Permit M91
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00432
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/31/2015
Parcel: 1 S 134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 500
Project: Express Employment Professionals Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: Relocate(1)lav,add(1)breakroom sink and install water supply for ice maker.
Contractor: JAMES ROOD PLUMBING INC Owner: ROBINSON, CONSTANCE A
125 S 1ST AVE#542 BY KILLIAN PACIFIC LLC
HILLSBORO, OR 97123 500 EAST BROADWAY, STE 110
VANCOUVER,WA 98660
PHONE: 503-547-0491 PHONE:
FAX: 503-547-0492
FEES
Quantity Description Date Amount
1 ea Ice Maker 12/31/2015 $12.51
Specifics: 1 ea Sink 12/31/2015 $25.02
1 ea Lavatories 12/31/2015 $25.02
Type of Use: COM 1 12%State Surcharge- 12/31/2015 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment- 12/31/2015 $9.95
Occupancy Grp: Plumbing
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 direct o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue By: Permittee Sign ure:
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 RECEIVED
Ci of Ti aird Received
rY g ��� Date/By: Permit No.: ( w
13125 SW Hall Blvd.,Ti aid 2 S 2015 Plan Review
iN
Phone: 503.718.2439 Fa. 50 59 Other Pennit No. aha
Inspection Line: 5t13.639.Z&6-?TIGARD Date Re
Internet: www.ti d-or Date ReadyBy: loris: � Seo Page 2 for
I Notified/Method:-IsSupplemental Information
❑New construction ❑Demolition For special ir1formetaon use checklist
Description I QtJ,-. Ea. _ Total
Addition/atteration/replaeetnetit ❑Other: 1-1
New I-2-family dwellings(includes 100 ft.for each utility connection) O
u SFR(1)baht 312.70
9❑1-and 2-family dwelling Commercial/industtial SFR(2)bath 437.78 (�,)
❑
SFR(Accessory building El bath 500.32
\
Each additional bath/kitchen 25.02
❑Master buildar ❑Other: Fire sprinkler t sq,ft. Page 2
Site utilities:
Job site address: /0 !p1. c Catch basin or area drain 18.76
City/State/Z1P: 11 1]rywoll,leach line,or trench drain 18.76
• ' p *�. Footing drain(no.linear ft.:`, Page 2
uit )Idg"/apt.no.: Project name:E pq fA F`q /�� 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 It:_ ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: 76-1 1 13 6R53 Backflow preventer 31.27 v
Backwater valve 12.51
Clothes washer 25.02
CC-l! 1 I i/d~1"' t�� Dishwasher 25.02
1 K 08.x- Drinking fountain 25-02
Ejectors/sump 25.02
Expansion tank 12.51
Name: 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:( ) !ce maker 12.51
Interceptor/grease trap 25,02
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 12.51--�
Roof drain(commercial) 12.51
Address:
SittWt)asitt/lavatory25.02 SO 0 t
City/Statc/Z1P: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: /&-YN6! 9- 6mat-1 Urinal 25.02
Water closet 2 5.02)
Water heater 37.52
Business name: S Waterk/
n p P t ir DWV 56.29
Address:I as25.02
rD
City/State/ZIP: { �- 0/-23
w w subtotal
Phone:(So?) Fax: !! b Minimum permit ffte: $72.50 5�
CCB r✓ic.: Plumbing 1 a-77� Lic.no.: �5 Plan review (25%of permit fee)
State surcharge(I2%of permit fee) 6,70
Authorized signator ..r TOTAL PERMIT FEE
Print trema: C&,e) Date: j This permit gpplicatiou expires if a permit is not obtained wtthln t80 days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
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Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire S-uppression S stems:
Footing drain-1"100' 50.03 0 0 1 to 3 $121.90
2 001 to 3.600 $169-69 .
Footing drain-each additional 100' 37.52 3,601 to 7.200 $233.20
Sewer-1 st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Sys MS
water Service-each additional 100' 37.52
Storm&Rain Drain-15t 100' 62.54 $Loo to$1,000.00 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
each additional$100.00 or fraction thereof,to
and including$10,000.00.
inspection of existing plumbing of 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-7 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 AS for
hours(minimum char -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'.
;
Plan review is required for any of the following.
" Please chock all that apply_
Ba tilt /Font ❑ Any new commercial building with water service 2"and
Bath -Tub/Shower
-Jacuzzi/Whirl1 greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cas idor/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 OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3„ "
.4"
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestio-food related that meet the qualffications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Re h.g.Drains
Oil Separator(Gas.Stitiorl CoMnients rega din fixture work:
Rec.Vehicle DumpStation pV0.uk
Shower -Gang1.,,, d►�.� /
-Stall
Sink/Lav Non-food related
-Bradley fib► 2
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
washer-Clothes
Water Extractor increase of sewer EDUs,a sewer pergtit will be issued and
Water C1oSet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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