Permit i V
CITY OF TIGARD PLUMBING PERMIT
111111 I COMMUNITY DEVELOPMENT Permit#: PLM2015 00389
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/18/2015
Parcel: 2S 101 AD02400
Jurisdiction: TIGARD
Site address: 12753 SW 68TH AVE
Project: George Fox College Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Installation of grease trap for cafe. R&R water heater for grease trap install.
Contractor: MODERN PLUMBING Owner: GEORGE FOX UNIVERSITY
11120 SW INDUSTRIAL WAY ATTN: FINANCIAL AFFAIRS
TUALATIN, OR 97062 414 N MERIDIAN
NEWBERG, OR 97132
PHONE: 503-691-6166 PHONE:
FAX: 503-691-6771
FEES
Quantity Description Date Amount
1 ea Interceptor/Grease Trap 11/18/2015 $25.02
Specifics: 1 ea Water Heater 11/18/2015 $37.52
1 12%State Surcharge- 11/18/2015 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 11/18/2015 $9.96
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 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 dire uestions . OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: / ` Permittee Sig I
Call 503.639.4175 by 7:00 a.m.for the next available ins.: ion 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.
Nov. 13. 2015 12: 57PM Modern Plumbing No. 9249 P. 1
Plumbing Permit Applicat a•
r'IVE'j P
Building Fixtures FOR OFFICL USE ONLY�/�t�c �q�t2G
City of Tigard Cl.' Received //'� _ l% Permit No pt_ rOVI�[ie�JQ9
ty g r�tr 7. 7 o-t By;
II
n 13125 SW Hall Blvd.,Tigard,OR 9723 Plan Resiew
0 Phone: 503.718.2439 Fax: 503.598.1960 , i p DatelB}._ Other Permit No.:
inspection Line: 503.639.4175 �,L l Ut I lb AM)
Date{lead/B h.rfs Sae Page 2 for
71GAItD Internet: wwiv.tigard-or.gov ,, 5 ' Notitiedrhi t y /�/fs Supplemental
age 2 for
Information
TYPE OF WORK ., -`w :.!.udv°f `,�' SCII I IILE t =,' . . ,•
❑New construction ❑Demolition, Fur 3-pedal1.r orntarlou use cheekily.
Description 1 Qty. I Fa. 1 Total
®Addition/alteration/replacement ❑Other: New I.2-family dwellings(includes 10011.for each utility connection) _
..:b,-;, dr:w•: . x.-. SFR(►)bat1, 312.70
CATEGORY.OF CD1VlyiR[I TIQP ,: ;t`c a�aw=•',-.,- "..; �'
❑ 1-and 2-family dwelling ®Commercialfmdustrial _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 INFORMATIOIV'i D'. .- xr . ;.:7 Slte utilities:
Job site address: 12753 SW 68i1'Ave. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear R. ) Page 2
Suite/bldg./apt.no.: Project name:George Fos College Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
� Sanitary sewer(no.linear ft.: 1 Page 2
- r _ - - - . . - Storm sewer(no.linear ft,: ) Page 2
, Water service(no.linear ft.: 1 Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Back flow preventer 31.27
D 4 °"3 °- ` d rt r g 'y' Backwater valve 12.51
Clothes washer 25.02
r l'1 S+-a,ti o rase Dishwasher 25.02
t 1\r,1\r, TJ� •- I,„-, I ` to Q Drinking fountain 25.02
Ejectors/sump 25.02
-', C,i"t <y i? -�Xr'v Expansion tank 12.51
❑'PROPERTY OWNER t: >- .., w-':.,.4 " ti• .*�-.
Fixture/sewer cap 25.02
Nome:
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) lee maker 12.51
❑ APPLICANI' ❑ -M APE 7'7 interceptor/grease trap 1 25.02 25.02
Business name:Modern Plumbing Medical gas(value:5 ) Page 2
Primer 12.51
Contact name:Don George
Roof drain(commercial) 12.51
Address:11120 SW Industrial Way, Bldg.9-3 Sink/basin/lavatory 25.02
City/State/ZIP:Tualatin,OR 97062 Solar units(potable water) 62.54
Phone:(503)691-6166 Fax::(503)691-6771 fhb/shower/shower pan 12.51
E-mail:deborahlmodernplumbing,us Urinal 25.02
c: > /(� �t`P � �:,fit. Water closet 25.02
. .•"y� . . L,v , .. -.�<0.14 i.-'cam v4,3:.* .Ii* : Water heater 1 37.52 37.52
Business name:Modern Plumbing Waterpiping/DWV 56,29
Address: 11120 SW industrial Way,Bldg,9-3 Other: 25.02
CilylStaterZIP:Tualatin,OR 97062 Subtotal 62.55
Phone:(503)691-6166 Fax:(503)691-6771 Minimum permit lee. $72 50 72.50
Plan review (25%of permit fee)
CCB Lie.:87906 Plumbing Lic.no.:31-250P11
State surcharge(12%of pemtit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20
'Ibis permit application expires Ira permit Is not obtained within 180 d II)$�J� �
Print name:Deborah George Datc. Z (S P C�
after it has been wcceplcd as complete.
*Fee methodology set by Tri-Comity Badding Industry Scrsicc Board.
UH'ildin5\Permit9PL\IU-PermitApp.doc 1001/09 440-1616T(10.'O1/COSr/WEB)
Nov. 13. 2015 12:57P\1 Modern Plumbing No. 9249 P. 2
Plumbing Permit Application . City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr. Fee(ea) Total StjIItiire..Footage: Permit Fee:
Footing drain-1'100' 50.03 0 10 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-1s1100' 62.54 Medical Gas Systems: _
Water Service-each additional 100' 37.52 a' •; ltj a °;'
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
�" �` :��" � 'A Q(y IOW o` }; :� Ata1 '. each additional$100.00 or fraction thereof,to
Othe�:Iiispectiopsor: ees • .. ... =P. t., � r�•=k and includin:$10000.00.
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 includin_$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) cach additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and includin-$50,000.00.
Additional plan review for revisions 90.00/lir $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. , _ _ _ eq.�y �y�s
t by Type J J$•r a a 1f.. .3TOI- ,I1i1W�11< alt4!' tii... .$.c •r"
Quanfit}'b )✓ixturcl' e � � � ) � l t< i'>.:.'.
Fixture Type for Replace/
Plan review is required for any of the following.
Work Performed: Cupped Added Relocate 9 y g
Baplistry/Font Please check all that apply.
Bath -Tub/Shower ❑ My new commercial building with water service 2"and
-Tub/Shower pool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 13 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Astor as defined in 0AR918-780-0040.
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 OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Car wash Drain ,..-:.IsgmetriG1pr�s.k�M� r: m;:A•
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 MachlRcfrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
_ -Stall
Sink/Lay •Non-food related
-Bradley
-Commercial-food related -
-Service _
Swimming Pool Filter - *Note: If the fixture work under this permit results in an
washer-Clctor increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet • fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:1Uscrs\rnary\Documents\Downloads\PLMF_PermitApp(8).doc 2