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Permit 11111 CITY OF TIGARD PLUMBING PERMIT g COMMUNITY DEVELOPMENT Permit#: PLM2015-00108 T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/07/2015 Parcel: 2S101AD03200 Jurisdiction: Tigard Site address: 12909 SW 68TH PKWY 190 Project: Professional Eye Care Associates of America Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT Project Description: Interior plumbing for TI:Adding(1)break room sink and(1)domestic dishwasher. Contractor: DEAN WARREN PLUMBING&REMODELING INC Owner: PACIFIC REALTY ASSOCIATES PO BOX 14701 ATTN: N PIVEN PORTLAND,OR 97293 15350 SE SEQUOIA PKWY#300 PORTLAND, OR 97224 PHONE: 503-236-4152 PHONE: 503-624-6300 FAX: 503-296-2218 FEES Quantity Description Date Amount 1 ea Dishwasher 04/07/2015 $25.02 Specifics: 1 ea Sink 04/07/2015 $25.02 1 12%State Surcharge- 04/07/2015 $8.70 Type of Use: COM Plumbing Class of Work: ALT 22 ea Minimum Fee Adjustment- 04/07/2015 $22.46 Type of Const: Plumbing 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 rules adopted by the Oregon Utility Noti cation enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or dir questions to O l by c. . 503.232.1987 or 1.800.332.2344. Issu d By: / /' Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection d•te. 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. Plumbini Permit Application iL)Qom?/h--t°c7 3g Building Fixtures O FOR OFFICE USE ONLY `I Received City of Tigard r+�w Date/By: Permit N. IN �� 13125 SW Hall Blvd.,Tigard,01 3`J O y fi�1 Y~ !� I,� �� Phone: 503.718.2439 Fax: 50 960 (1 15 Plan Review ■ L Date/By: Other Permit No.:�,�Q�i�•Inspection Line: 503.639.4175 Q Date ReadyBy: Juris: ® See Page 2 for TIGARD Internet: www.tigazd-or.gov �`� F� aP�OA` Notified/Method: j r` Supplemental Information TYPE OF WO' , -0 OGo\NI\ \ ," FEE' SCHEDULE ❑New construction PI D:I a Hion For special information use checklist . Description I Qty. I 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: 1'• ,4\l0`l 6(;) C,3 f-4-• r Ko( t Catch basin or area drain 18.76 City/State/ZIP: m(, Q. ) OR- 1 - -a2LJ Footing drain line,ne trench drain age 2 T-4- 1-( Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: \'\ I Project name: f g.p E''£ cale.E /455. OCAIr11:Rr anufactured home utilities 50.03 Cross street/directions to job site: 1 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 It.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: ,5 /6/ //DO ?j 2-oo Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 t• RD 0 1 8.J EF-k Si P3 1< Dishwasher \ 25.02 C).2... 1 0i51- k/312E-A h Drinking fountain 25.02 Ejectors/sump 25.02 Ig PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: ?&CTICIA,G.1 Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 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: of(4 0 t,�c RED, Medical gas(value:$ ) Page 2 Contact name: 04119....5 cEPrimer 12.51 Roof drain(commercial) 12.51 Address: Sink/basin/lavatory C 25.02 As.D„2 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 /� Water heater 37.52 Business name: 9t-a-t1J t,PtR V. P(�.t�t %t 3C. Water piping/DWV 56.29 Address: 170 ec, jt../ ( \ Other: 25.02 City/State/ZIP: ft 4-n..1,31 f-.D 0 Subtotal ' ,LJ/ Phone:(503) 7}$0 q Lt (e Fax:( ) Minimum permit fee: $72.50 -742, Plan review (25%of permit fee) CCB Lic.: 154G``� Q c7P Plumbing Lic.no.: � s State surcharge(12%of permit fee) •?v Authorized signatur� c��✓ (-- TOTAL PERMIT FE �1 r P-C Print name: /^ / Date: This permit application expires if a permit is not obtained within 180 days �1- l �� LAC " . after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. 1:\Building'Permita\PLMU-permitApp.doe 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-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&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 Qty. 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 $50.00 I.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 ❑ Any new commercial building with water service 2"and Bapti stry/Font -Tub/Shower greater,except systems designed and stamped by licensed Bath: engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Stall 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 t ❑ 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" 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: -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 Filer 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 WaterCloset-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 12909 SW 68TH PKWY 190, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2015-00108 Chip Barnett Violation Summary: Inspector Contractor