Permit CITY OF TIGARD PLUMBING PERMIT
1111 I ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00299
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/14/2015
Parcel: 1S133AD16200
Jurisdiction: Tigard
Site address: 12700 SW NORTH DAKOTA ST 180
Project: Straight Up Chiropratic Subdivision: 1995-073 PARTITION PLAT Lot: 3
Project Description: Install(1)new clothes washer,cap(1)sink.
Contractor: EAST WEST PLUMBING INC Owner: PACIFIC CREST PARTNERS SCHOLLS L
10610 SE 145TH AVE 7000 SW HAMPTON ST, STE 130
HAPPY VALLEY, OR 97086 TIGARD, OR 97223
PHONE: 503-777-1594 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 09/14/2015 $25.02
Specifics: 1 ea Fixture/Sewer Cap 09/14/2015 $25.02
22 Minimum Fee Adjustment- 09/14/2015 $22.46
Type of Use: COM Plumbing
Class of Work: ALT g 12%State Surcharge- 09/14/2015 $8.70
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within t0 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t• follow the rules .dopted b e Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0e•0 You may •• .in a co*, of the rules
or direct que '•• to OUNC b calling 503.232.1987 or 1.800.332.2344.
Issued : • , ' Permittee Signature: 4. /)�'1 .
Call 503.639.4175 by 7:00 a.m.for the next available inspe,'•n date.
This permit card shall be kept in a conspicuous place on the job site unti completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVEP P FOR OFFICE USE ONLY
City of Tigard Received / Permit No.:
Date/By: 9 /e/ /� r`.).40 r 64/0;2.4,/,,--..e.....26,;;;;1/49 9
13125 S50 Hall Blvd.,Tigard,59722 G Plan Review Other Permit No.:�W p/.;vital/U
Phone: 503.718.2439 Fax: �$.16At Z •1
Inspection Line: 503.639.4175 Date/By:
T I G A R D Date Ready/By: Anis: la See Page 2 for
Internet: www.tigard-or.gov t. ) Notified/Method: Su lemenalInformation
❑New construction Demolition For special information use checklist
Description I Qty. 1 Ea. 1 Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) J
-' CGOR O CONSTRUCTIOII ll SFR(1)bath 312.70
❑ 1-and 2-family dwelling LCommercial/iindustrial SFR(2)bath 437.78 �l\
SFR(3)bath 500.32 51❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATIO Site utilities:
Job site address: 2„7Q d /v A ital., 5-- Catch basin or area drain 18.76 - '
y Cv Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: f Q I Project name: e4/4w,4,P�jh1/Q nTe.-, 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 r
Subdivision: �" I Lot no.: Fixture or item:
/
Tax map/parcel no.: 5 / 5.3/3D f/0C)e Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
GO/fr,,/ ,J Clothes washer t 25.02 015 O2-
kI 6f,4Ll,.(/) A)e w CLC7rn5 L COTE Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap ( 25.02 Name:
Floor drain/floor siridhub 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:
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
Water heater 37.52
Business name: pa S- (.4/4 4.- (A wt L M.% Water piping/DW V 56.29
Address: 166 i i i J /V.1-44---- / ,C Other: 25.02
City/State/ZIP: -- (4.117 O._- y 70e45 Subtotal
Phone:(4 7l _5-40" .:.
pG.. ll Fax:( )
Minimum permit fee: $72.50 7e.•
CCB Lic.: �i U�5-r ( Plumbing Lic.no.:aZ s3) go
Plan review (25%of permit fee) -r'C
State surcharge(12%of permit fee) V-76'
Authorized signature: 1/ „"'�����i°°° -
4....e._ /l ` TOTAL PERMIT FEE 8'/.o2
Print name: Date:e`yam�5 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
s 7
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/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-1st 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 v„ : ,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
t er nspect><ons or ees Qh'• 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*. j 1 bi ial tallat b `.
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 ❑ Any new commercial building with water service 2"and
i}„m
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car 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 El Any multipurpose tire 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
❑ 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 fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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