Permit CITY OF TIGARD PLUMBING PERMIT
: COMMUNITY DEVELOPMENT Permit#: PLM2013-00325
T I G AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/19/2013
Parcel: 1 S135DD01800
Jurisdiction: Tigard
Site address: 11565 SW HALL BLVD 160
Project: Acupuncture Clinic Subdivision: METZGER ACRE TRACTS Lot: 32
Project.Description: Interior Plumbing:CAP(4)sinks,ADD(1)clothes washer and(6)non-food related sinks.
Contractor: VENNE PLUMBING LLC Owner: BKB PROPERTIES LLC
• 15145 SW DIVISION ST 11255 SW DAVIES RD,APT 1014
SHERWOOD, OR 97140 BEAVERTON, OR 97007
•
PHONE: 503-624-9309 PHONE:
FAX: 503-684-0940
FEES
Quantity Description Date Amount
1 ea Clothes Washer 09/19/2013 $25.02
Specifics:, 4 ea Fixture/Sewer Cap 09/19/2013 $100.08
6 ea Sink 09/19/2013 , $150.12
Type of Use: COM 1 12%State Surcharge- 09/19/2013 $33.03
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $308.25
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: 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 , ryQdo _ �7 I I P `
Site Utilities FOR .OFFICE I. ONE).
Received
City of Tigard 'L0\ Date/By: 14/13 Permit No.: /012z)l S rek v 13125 SW Hall Blvd.,Tigard,OR ' , Plan Review
li
0 Phone: 503.718.2439 Fax: 503.598.1961 \r��0 y. Other Permit No.: % '
Inspection Line: 503.639.4175 v o Date Re /B Jtas: H See Pa e .or
r1GARD ��( \`1\S\ /M r g
_ Internet: www.tigard-or.gov �\ ��®V Notified/Method: �6' Supplemental Information
TYPE OF.WORK FEE* SCHEDULE _ '
For special in checklist.
❑New construction ❑De o l F s information use checklis
tuon P f
Description f Qty. Ea. 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 ommercial/industrial SFR(2)bath 437.78
, C
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: 'f 5 Q'' ' U I 'p\V cl:-. c j,4<,, C Catch basin or area drain 18.76
gay-
6i T1 a o of Z2--3
Drywell,leach line,or trench drain 18.76
l gig, Footing drain(no_linear ft.:_) Page 2
Suite/bldg./apt.no.: 4, Ugi, Project name: U 11C�'if1r e, e1in, 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 e or item:
item:
Tax map/parcel no.: Backflow preventer 31.27
I '. DESCRIPTION OF WORK Backwater valve 12.51
In 4 i \i(\0 S4f-Q/� i1fl2/1� I y� Clothes her 25.02 2Gj.(1Z
y� 1�5 Dishwasher 25.02
a
id 0 C, Okkt&L . was. Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER , I . ,TENANT .. Expansion tank 12.51
Name: A.c C.�IP•wN ci-46 E_ UA 1 N I Fixture/sewer cap S//i//�$ 25.02
Address: L I s -4z . 1 1`�,,� r /� Floor ge drain/floor disposal sink/hub 25.02 ot) 4 Ivt l l Y SU 1'T�..l� Garbage disposal 25.02
City/State/ZIP: 1 I I/ay OI "1 z'2 3 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
•
'❑ APPLICANT.- • ' ❑ CONTACT'PERSON Interceptor/grease trap 25.02
V �'1JN P u!t�l Q 110 Medical gas(value:$ ) Page 2
Business name: V
Contact name: �1/t�N v•�V 1 � Roof 12.51
Roof drain(commercial) 12.51
Address: `. I 5 i\,)(1 I
?'. Sink/basinllavatory 4 25.02- 11Cj,ill
City/State/ZIP: .1A)0 1' / 0 i - -7 LI C' Solar units(potable water) - 62.54
Phone:( ) 62 2,4 01 36el Fax: :(V) (g ti - O LQ Q Tub/shower/shower pan 12.51
E-mail: iA/Q(‘a VQA'1 & ^ �liI\Ot , L0rn
Water 25.02
1 CONTIACTOR- \ Water closet 25.02
C Water heater 37.52 .
Business name: 7s.e A®®'*E. Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal :249e [qi
Phone:( ) Fax:( ) Minimum permit fee: $72.50 :977 t a
CCB Lie.: Plumbing Lie,no.: 5 . Plan review (25%of permit fee) 3'�,03
State surcharge(12%of permit fee) A
Authorized sign: : TOTAL PERMIT FEE
MI This permit application expires if a permit is not obtained with 1110 days
-- ,� , ,� Date: after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-06161(10/07JCOM/WEB) 300
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Slte..Utilltles - ,.Qty..;, .Fee(ea) Total. Square Footage: Permi •Fee -
Footing drain-l"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- I st 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
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 engineer.
-Jacuzzi/Whirlpool _ . — _ ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall
Drive Thru 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"
3,. Isometric or Riser:Diagram -
4° ❑ 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/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 I fees assessed for the sewer increase must be paid before the
Water Extractor
WaterCloset-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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