Permit (57) CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit#: PLM2016-00540
Date Issued: 10/27/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S 27/201 0600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Clean Water Services-Solids Building Elevator Power Subdivision: None Lot: None
Project Description: Add Eemax heater to existing janitor sink.
Contractor: YORK CUSTOM MECHANICAL Owner: BURLINGTON NORTHERN INC
PO BOX 21474 PROPERTY TAX DEPT
KEIZER, OR 97307 PO BOX 961089
FORT WORTH,TX 76161
PHONE:
PHONE: 503-554-1771
FAX: 971-273-0647
FEES
Quantity Description Date Amount
1 ea Water Heater 10/27/2016 $37.52
Specifics: 1 12%State Surcharge- 10/27/2016 $8.70
Plumbing
Type of Use: COM 35 ea Minimum Fee Adjustment- 10/27/2016 $34.98
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ! 4 Permittee Signature: 4, , v/696.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
EPlumbing Permit Application. .4 (6iiq/ j✓l 15-2J)`}f
Building Fixtures rc,l< .)rl-l( l•. l `+r 10.1 l
nr'City of Tigard r 2 lcRecelava to v /to 41-A-10210/6,e(cqc
Permit N961
11,. m 13125 SW Ball Blvd.,Tigard,OR 97223Plan Review
h ��'
• Phone: 503.718.2439 Fax: 503.598.1960`' 1I.(JAYICI Datx/8y; Other PannitNo.:
Inspection Linc: 503.639.417$ _,.:.� .-,... bate Ready/By: )�uis: See Page 2 for
TIGARD
Intertlet: www.tigard-or.gov Notified/Method: Suppiementat Information
': TYPE OF WORK - • FEE* sCBEDIJLE •
0 New construction . ❑Demolition For s'edrilIn ormatlon use checklist.
Description •ty. Ea_ Total
E Addition/alteration/replacement ❑Other: New 1-2-tinnily dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRLCTJON SFR(1)bath ---- 312.70
0 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
-� --µ SFR(3)bath 500.32
❑Accessory building ❑Multi-family Bach additional bath/kitchen 25.02
Q Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
y
JOB srrE 'INFORt1LATION AND LOCATION Site utilities:
Catch basin or arca drain 18.76
Job site address:1.6580 sw 85th Avenue --�-� --
- Oiywcll,leach lint,or trench drain 18.76
City/State/ZIP:Tigard
------ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:1Diosolids Dewatering bldg 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: Lot no.: -Fixture em:
Tax map/parcel no.: Backflow preventer 31.27
17Y SCR1FTION'1JF WORKBacF:watervalve III12.51
' Clothes washer 25.02
Add Eemax-heater to existing janitors sink bishwashcr _ 25.02
1]rinlanq fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER ❑ TENANT.' Expansion tank 12.51
- Future/sewer cap WIIIII 25-02 III
Name: -
____ - Floor drainkloor sink/hub 25.02
Address: Garbage disposal 2502
City/Slate/ZIP: L Hose bib 25.02
Phone:( ) Fax:( ) ^Tec maker ill 12.51
1 APPLICANT 0 CON'1-AC1' PERSON Interceptor/grease trap 25,02
Business name; York Custom Mechanical Inc Medical gas(value:$ ) Page 2
... ._.... 1 Primer 12.51
Contact name:Travis York
,,__- Roof drain(commercial) 12.51
Address:PO Bos 21474 Sink/basin/lavatory 25.02
City/State/ZIP:Keizer,OR 97307 Solar units(potable water) l 62,54 Phone:(503)932-8764 Fax::(971)218-0647 Tub/shower/shower pan 12.51EMS
E-mail:travis.yorkZyorkcustotti.coen Urinal
• Water closet 25.02 im
CONTRACTOR - Water heater 37.52
Business name:York Custom Mechanical Inc Water piping/DWV 56,29
Address:PO Bus 21474 Other: �_ 25.02
IIAI
City/State/ZIP:Keizer,OR 97307 _ Subtotal
Phone:(503)932-8764 Fax;(971)273-0647 Minimum permit fee: $72,50 72.5
._- Plan review (25%of permit fee)
CCB Lie.:203341 Plumb- Lie,no.:54700 State surcharge(12%of permit fee) 8.70
~y
Authorized signature: TOTAL PERMIT FEE 81200
I Print name:Travis York -Date:10/13/16 Till permit application expires if a permit is not obtained within 180 days
after it has been accepted as comiltetr_
*lee methodology set by Tri-County Building Industry Service Board.
r:1s,.il&og\Parmiu\PLNILY-hmriiApp.aa: 10/01/09 440-0616T(t0/02/COM'WsB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site titilittes Qtr. Yee Oa) - 'roil' Square Footage: Permiit Fee: .
Footing drain-is 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:. .Perinit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm it Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 arid—S-1.52 for
Other inspections or Fees lee ea) 'E'otal each additional$100.00 or fraction thereof,to
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 Sec is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum char.•-.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 char e-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr �� and including$50,000.00.
$50
Additional plan review for revisions 90.00/hr ,001.00 and up $742.00 for the first$50,000.00 and$i.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing frxtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
9uantktjy by Fixture Type Plan Review for Plumbing Installations
fixture'type for Replace./ Plan review is required for any of the following.
Work Performed: Capped Added Relocate W
Please check all that apply.
Saptistry/Font EI Any new commercial building with water service 2"and
Bath -Tub/Shower i
greater,except systems designed and stamped by Iieensed
-Jacuzzi/Whirlpool
Car Wash -Each Stallengineer.
-Drive Thm a . 0 New exterior plumbing site utilities for at),complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040,
Dishwasher -Commercial CI Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinki •Fountain r El Any complex structure as defined in OAR918-780-0040.
5ye Wash -_' -__-
- -
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or er Dia ram
Car Wash Drain
Garbage -Domestic--non-food Isometric or riser diagramttisis required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Rcfiig,Drains
Oil Separator(Gus Station) - Comments regarding fixture work:
Rec.Vehicle Dump Station •
Shower -Gang
_ •Stall
Sink/Lav -Non-food related
-Bradley
-Conunercial-food related „_
-Service -
Swimming Pool Filter , -,. *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer ED[Is,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: .
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