping/DWV 56.29
Address: i/ e y G 3 -._ ,4-1,4,e__- Other: 25.02 �+
City /State /ZIP: z� Y--t-,_
9 Subtotal /no . 0 /
p Minimum permit fee: $72.50
Phone: / ) � AO fax: ( /- O8�
CCB Lic.: 7f/ p 5 Plumbing Lic. no.: --117 Plan review (25% of permit fee)
< State surcharge (12% of permit fee) /A ,O(
Authorized signature: r/
a . : �� TOTAL PERMIT FEE / /A . 0g
�� -�i
This permit application expires if a permit is not obtained within 180 days
Print name: ` ? � ,,,f/C Date: �//�
after it has been accepted as complete.
*Fee methodology set by Tri-County Building I dustry Service Board.
1A 13uildingTermitaLMU- PermitApp.doc 10 /01/09 440- 4616T(10 /02 /COM/WEB) , -0-4-. p.p.I..Gt' // 7 3/43
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
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit' Fee:
$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 Ins ections 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 * . 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.
Cat Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall 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 OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2" 1
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: -LavBar non -food related f .
- Bradley
- Com/Serv/Util 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 plumbing Closet - Toilet P g P ermit can be issued.
Urinal
Other Fixtures:
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