Permit IN 2 - CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00369
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/11/2016
Parcel: 1 S 136AD04000
Jurisdiction: Tigard
Site address: 11507 SW PACIFIC HWY B
Project: The Bridge Subdivision: VILLA RIDGE Lot: 7
Project Description: Move(1)sink,replace(2)lays&(4)water closets.
Contractor: WHITTINGTON&SONS PLUMBING COMPANY Owner: PACIFIC TERRACE COMMERCIAL LLC
6375 SW CHERRYHILL DR BY SMITH, EDITA M
BEAVERTON, OR 97008 833 NW 170TH DR
BEAVERTON, OR 97006
PHONE: 503-536-5910 PHONE:
FAX: 503-648-0617
FEES
Quantity Description Date Amount
1 ea Sink 07/11/2016 $25.02
Specifics: 2 ea Lavatories 07/11/2016 $50.04
4 ea Water Closet 07/11/2016 $100.08
Type of Use: COM 1 12%State Surcharge- 07/11/2016 $21.02
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $196.16
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 wor ,is not started within 180 days of
issuance, or ork is suspended for more the 180 days. ATTENTION: Oregon law requires you of follo the rules dopted by the Oregon
Utility 'otification Cen Those rules are set forth in OAR 952-001-0010 through OAR 952-00 -009p Yoij may ob n a copy of the rules
or' rect questions to OUN sy _ • g 503.232.1987 or 1.800.332.2344. 1
1
I-sued By: Permittee Signature:/
/_� iiiI A 1 Ili ;Y .: •/ All
Call 503.639.4175 by 7:00 a.m.for the next available inspe ti.
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 Applicatici . .-Y�
Site Utilities , , ' '� '.{ 4
ed / i� i L��D�(t?'� 2 7
City of Tigard Permit No.:
IN q 13125 SW Hall Blvd.,Tigard,O I72Zi3 �) I! Date/By:
® Phone: 503.718.2439 Fax: 503.598.1960 an Review
DateBy: Other Permit No.:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gotrNotified/Method: Supplemental Information
TYP 101�'A�it ' '�''' i, '" FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling KrCommercia1/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
(150'7 JOB St%ITE SINFORMATION AND LOCATION Site utilities:
Job site address: 14.-��' .'7 ' Ott 1� I t 1+)y- Catch basin or area drain 18.76
City/State/ZIP: I I�j ,,i n i� '} Drywell,leach line,or trench drain 18.76
/ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: The, 5ri 1x7 E,C illi rc)1 Manufactured home utilities 50.03
Cross street/directions to job site: o eprc 1.V.-( 1-1%,,i y• /S`\ij f-1,s"i"/Wts 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
mcIire S t ll k t , ✓t ... ---(Lo c3 -&e® Dishwasher 25.02
/ LO a L Q i s Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 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
0 APPLICANT i gi CONTACT PERSON Interceptor/grease trap 25.02
Business name:IA)hi, I!I`ieviy11 i ) 115 0I,(,balte°iG)�L C�7ti'yl Pk y Medical gas(value:$ ) Page 2
I 1 Primer 12.51
Contact name: Me( Wil i ,rN1' 1i / Roof drain(commercial) 12.51
Address: S C1i C i{tr%1 rc f��t if Aft= Sink/basin/lavatory 25.02 75:e40_
City/State/ZIP: .►�' Gt_i/�E'4�,`i ` VC., Cf 1-oodrp Solar units(potable water) 62.54
Phone:(503)c 36,.-SC to Fax::(h,, )(£j 044 7,... Tub/shower/shower pan 12.51
E-mail: " J. Urinal 25.02
CONTRACTOR Water closet 4 25.02 /QCP•6'1.
Water heater 37.52
Business name:
Nil 11Y1tj- y) tr1S �(,Zt +�%(E)° IILCcnt,r Water piping/DWV 56.29
Address:(r 3-9c st t� (l 1r7-bi If r 9 Other: 25.02
City/State/ZIP: eti,vee„ �� / ti I c't Z; Subtotal /75,Ig
Phone:(503 j$t S--41(L V Fax: j )( ' 'e. 6;(1. Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: :2c,-7._e2_ 94i,,Lp/l7 Plumbin Lic.no.: pd/eri 9 - �7-
f,i,
State surcharge(12%of permit fee)
Authorized signature: 7� r 7 y
TOTAL PERMIT FEE 4'8'6,16
Print name: i_ J� („ '�;�CA) Date•. /fe l/6 This permit application expires if a permit is not obtained within 180 days
" r after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1\Building 1Permits\PLMU-PennitApp.doc 10/01/09 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1g 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
Water Service-each additional 100' 37.52 Medical Gas Systems:
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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
Other Inspections or Fees Qty- Fee(ea) Total each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including$10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr and including$25,000.00.
hours(minimum charge-2 hours) $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours
Reinspection Fees 90.00/hr each additional$100.00 or fraction thereof,to
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 PIumbing Installations;
Fixture Type for Re
Work Performed: Capped Added 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 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 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 Isometric or Riser Diagram
Garbage -Domestic-non-food 0 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 /7 9 N /'-R � �/ ;/J �i Gang :4 K �D
Shower
-Stall
Sink/Lav -Non-food related 3
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet y fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\Kaleo\Downloads\PLMU PermitApp.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11507 SW PACIFIC HWY B, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2016-00369
Inspection Type: Inspector:
399 Plumbing final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor