Permit 7' ' ,Ii, CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMENT Permit#: PLM2015 00404
Date Issued: 12/02/2015
TIdARLI 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
} ;, Parcel: 2S102AC00700
Jurisdiction: Tigard
Site address: 12540 SW MAIN ST 200
Project: CDS-Complete Distribution Services Subdivision: BURNHAM TRACT Lot: 1
Project Description: TI for new tenant:Add(1)breakroom sink,(1)primer,(1)hub drain for water heater&(1)water heater.
Contractor: JAMES ROOD PLUMBING INC Owner: DOLAN&CO LLC
125 S 1ST AVE#542 BY FLORENCE T DOLAN
HILLSBORO, OR 97123 4523 NE DAVIS ST
PORTLAND, OR 97213
PHONE: 503-547-0491 PHONE:
FAX: 503-547-0492
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 11/30/2015 $25.02
Specifics: 1 ea Primer 11/30/2015 $12.51
1 ea Sink 11/30/2015 $25.02
Type of Use: COM 1 ea Water Heater 11/30/2015 $37.52
Class of Work: ALT 1 12%State Surcharge- 11/30/2015 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.08
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct ques• as . •UNC by calling 503.232.1987 or 1.800.332.2344.
Issued Cie
, Permittee Signature: r
otywir
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVEI l•ali 01,1:1c-1.: i til; ONI.1 J c,
City of Tigard Received
t o?5 5 i Permit No.: ,1i17Qf0/�-� `e)
NI ■ 13125$W Hall Blvd.,Tigard,OR 722 5 2015 Pian Review '
' Phone: 503.718.2 t39 Fax; 503. 98.160 Date/By: other Permit Mo-604/6 00159
T I G A R FJ Inspection Line: 503-639-4 71TY OF T1 OAR D D.Ready/Ety. mriy; it See Page 2 for
Internet: www.tigard-ongq a k r`41 fi a .t „r Nolitied/iVlelltod: 1.� v���tl��� Su,slemental Information
Yf \ 1 .'�. 7•`F, M +'MY^t;tTl�^�"i1+y';^M'M1: .^Y', r. r-i�1t:i.'N:� t '1� l .F r}' r 1.9, ( y.:n:"'nv k�„., }, v.,M„nw'r.. � 7,37 K?::0.1,.
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El New construction ❑Demolition iisT1• For special information use cheekl st
Description I Qty. I Ea. I Total
I i'Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) "
rm,.,
„s.'.MkloKa.} . ",77 .,""+ „rn'"7, =7. 4 ^+.s. 1
SFR(1)bath
312.70 j,Wvp M '1 ( 2 ilk w wT r
y.V. C,,,a;iw a✓ ,,ar.• ,irryntr..of.. .. v.. ..,a. /( •, .siuw�1 ,,. .rr:..,,, ,. ,aSFR(2)bath
437.78
❑ 1-and 2-family dwelling .Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other• Fire sprinkler( _,sq.ft) Page 2
:. c ,pt, 3..,_..rlrP.,.w :-..u.-..:...":m n; '; ..�l"�. `n,...]:3'.✓,.�wi"{'� �'y�;.r;.u.;�; e ,:f.. -
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,v.e..:. n ra.:: .aamo- »,HS."rv".':: „n1-sei.:t., ,.uc..,.ocwar..,..» . .. »t..S r , :-:• - Catch basin or area drain 18.76 04
Job site address:d Sit) S(' tyat•- S'C. -
Dry-well,leach line,or trench drain 18.76
City/5tate/ZIF: ,5 Rl V^ Footing drain(no.linear ft.:, ) Page 2 dI
gip. no.: GaZeii Project name: Manufactured home utilities 50.03
Cross Street/directions to job site: C-06" e_ • . :t,. .t i i M anholes 18.76
6-47-1 Je.A.) Rain drain connector ,J 18.76
Sanitary sewer(no.linear ft.:_ ) Page 2
- Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item: -.
Tax map/parcel no.: ., 5 x-11-do 0?4C) Backflow preventer 3127
..:rvrn-.:r:. :^..::.r.r�vl .....•w:w...xrc:,.x...;..r,.: ......... .,y,.a+w•-,w'*:�•n�:TM..,......-:::::•: "+M ."'`.;;,�: --�,,brr.4'. ..�... �)8 r valve
.f.....41 ll1 1 (9N JY1 (i M 4 t lM 1'pl1 iy Fh w• k ii1 '4' P cltwate val 12-51 .,-.
.;.x;i',"-.,.•..a..144 11i:i,° l f oA ?ign 11�e.,,i)1' s..i i: (a, Ft c 9<:y.. Fi,.
�:!Ylaj,rd�i.�rw, 'n ;,d r..:.,r17•Y.. .,.�,,..T ..,,..5>7r. �,�„., ��S.a+ e,....,.,., 3x...:..,w ,-,•l .�. ...:.�x.�.,,rlyd CIOthC9Wasl}er 25.02
- ,03.4:-........// $�`'� 1�GTt , Sr Dishwasher 25.02
(J`0.. - �..t9 fe Al b G>t rdr l- pre,'/i Drinking fountain _ 25.02
Ejectors/sump 25.02
•.•.i t'W q .ri. ,.,'r '•tr � 1 .....:'.. ' 7 r< r T 9iu- o->rF
Expansion tank 12.51
lY2k.x • a5- .;tr7' . l .l .}..,:dsJ �Y.0 . e[..r1J,.l•.•>rfi, h.t_tr� r.�:. :,..,J$ 3IS,. ..:
Fixture/sewer cap 25.02
Name:
- Floor drain/floor sin hu) 1 25.02 1 s'),,,,.
