Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00427
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/23/2015
Parcel: 1 S 135BC00202
Jurisdiction: TIGARD
Site address: 10763 SW GREENBURG RD 100
Project: Acadia Healthcare Subdivision: OAKBURG Lot: 27
Project Description: Plumbing fixtures for TI: CAP(3)non-food sinks and(4)water closets;ADD(1)ice machine,(4)cup filling sinks,
(2)hand wash sinks,(1)break room sink, (6)lays,(1)mop sink,and(6)water closets.
Contractor: YORK CUSTOM MECHANICAL Owner: BELANICH, ROGER M
PO BOX 21474 22020 17TH AVE SE#200
KEIZER, OR 97307 BOTHELL,WA 98021
PHONE: 503-554-1771 PHONE:
FAX: 971-273-0647
FEES
Quantity Description Date Amount
7 ea Fixture/Sewer Cap 12/23/2015 $175.14
Specifics: 1 ea Ice Maker 12/23/2015 $12.51
8 ea Sink 12/23/2015 $200.16
Typo of Use: COM 6 ea Lavatories 12/23/2015 $150.12
Class of Work: ALT 6 ea Water Closet 12/23/2015 $150.12
Type of Const: 1 12%State Surcharge- 12/23/2015 $82.57
Occupancy Grp: Plumbing
Stories:
Total $770.62
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
Cd
�, _wo,ks suspended formore the 180days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
uestions to OUt�1C calling 503.232.1987 or 1.800.332.2344.
: Permittee Signature:
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
City of Tigard ` Received
i DatrBy- �a ,eS
■
13I25 SW Hall Blvd.,Tigard,OR 912E C 21 2015 Petit�
Plan Rcview
Phone: 503.718.2439 Fax: 503.598. 9 Other Permit
Date/By:
Inspection Linc. 503.639.4175
t. Date Ready/By pais: 0 See Page 2 for
Internet: www.tigard or.gov a`, L�
OF
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CITY !
t
ou6ed;?vleh
od.
Supplemental teformafinn
•
❑New construction 1 ❑Demolition # M / For ce en ormt on ure c ecklist ! I�
T}escsi 'oQty-
n
Addition/aiteration/replaoement ❑Other: ? New i-2-family dwellings(includes 100 it.for each utility_ connection) \
:`;:::;•::: '"r;,?.,;:;:ii::": :. ::;':,'..,:.. :,••:.........:.....,:, i SFR(1)bath
-. ',,:;.,.,,:.• "^ ' , S 312.70
_.CATEGORY>OF;GUIVSTI2UGTItN�1;,>"_',::<:;<,;^;:',::::;:r.:.. .•
❑ (2)bath 43 7.78 I-and 2-family dwelling ! �Commercial/industrial SFR )
SFR(3)bath 500.32 Q
❑Accessory building ❑Multi-family
€ € Each additional bathi€citchen
❑Master builder ❑Other: € Fire sprinkler
(_sq.ft} Page 2 p
'
JO?B:SlTE'�—ftZR3►iAi<TQ?4 A :;Lt?CATION-:.i' r `:� Site utilities:
Catch basin or area drain ! 18.76 4
I Job site address: ` !
Cit•/State'ZIP: :70— f 0 R C-722,S Cs f� - Footingywell,leach line,linear
trench drain 18.76 �
Footing drain(no.linear Page 2
uit ldy/apt no.: Project name: I Manufactured home utilities 50.03 ? z
�� r
Cross street/directions to job site: Manholes j i 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear 1z:? _+_Page 2
Storm sewer(no.linear ft.:_} f Page 2 €
Water service(no.linear&: i Page 2 !
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: ! Backflow preventer 31.27
,,.... -..;...
Backwater v ve
nEScRWnox:
Clothes washer € )5.02
t Dishwasher j 25,02
Drinldn€fountain f 25.02 I j
Ejectors/sump I 25.02��
PER ,
WPi <:.
