Permit (75) CITY OF TIGARD PLUMBING PERMIT
Fri COMMUNITY DEVELOPMENT Permit#: PLM2017-00229
13125 SW Hall Blvd.,Ti Date Issued: 06/13/2017
T(GARDand OR 97223 503.718.2439 9
Parcel: 2S112 DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY
Project: PacTrust Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Relocate(3)catch basins,approximately 30'of storm sewer line.
Contractor: MUNITOR CONSTRUCTION LLC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 328 ATTN: N PIVEN
NEWBERG, OR 97132 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-504-4300 PHONE: 503-624-6300
FAX:
FEES
Quantity Description Date Amount
3 ea Catch Basin or Area Drain 06/13/2017 $56.28
Specifics: 30 If Storm Sewer 06/13/2017 $62.54
1 12%State Surcharge- 06/13/2017 $14.26
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.08
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 19RZ�� unn 32.2344.
Issued By: / Permittee Signature:
2c��+•%-2-1) r. R-OPa-Eht*+a
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.
Plumbing Permit Application
Site Utilities RECEIVED FOR OFFICE USE ONLY
City of Tigard V Y GReceived / _ Q 1 ' LH n O�et 7`QO��
Date/By: (,( fp Permit No.: �/J
IN II.it 13125 SW Hall Blvd.,Tigard,OR Tr'',c 6Plan Review
Phone: 503.718.2439 Fax: 503. ':. '60 2017
Date/By: Other Permit No.:
TI G A R D Inspection Line: 503.639.417tITy OF TIG A Date Read /B urs: ® See Page 2 for
Internet: www.tigard-or.go �r 71 Ready/By: jg�7���
p(I ryt IG DIVi i1OAt Notified/Method: Supplemental Information
TYPE }1g��llujil� Y 1+7 Ptd eyhe r a o.d)-,1t aic FEE* SCHEDULE
ID New construction El Demolition J For special information use checklist.
Description Qty. Ea. Total
❑Addition/alteration/replacement ❑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
1=IAccessory building ElMulti-familySFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
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 5(/JiM
City/State/ZIP: -N OA-- Drywell,leach line,or trench drain 18.76
k 7 Z-. +
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: FFC 24o1Zt( 1-Mt O,.
it cop a s,r-7 4Ad Manufactured home utilities 50.03
Cross street/directions to job site: R 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
_-> Dishwasher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,,,PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: _ Fixture/sewer cap 25.02
t j Floor drain/floor sink/hub 25.02
Address: {7350 S(,tl <` "tL ?'4r{- 4t CK-1A11Fy S✓fTE"3av
( Garbage disposal 25.02
City/State/ZIP: f(2 q./.1p ,... 7210-4t-- Hose bib
r25.02
Phone:( '-,' - ) 474:_4-goo Fax:(c'0'') C Z •7 52 Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: i Medical gas(value:$ ) Page 2
t 0___.V., �d't t�(3Gl(L�11\a_ Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
t Water closet 25.02
Business name: el u,,\.;i ro R ,_....,6,' ,i„ ,:-,,, ,,,t _ Water heater 37.52
ps r Waterpiping/DWV 56.29
Address: 0 350 N, Viq Aiann eie. WT1-'t/ -44e- ?
Other: 25.02
City/State/ZIP: Po 'rc,,.N D( ?7Z 1 7 Subtotal /i$, ,�,
Phone:( ) _ Fax:( ) \\
Minimum permit fee: $72.50
\ Plan review (25%of permit fee)
1
CCB Lic.: lingo Plmbing Lic.no.:FBI 6.+ 1
PA.- . , c. /2GY4-z--rr QG./ �--� (0agt c{,� State surcharge(12%of permit fee) �. j
Authorized signature: tom; �F A I ! TOTAL PERMIT FEE 133'OS
Print name: ( f�� -/ This permit application expires if a permit is not obtained within 180 days
1 -(Gtth fl r. Kit PP ke�1 l0`6�zo / 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)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtv. fee(ea) mTotal Square Footage: Permit Fee:
Footing drain-Pt 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
Qty F�(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*.
w
Quantity by Fixture Type '''''f' Plan'Review for Plumbing Installations
Fixture TypeReplace/
for Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Please check all that apply.
Baptistry/Font
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool
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.
-3"
:...
'il�Isometric a1r,Rnser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
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
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU PermitApp.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15350 SW SEQUOIA PKWY, TIGARD, OR, 97224 December 7, 2017 at
2:02:18 PM
Record Type: Record ID:
Commercial - Plumbing PLM2017-00229
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor