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Permit
CITY OF TIGARD PLUMBING PERMIT .111 COMMUNITY DEVELOPMENT Permit#: PLM2016-00261 T[GAR t) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/18/2016 Parcel: 1S135BD00300 Jurisdiction: Tigard Site address: 9735 SW SHADY LN 103 Project: PMO Care Subdivision: None Lot: None Project Description: Relocate(1)lay and(1)water closet. Contractor: CASCADE PLUMBING CO Owner: MCFADDEN,ARTHUR L 15765 SW 74TH AVE#110-A BY SKLARZ, ERIC TIGARD, OR 97224 621 SW MORRISON ST, STE 800 PORTLAND, OR 97205 PHONE: 971-312-1174 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Lavatories 05/18/2016 $25.02 Specifics: 1 ea Water Closet 05/18/2016 $25.02 1 12%State Surcharge- 05/18/2016 $8.70 Type of Use: COM Plumbing Class of Work: ALT 22 ea Minimum Fee Adjustment- 05/18/2016 $22.46 Type of Const: Plumbing Occupancy Grp: Stories: Total $81.20 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct•.- ions • &UNC by calling 503.232.1987 or 1.800.332.2344. M.A.A514-6 Issue By: / �- ` rPermittee Signature: WAIL Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Applicatio �t Building Fixtures atc V I OR 0l 11c1: ,SL 0\I.\ City of Tigard Received � Date/By: ( ( l b (I ` a,Q��'' Permit No.:pL41/L.//__,b0 9/_I 13125 SW Hall Blvd.,Tigard,OR 97224Y 8 2016 plan Reviewillq . JJtt�� yr O�� Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.: P��/ 4$ I I t i A R n Inspection Line: 503.639.4175 ('�/OF FY Date/By: f0 Date Ready/By: .[oris: H See Page 2 for Internet: www.tigard-or.gov ��i [ �A� Notified/Method: Supplemental Information u o N o New construction 0 Demolition For special information use checklist Description Qty. Ea. Total IlKddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) , CATitGORY OF CON IXII0 .. _ SFR(1)bath 312.70 ❑ 1-and 2-family dwelling commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE IN]OR11IATION AND I TION Site utilities: Job site address: 0, V 5 Sw 16-5 Catch basin or area drain 18.76 City/State/ZIP: `1w i►_ ti) Drywell,leach line,or trench drain 18.76 '`� Footing drain(no.linear ft.:_) Page 2 �a Suite/bldg./apt.no.: I Project name: Y�ha. ,� 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 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 , , Clothes washer 25.02 AliCCAOYAJ 4. • • Dishwasher 25.02 LL Drinking fountain 25.02 '•.` t VOLAAVWC ©%4 - pQ"A'i( Ejectors/sump 25.02 ■ PROPERTY OWNER I 0 TENANT 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:( ) Ice maker 12.51 (APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: �xCe � ` Medical gas(value:$ ) Page 2 Prim Contact name: 91111\./..at, , Roof drain 12.51 Roof drain(commercial) 12.51 Address: \ '516.5 (4.) 1 lit m-N.a, )4. 110 - A Sink/basin/lavatory ' 25.02 City/State/ZIP: -r� ` s OK- q1,a a.4- Solar units(potable water) 62.54 Phone:(5 65) i tq.lock Fax::( ) Tub/shower/shower pan 12.51 E-mail: Nyu.11tt tyy� (,By6,�� a, O•. �,8.y� Urinal 25.02 O CONTRACTOR Water closet , 25.02 Water heater 37.52 Business name:Cascade Plumbing Co Water piping/DWV 56.29 Address: 15765 SW 74th Ave#110-A Other: 25.02 City/State/ZIP:Tigard,OR 97224 Subtotal Phone:(503)289-7095 Fax:(503)283-9514 Minimum permit fee: $72.50 Q.-•s CCB Lic.:204392 Plumbing Lic.no.:PB1528 Plan review (25%of permit fee) X �� ✓�� State surcharge(12%of permit fee) � V-1(7Authorized signature: TOTAL PERMIT FEE g 1• Print name:Crystal Jones Date: J r:J I This permit application expires if a permit is not obtained within 180 days 11 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:Building,.PermitsPLMU-PermitApp.doc 10'01'09 440-4616T(I002 COM WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fa(ea) Total Square Footage; Permit Fee: Footing drain-P 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 Valuation: Permit Fee: 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 Qty. IFee(�) each additional$100.00 or fraction thereof,to Other Inspections or 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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath Tub/Shower ❑ Any new commercial building with water service 2"and Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any 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 OAR9 1 8-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -3" 4,. Isometric or Riser Diagram Car Wash Drain 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 Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related ( -Bradley -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 permit will be issued and Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: C:\Users\Cascade Main\Desktop\PERMITS\Tigard plumb.doc 2