Permit CITY OF TIGARD• PLUMBING PERMIT
$11i COMMUNITY DEVELOPMENT
Permit#: PLM2017-00084
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/14/2017
T t r;; lt.r i 9 Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15495 SW SEQUOIA PKWY 100
Project: Kinetic Computer Solutions Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Relocate(1)break room sink and(1)water closet for TI.
Contractor: DEAN WARREN PLUMBING&REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 ATTN: N PIVEN
PORTLAND,OR 97293 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-236-4152 PHONE:
FAX: 503-296-2218
FEES
Quantity Description Date Amount
1 ea Sink 03/14/2017 $25.02
Specifics: 1 ea Water Closet 03/14/2017 $25.02
1 12%State Surcharge- 03/14/2017 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 03/14/2017 $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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/Air
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available insp"�on 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 /? . FOR OFFICE. ISE O\l.l
City of Tigard @ Received /f 77 4p4,..._ leak
f 1 A R 1 4 2017
Date/By: 3/14,///7
!y/ l Permit No/If-APO//`(/G'L'o
eir
1114 . 13125 SW Hall Blvd.,Tigard,OR 97223•
_ Plan Review
Phone: 503.718.2439 Fax:
503.59 . 0 .1.-;
�(� y � Date/By:
Other Permit
^
Inspection Line: 503.639.4175 ' � �
TICAItD s ., ,° ,O KDate Ready/By: Juris: El See Page 2 for www.tigard-or.gov ! ILi 't 4`" :
Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description I Qty. Ea. Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF aCONSTRUC OON SFR(1)bath 312.70
❑ 1-and 2-family dwelling ,%1 Commercial/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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
/> YS� s SSG C' t / td_�
Drywell,leach line,or trench drain 18.76
City/State/ZIP: T is...),-.1 >) yu Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: fa-6 I Project name: f7(%La;7`t c: 4./x'6 J/C_..., 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
........ ...............
I?)SCRIIPTION OF`"WORK Backwater valve 12.51
` Clothes washer 25.02
/,e.!oc a JC-t /5y 5, Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER -TENANT; Expansion tank 12.51
Name: / Fixture/sewer cap 25.02
��C Tis
Address: 356S cs- s (2q CJof 74.rt Floordrain/floorsink/hub 25.02
/ Garbage disposal 25.02
City/State/ZIP: r-054.,,d aj 7 2 2 Cr Hose bib 25.02
Phone:( ) a y!(-C 3 a a Fax:( ) Ice maker 12.51
_;AEPLICAI�TC ` ❑ CONTACT PE ?N Interceptor/grease trap 25.02
Business name: 0,,Z, u„,r(v',yyy,-/1 ,(7(/tom c / Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: "Jc. /L�,,)_ Roof drain(commercial) 12.51
Address: i''' 0 g et?c,1 Sink/basin/lavatory t 25.02 2_3":pZ
City/State/ZIP: /., 6.271, of 7) 1� ? Solar units(potable water) 62.54
Phone:( {,ag) ':76 c'- 94,$c Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRt1CTOR Water closet 25.02 Z s dZ
Water heater 37.52
Business name: 7`' C��, AJ 4,9 e, /04.0116` E-- Waterpiping/DWV 56.29
Address: �L- Other: 25.02
City/State/ZIP: Subtotal Sk.{i Y
Phone:( ) Fax:( ) Minimum permit fee: $72.50 71,j a
CCB Lie.: / $-y 9/q Plumbing Lic.no.: C 73 6--/4' Plan review (25%of permit fee)
//{�f State surcharge(12%of permit fee)
Authorized signa �_"!s TOTAL PERMIT FEE Jj,,,0
Print name: .)--0,. /� Date:?-I y.,r
This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) /6 X . `
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities; • Fee Total Square Footage: Permit Fee:
Footing drain-l'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
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 Inspecti•ons or Fees Qty. Fee(ea) Total
each additional$100.00 or fraction thereof,to
hand 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*. Plan Review for Plumbing Installation;-
Quantity by Fixture Type Plan review is required for any of the following.
Fixtu ,Type for Replace/" Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
Jacuzzi/Whirlpool
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
-3" Isometric or Riser Diagram
4„
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice MachiRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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