Address _ Garbage disposal 25.02 _T
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) - Ice maker VT 12.51
3 ,, w..,i a,<ia<3.rfr1. `a.mxchI�:gf,/:.t i}isyaal 3 rJ.<,z•,atz:elX!^,:-: „.4, vr`"".....�:V.s Interceptgr/greasetrep -----
Mediu!
.w.._-
Business name: Medical gas(value:$ ) Page 2
Primer ! 12.51 a ,�,�=..
Contact name: ,F
-- Roof drain(commercial) 12.51
Address: - Sink/basin/lavatory J. 25.02 r_ l9
r
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
____
E-mail: Urinal 25.02
•
,... i ?.,: ' " Water clos25.02
'' ' +r ati , lrr ,t Yi'"` " a i fr:+.37,1,,,lf J C �t!}.-,---,:,-,••
di•. s rf J ,nFk } r 1 eu f$• s � F 'i
,Zgi,tt,; .4., 4;-..a.,�« .esr_f.-4u . 1:4-Cat,:,..,,:,-174;e "w.4:.-•.;o....1J2Z4', .Atu;f� Water heater / 37,52
3). s'
Business name: `� pj , 5 �. Water piping/DWV t'a�,a C.,rv..:. t� pi m WV 56.29
Address: i 4.5. s•, is, I.['d� • Other: 25.027
,
City/State/ZIP: 'i&601„._A__o
p-, 97/2..3° _ Subtotal,, ' �, .,
Phone:( ) ,s-2/7._.0<0.-9/ Fax:TO) 5-4-2_0 '99 7Minimum permit fee: $72.50
CCB Lic.: 0/ PlumbingLie.no.: Plan review (25%of permit fee)
�� ! ��^�� State surcharge(12%of permit fee) /AP/
Authorized signature• -d„ `yy.•/f TOTAL PERMIT FEE /`i p$
,ly( �rr,/
I Print name: (, e � Date:///2.5//f' This permit application expires if a permit is not obtained within 18 days
Y after it hos been accepted ea complete.
*gee methodolog Set by Tri-County Building Industry Service Board.
1:\Build ing\Permite\PLMV-PermitApp.do°10J01/09 410.4616'[t10IO2ICOA•1/WE6)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information j
Fee Schedule:
.w. .:.: . u . ,.,-'..., Residential
esidential F_...ire S
u...i 1 res
si.._o,.4n S ...stems.:.::
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> r ,
.�„
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Footing drain•1a 100' 50.03 0 to 2.000 $121.90
Footing drain-each additional 100' 37.52 001 to 3,600 $169.69
Sewer-1st 100' _ . 3 601 to g $233.20
7,201 andd greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' ZEE� .w " r '"`r 1'd r,'"p r "a y , u, a �- ,::. ,S ,y^g
,_''..:rn :7:f Jz�1 r.wr.tc:.". tY.ayia1 cid... 1 1' ..:J.., :.7x.-,4,,ti
Storm&Rain Drain-1st 100' 62.54 `e , 0"
$1.00 to$5,000-00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' IBM $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
vw: =771,17i 7.7. 1 .,, :7 r 1�,.y •
f r e, Y� G, / L9eachadditional$100.00or fraction thereof,to
fir.‘4ryy\ ae:.Nv.t i. nv.tS ....6.1...Y ,w _ r._), (,,... ,R .):,z:,;;w4,:w;
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 noimal business - 90.00/ r 11111 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours minimum char;•-2 hours each additional$100.00 or fraction thereof,to
Reinspection Fees _ 90.00/hr and includint$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
accuratel re Sort fixtures could result in increased sewer fees*.
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*4,,rrry9.r14 ji{(d! di /,.ii'.Io^n71`'ll'or 1.,ly,.r i�Ttir +v ?`a' -4',if <,+h :aj� iTillir Plan review is required for any of the following.
y baptistry/Font Please check all that apply.
Bath Tub/Shower CI Any new commercial building with water service 2"and
mates',ater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive ThruCINew exterior plumbing site utilities for tiny 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 OAR9I8-780-0040.
•
Eye Wash
Floor Drain/sink -2" ' 1 Submit 2 sets of plans with any of the above.
,F;'; , XTrr r'l n -3..
' as 1.1, o'.:'04.."4,-,4.....e"'%7'.. °„ t, a f f ff t rv,z r
Car Wash Drain „:1, r. �.... F..:. .,5
Garbage Domesrio-nonfood
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the 'ualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains _
Oil Separator(Gas Station) Comments regarding fixture work: ,
Rec.Vehicle Dump Station Adet 1 C ) yI / , Ief ol1 Iy%, y�r Iw.
Shower
-Ga-Stag
Shower
VI' 0216 ,}AI �K&C T�7
Sink/Lav -Non-ibod related i A. d I ea3 0
-Bradley _ � L1�5; "
-Commercial-food related - /�(,(8'D61 AOR ER 1 d-y 4> cg_
-Service "Deco ..)or-7,)et7) - 8f-d41-Lt44-RTab fz*Q-Sia--
Swimming fool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an .1;"'
water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toiletfees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Usersljim\Downloads\?LMP_PermitApp(4).doc 2