Expansion - { 12 51 ,
ame:
Fixture/sewer cap `7 25.02 11-75,1
iFloor drainlitoor sitt1tub 25.02
Address: ;
Crarbage disposal i 25.02
City/State/ZIP: Hc>- bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
: Interceptor/g ease trap ( 2_5.02
Business name: �j� / /-� AA
gas(value:S } i Page 2
`
L 1(7t t vy,AR r`��tl V,IeAi VyL-
Contact name:` I � �� � Primer 12.51
{ fay� i Roof drain(commercial) 12.51
Address: (� v
! ' �'C?trl: ��� i � Sinlubasir0avatory i 25.42 ! �
City/State/ZIP: -7 &7 Solar units(potable water) i 62.54
Phone:(�Jr`�) __/���t�j �J i Fax::(C) 27—t Z`f Tub/shower/shower pan ( 12.51
1 E-mail:` �41�1z lin F- 1 �F ��L1+ fM1 Urinal 28.02 F
water closetT 25.02
Waterhea,-ter r f 3762 I
Business Warne: ;Uti ^nn fLl L;yt i(LT Wateri ina'DVVV ! 56.29 €
P P� �
Address: _ Other: 25.02
is
City/State/ZlP: € Subtotal ! 7,(;
Phone:{ ) jq j1P Fax:( ) 6 j S;/ 2111112Minimum permit fee: S72.50 {
Ih } Plan review (25%of permit fee)
} CCB Lia: bj ✓� Plumbing Lie.no.: t �� State surcharge(12%of permit fee)
7
Authorized signature: J _
TOTAL PERMIT FEE ?�?i
( E
Print name: "' Y Date: ! This permit application eipires if a permit is not obtained within 8o days
*^ ! after it has been accepted as complete.
*Fee me bodnlogy set by Tri-Courcy Building Industry Service Boards.
L•ll3uilding`.Pernt4M.tit.1Ri-?rncAtp dtt :NtiS:00 440.4676T(1Q�JCd\f114FF) ��V / Y'
Plumbing Permit Application - City of Tigard ty
Page 2-Supplemental Information
Fee Schedule: Residential Fire Supp ession Systems:
er .,ee: !
mtep
Footing drain-10 IGO, 50.03 0 to 2,000 1 $121.90
Footing drain-each additional 100' 37.52 --Z,001 to 3,600 $169.69
3,603 to 7,200 5233.20
Sewer-1st 100' 62.54 7,201 and Mater $327.54
Sewer-each additional 100' 37.52
t
Water Service-1st IGO' 62.54 3x,
Medical Gas Systems: iT
Water Service-each additional 1001 37-52
Feer::Storm&Rain Drain-I st 1001 62.54 S 1.00 to$5.000.00 Minimum fee 52.50 tj
Storm Rain Drain-each additional 100' 37.52 55,001.00 to 510,000.00 $72.50 for the first 55,000.00 and 53.52 for
n thereof to
each additional S 100.00 or fractio
W,
and including$10,000,00.
Inspection of existing plumbing or for SIO;OOLOO to$25,000.00 $148-30 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 90,00ft $25,001.00 to S50,000.00 1 $379.50 for the first 525,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100-00 or fraction thcrcaf,to
Reinspection Fees 90,00/hr I and including S50,000.00.
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 SI00.00 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
an
ti Fixture TYI*:
Fixture Type f6r s
Plan review is required for any of the following.
1,
Rork Performed: Added,:' Relocate
Btistr�aFont I Please check-all that apply.
ap
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-JacuzzMirlpool greater,except systems designed and stamped by licensed 7�
Car Wash -Barb Stall engineer. t
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspi or/Wat"Aspirator 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 C1 Any complex structure as defined in CiAR918-780-0040.
Eve Wash
Floor Drain,sink -2" Submit 2 sets of plans with any of the above.
-3"
-4�
ptis*
Car Wash Drain isometrlc�or er D
Garbage -Domestic-non-food ❑
Isometric or riser diagram is required for new buildings
Disposal -Domestic-flood related that meet the qualifications above. tN
-Cbrnmercial-food related
-industrial-food related
IccMaj-h./Reffig.Drains
Oil Separator(Gas Station) Comments regarding fix re work:
Rec.Vehicle Dump StationVA_f
Ss'
Shower -Clamp Ao-XH 'a giau�,e 7VY
-stall
Siiik/Lzv -Non-fbod related
-Bradley
-Commercial-food related
-Service
Swimrrin&Pool Filter *Note: If the fixture work under this permit results in an_:Cr1
FWasher-Clothes increase of sewer EDUs,a sewer ermit will be issued and
Wii�r Extractor p
I Water Closet-Toilet fees assessed for the sewer increase must be paid before the
I Urinal plumbing permit can be issued.
Other Fixtures:
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