Permit J p CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit#: PLM2014-00082
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/26/2014
Parcel: 1 S 135BD01200
Jurisdiction: Tigard
Site address: 9800 SW SHADY LN
Project: Portland NCS Subdivision: MEADOW VIEW Lot: 8
Project Description: Cap(1)floor drain,relace(1)lay&(1)water closet,adding(1)breakroom sink,(1)lay,(1)water closet.(1)
expansion tank,(1)primer&(1)water heater.
Contractor: CASCADE MECHANICAL SYSTEMS INC Owner: BURDICK-FORBES INVESTMENTS LLC
PO BOX 399 BY DONALD C BURDICK
ESTACADA, OR 97023 434 RIDGEWAY RD
LAKE OSWEGO,OR 97034
PHONE: 503-630-4492 PHONE:
FAX: 503-630-5510
FEES
Quantity Description Date Amount
1 ea Expansion Tank 03/26/2014 $12.51
Specifics: 1 ea Floor Drain/Floor Sink/Hub 03/26/2014 $25.02
1 ea Primer 03/26/2014 $12.51
Type of Use: COM 1 ea Sink 03/26/2014 $25.02
Class of Work: ALT 2 ea Lavatories 03/26/2014 $50.04
Type of Const: 2 ea Water Closet 03/26/2014 $50.04
Occupancy Grp: 1 ea Water Heater 03/26/2014 $37.52
Stories: 1 12%State Surcharge- 03/26/2014 $25.52
Plumbing
Total $238.18
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 1J oO t! Perm ittee 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.
N Plumbing Permit Application
.�) Building Fixtures riti
City of Tigard Received dg , j oA�/ C Permit No.: �( / -two c(?„,
q 13125 SW Hall Blvd. Tigard,OR 194223 2 5 r Plate/By:
.1 Ill
i Plan Retiticx '/
Phone: 503.718.2439 Fax: 503.598.1960 Date/By. Other Permit No.:�/`f S
Inspection Line: 503.639.4175
T I G A R D �I`��! i.,t^ t`7�!-{t; Date Ready/By: luris: ®See Page]fur
Internet tvtvw.tigard-or.gov NotifedTletltod: Supplemental Information
j1/4,21 )
11 PE OF WORK FEE•SC11EDULL
El New construction ❑Demolition For special li Information use cliecklisl.
Description I Qty. I Ea I Total
jAddition/alteration/replacement ❑Other: New 1-2-foully dwellings(includes 100 l 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
13 1-and 2-family dwelling I CommerciaUndustrial SFR(2)bath 437.78
CI Accessory SFR(3)bath 500.32
ry buildin g ❑Multi-family 1
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.it) Page 2 O
JOB SITE INFORMATION AND LOCATION Slte utilities:
Job site address: ctgov `S`,0 51n A CIA. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/Slale/LIP: V t L'- OR. 22.7 Footing drain(no.linear R.:_) Page 2 ---L-....
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear R.:_) Page 2
Storm sewer(no.linear R.:_) Page 2
Water service(no.linear R.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Back-flow preventer 31.27
' A)SSCRIPPO..OF 11'ORK ' Backwater valve 12.51
Clothes washer 25.02
It cif L- ....• (h P ( L-' Dishwasher 25.02
4,\A 1, V 1C)Yeekl.0 Cu'1'bl SUAL Drinking fountain 25.02
Ejectors/sump 25.02
.3-PROPERTY OWNER I ❑ TENANT Expansion tank i 12.51 4,,-/
1G\ Fixture/sewer cap 25.02
Name: 4
-�ovia C re Sucie t�
Address: � � Floor drain/floor sink/hub / 25.02 a S-<<-
5 Q '�P Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax ( ) Ice maker 12.51
❑ APPLICANT ' q CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:S ) Page 2
Contact name:
Primer / 12.51 /A.V
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory .S 25.02 -75,''
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 jQ.0ie
CON
Business name: c�C�� { C Water heater / 37.52 37.77 1
r '� e. {V`Q(-V L>\ � V1( Water piping/D1YV 56.29
Address: 'Q Other: 25.02
City/State/ZIP: ` . 111, 701_ Subtotal 09.../..2•l
i .. _
Phone:(58)W O-- ( • 2_ Fax:(W) (0y)-515-1D Minimum permit fee: 572-50
CCB Lie.: 12'"t Ot') j //b, Plumbing Lic.no.:3-32.f Pg
Plan review (25%of permit fee)
( State surcharge(12%of permit fee) A 5-•5
Authorized signature: TOTAL PERMIT FEE ,A 3q, /s
�t� ( • 1 NI 'Phis permit application expires if permit Is not obtained within 180 days
�� / L �ljAfC.. after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board.
1:1Ruilding\PermitsrPLMU-Permit App doc 10.V1i09 404616T(1o.•021COMAYEH)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential File Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Fooling 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-lot 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
Stone&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 41)'• Fee(ea) Total each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including
50f for a first 100.
which no fee is specifically indicated 90.00/ly $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
wti ch non fee is spe 1/2 hour) each additional$100.00 or fraction thereof,to
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
Rcinspection 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*.
Quanll '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 9 )' g•
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
1acu�li/11'hirlpool 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 OARS 18-780-0040.
Eye Wash
Floor Drain/sink -2" J Submit 2 sets of plans with any of the above,
-3"
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
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
Shower -Gang
-Stall
Sink/l.av -Non-food related ! JI
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter Note: If the fixture work under k d this permit results in an
Washer-Clothes t
Water Extractor increase of sewer Mils,a sewer permit will be issued and
Water Closet-Toilet I j fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\1 U I,l GU)esktop\PLMF-Perm itApp.doc 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
9800 SW SHADY LN, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
2014-04-18 00:00:00
PLM2014-00082
PASS - No C of O
Violation Summary:
Inspector Contractor