Permit (127) CITY OF TIGARD
R n . . COMMUNITY DEVELOPMENT PLUMBING PERMIT
t#:
PLM2016 00559
[GA&tD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/14/2016
T
Parcel: 2S112DB00100
Jurisdiction: Tigard
Site address: 15175 SW 72ND AVE
Project: LANDMARK FORD Subdivision: FANNO CREEK ACRE TRACTS Lot: 45
Project Description: Backflow preventer replacement.
Contractor: POWER PLUMBING CO Owner: UNION PACIFIC RAILROAD CO
PO BOX 19418 1700 FARNAM ST, 10TH FL SOUTH
PORTLAND, OR 97280 OMAHA, NE 68102
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/10/2016 $31.27
Specifics: 1 12%State Surcharge- 11/10/2016 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 11/10/2016 $41.23
Class of Work: ALT Plumbing
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.
i
Issued By: 4Z-f-4 e"--- .." ,
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.
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s
RECEIVED
Plumbing Permit Application
Building Fixtures NOV 9 7010 NOR OfrrcE USE ONLY
Cit R � /
IN
}�of Tigard+ fay O F TIGA Dstc/Byece" d: �� � Permit No.: "8'1,2/6` 1�� �
IR 13125 SW Hall Blvd.,Tigard,O 2. Plan Review
Phone: 503-718.2439 Fax: ION Other Permit No.:
Inspection Line: 503,639.417 >i Daie/Ry:
1 i C.n i.1.) Internet: www.ti and-or. ov NovRd/ o: lurk: S See Page 2l for
S b Notified/Method: Sapplemc�allafarmtrtion
TA'P'E.OF WORK; ' '" FEF.! SCHEDULE
New construction Fors cid information use checklist.
❑ ❑Demolition
Description Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1.2-family dwellings utility(includes 100 ft.for each utili connection)
CATEGORY OF. COrOTRUC3,'ItON SFR(1)bath 312.70
❑1-and 2-family dwelling X Commercial/industrial SFR(2)bath _ _ 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additicmal bath/kitchen 25.02
Q Master builder ❑Other: Fire sprinkler(r„r sq.ft.) Page 2
"' JOB SITE0.ORMAT10Nt'A1\D LOCATION �» Site utiliticn:
Job site address: /c/7s- 5`t.tJ 72k,°( �/-Q Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: --77,4, ,,,fO K 9 7z 2.3 ^^^
i Footing drain(nn.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 677 X 7rr r'p� 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.: Pagc 2
-• Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow prcvcntcr ' 31.27 ?J Ul
.:. .. i .. : _., . , Backwater valve
,DESCRII'TfON Ok WORK .i
r 12.51
Clothes washer 25.02
4,_i ,/ . / A. Az. I • Dishwasher _ 25.02
DrriNdng fountain 25.02
Ejectors/sump 25.02
1 I 1 0 PROPERTY OWNER,,' . :°I (� TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: _
Floor drain/floor sink/hub 25.02
Address:
. Garbage disposal 25.02
City/State/ZIP:- Hose bib 25.02
Phone:( ) Fax:( ) lee maker 12.51
e t1 APP,L.ICAN'" /_,❑;e(ANT4(PF ;e.RSON °:" Inien.eptor/grease trap 25.02
Business name: Po 1�e.vi9/(�.. bI r? (c Medical gas(value:$ ) Page 2
Contact name: yy�
Primer 12.51
pit./ JAJa///TA-'c`L---) - Roof drain(commercial) 12.51
Address: (-#f//f 5ti >I u/h7 6 -14 /6/Ceca't Sink/basin/lavatury 25.02
City/State/ZIP: 126 LG zi� Q 9 722 3 Solar units(potable water) 62.54
Phone:(ray) '1-/W-/9;A!) Fax::( , G. 4/4"._,5i.Re Tub/shrnver/showcrpan 12.51
E-mail: ' p P/ `-, ✓if /A // _ Ce,. •,` Urinal 25,02
Water closet 25.02
8 CONTRA , e R c -
Water heater 37.52
Business name: Pf)(itiatk.r '21uinb/ 69 Water piping/DWV 56.29
Address: f 60 x `9''/g J Other. 25.02
City/State/ZIP: t tJ) I a, W, 0 r q-7.2. Subtotal 3 I..)-]
Phone:(5.33) 2 i/• Fye:(,9)3 ))y�_ 8g2S-
Plan
S _ Minimum permit foe: $72.50 Z_
Plan review (25%of permit fee) _______--
CCB Lie.: Cr Z 3-74c' Plumbing Lic.no.:3 L /,._./d) v b
State surcharge(12%of permit fee) -70
Authorized signature: V.,(4.4„),..4 0_ aed .5' TOTAL PERMIT FEE g) 2 D
I • Date: I this permit application expires It a permit is not obtained within 180 days
Print name. I /14 atter it has been accepted as complete.
"Fcc methodology set by Tri-County Building Industry Service Board.
I:1nuilluk•1PertnitAFLMU-Poi iApp.io RNIAI9 44t}4c111'ti(M12/COM/WKR)
NOV-0E1-2016 01:59 From: To:5035981960 Page:2/2
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • �� Fee(ea) ' Total Square Footage: •Permit'Fee:
Footing drain- 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.522.001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $32754
Sewer-each additional 100' 37.52
Water Service-1st 100' -62.54 Medical Gas Systems:
Water Service-each additional 1(X)' 37.52 ,
Storm&Rain Drain 1st 100' 62.54 Valuation:,. , Permit Fee:.
_ $1.00 to$5,000.00 Minimum fee$7250
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $7230 for the first$5,000.00 and$1.52 for
Other Inspections or' 'ees �3 )Fee lea), Total
each additional$100.00 or fraction thereof,to
•� _aridincluding$lo,000_oo-
inspection of existing plumbing or for $10,001.00 co$25,000.00 $148.50 for the first$10_,000.01)and$154 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 53793(1 for the first$25,000.(X)and$1.45 for
hours(minimum charge• 2 hours) each additional$100.00 or frdctiom 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 $742.0(for the first$50,000.00 and$120 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*.
Quandy by Fixture Type; Plan Review for Plumbing Installations
Fixture Type for ''d' • 'Replace/
Wnrk Performed: ,Capped Added r Retacate r Plan review is required tOr any of the following,
Baptistry/Font W Please check all that apply,
Bath Tub/Shuwer ❑ 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 Tluv ❑ 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 ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0(W).
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plaits with any of the above.
-3,.
Isometric or Riser Diagram
Car Wash Drain
Garbage Domastio�ron-food
0 Isometric Or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-ludusurial-food related
Ice Mach/Rcfrig.Trains
Oil Separator(Gas Station) Comments regarding fixture work:
Roe.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food cial-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 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: Fib Lyn +
h tlp:l/w ww.tigard-or.gov/document_center/Bui lding/PLMF_Perm itApp.de