Permit CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit#: PLM2017-00220
f f ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/07/2017
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 100
Project: Spec Space Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Replace restroom fixtures: (5)lays,(5)water closets&(1)urinal. Cap(1)laboratory sink and install(1)mop sink
in same location. No change in EDU's.
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: 503 624-6300
FAX: 503-296-2218
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 06/07/2017 $25.02
Specifics: 1 ea Sink 06/07/2017 $25.02
5 ea Lavatories 06/07/2017 $125.10
Type of Use: COM 1 ea Urinal 06/07/2017 $25.02
Class of Work: ALT 5 ea Water Closet 06/07/2017 $125.10
Type of Const: 1 12%State Surcharge- 06/07/2017 $39.03
Occupancy Grp: Plumbing
Stories:
Total $364.29
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 N. a ion ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir= t questions to O C ca in. 03.232.1987 or 1.800.332.2344.
Istued By: Permittee Signature: r
Call 503.639.4175 by 7:00 a.m.for the next available inspe 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
City of Tigard RECEIVE]) Received / �/ 11��]��
Date/By: if
/ Permit No.: �� go 7 IV O /
III III 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 11
C Phone: 503.718.2439 Fax: 503.5 8 60 Other Permit No.:
Inspection Line: 503.639.4175 ''' �� G Date/By:
T I G A R D Date Ready/By: Juris: Id See Page 2 for
Internet: www.tigard-or.gov Notified Method: Supplemental Information
' �' 'Of� i'1GAR
TYPE OF�(TT � 't FEE* SCHEDULE
❑New construction i .a e> oTli ' " For special information use checklist
Description Qty. Ea. 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 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: s `J- 7 i- sc.,- 51,..7., ���c.,1 cr.. Catch basin or area drain 18.76
00,,d u ./ CO
Drywell,leach line,or trench drain 18.76
�r
City/State/ZIP: l ,-5 4 rj c &Q_ ri 7:2-5 C/
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: r 5-.575-S n`` C7c i G`- 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.: alajge7 a26 l i.2- 7, /6900 Backflow preventer 31.27
ESIONF WORK Backwater valve 12.51
1 Clothes washer 25.02
i e ".'rl- %Z /2- 0.-,!f,4--i
� Dishwasher 25.02
cliP f• S-1 ta'4 Drinking fountain 25.02
�. ct,(I / .- cur''5/ 4.4 Ejectors/sump 25.02
t 0 OPE OWNER ,'t , I "TENANT �: rt; Expansion tank 12.51
Name: 4c, f Y�fr Fixture/sewer cap 25.02 ;K09-
Floor drain/floor sink/hub 25.02
Address: 1
3 f a s w S V u c`� r/i 1"..1y Garbage disposal 25.02
City/State/ZIP: j r.- Jr of. cic 1 7) L.(t' Hose bib 25.02
Phone:(4'2 3 ) C)q- (36V Fax:( ) 12.51
Ice maker
nIC ' C ACT PERS} Interceptor/grease trap 25.02
Business name: 0,,,,i 14, U.,,_4_,,,,,..2..., /J/ i Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: j-C-Q
Roof drain(commercial) 12.51
Address:
7-9 c i4 eli- 1 t-/7c f Sink/basin/lavatory C 25.02' /56./a.
City/State/ZIP: Per i- "se_ ,72 5'3 Solar units(potable water) 62.54
Phone:(c,'2 I>) 70C, 't./f ' Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal j 25.02 ,,,/5:09-
/ - -
nWater closet S: 25.02
/a 5-70' ( ' F CO tOR 443 '< r fi , -77- ,2''At'" Water heater 37.52
Business name: � (1- -e-e::,
V -- Waterg/i m DWV 56.29
P P�
Address: Other: 25.02
City/State/ZIP: Subtotal 3A')-.
Phone:( ) Fax:( ) Minimum permit fee: $72.50 " Y
CCB Lic.: [ /H// Plan review (25%of pen it fee)
-y 9' 9 Plumbing Lic.no.:2 1`->3 crVie State surcharge(12%of permit fee) 39P371
Authorized signature:/ TOTAL PERMIT FEE 3lP`t,,�
' ( Date: This permit application expires if a permit is not obtained within 180 days
Print name: "
f / aa�
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermisApp.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 Fees
Footing drain-1s`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
Other Inspections or Fees Qty Fee(ea) Total each additional$100.00 or fraction thereof,to
p 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/lir $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge 1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees* 4 Paan Review for Plumbing Install tion
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed; Capped Added Relocate
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercialirator
Domestic El Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" =$Qme f C orRiser Diagram, ; t
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Co ments regarding fixture work: w �
Oil Separator(Gas Station) e:D
Rec.Vehicle Dump Station \\\
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related rj
-Bradley
-Com/Serv/Util food related 1
-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 ej plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15575 SW SEQUOIA PKWY 100, TIGARD, OR,
97224
Record Type: Record ID:
Commercial - Plumbing PLM2017-00220
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Caulk around base of mop sink.
2. Plumbing final approved with correction.
Violation Summary:
Inspector Contractor