Permit (100) CITY OF TIGARD PLUMBING PERMIT
IIII '' COMMUNITY DEVELOPMENT Permit#: PLM2017 00459
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/07/2017
T1a'Ae 9 Parcel: 2S112DD00300
Jurisdiction: Tigard
Site address: 15900 SW 72ND AVE
Project: 76 Gas Station Subdivision: None Lot: None
Project Description: Interior plumbing. Replacing water lines for the following fixtures:(1)hose bib,(1)primer,(5)sinks,(1)water
closet,and(1)water heater. SDC fees do not apply.
Contractor: PLUMBING CONCEPTS INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 1068 BY APRO LLC
CLACKAMAS, OR 97015 17311 S MAIN ST
GARDENA, CA 90248
PHONE: 503-658-5232 PHONE:
FAX: 503-658-5232
FEES
Quantity Description Date Amount
1 ea Hose Bib 11/07/2017 $25.02
Specifics: 1 ea Primer 11/07/2017 $12.51
5 ea Sink 11/07/2017 $125.10
Type of Use: COM 1 ea Water Closet 11/07/2017 $25.02
Class of Work: ALT 1 ea Water Heater 11/07/2017 $37.52
Type of Const:
1 12%State Surcharge- 11/07/2017 $27.02
Occupancy Grp: Plumbing
Stories:
Total $252.19
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 mayobt 'n a y of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/ G/ �C_.
Issued By: /" 444
_‘ •- i ittee 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.
Plumbing Permit Application
Building Fixtures ' FOR OFFICE t SE o 1.1
City of Tigard Received �'
Date/By: / �7 I Permit No �A�/�/7.Wj G/
Ill 41 13125 SW Hall Blvd.,Tigard,OR 97223 NOV 7 2017 6 / /
L^"r��l/ �/0 L
_ Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175
11 G A R D Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
:<t
""_ TYPE OF WORK FEE* SCHEDULE '
0 New construction 0 Demolition For special information use checklist
Description I Qty. I 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 yCommercial/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: 1" Catch basin or area drain 18.76
/5 00 5-lV w//7a/ ire
City/State/ZIP:���, , Drywell,leach line,or trench drain 18.76
1/1 c2c + 02 I L _J r Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: J I Project name: 1/121 i 6✓/(1c) J 7415b Manufactured home utilities 50.03
Cross street/directions to job site: 7(, ,-:.z�
CManholes 18.76
l o/�/`5,_ 1 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
A- rBackwater valve 12.51
_ DESCRIPTION.;QF WORK -464,-
/� /� j) lr' /' �
Clothes washer 25.02
/ (g I f/ E t.( / i J Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ P tWPERT OWNER ,,." td,,„ NANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
/ Garbage disposal 25.02
City/State/ZIP: Hose bib / 25.02
Phone:( ) Fax:( ) Ice maker
12.51
10 APPLICANT " CONTACT PERSON= Interceptor/grease trap 25.02Business name: Medical gas(value:$ ) Page 2
Primer / 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 5 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal
E-mail: / -, .. _ ; 25.02
I/? C �]�h//9)Ij1/?Cs (r, /? • (,� - Water closet / 25.02
//21-,.,„,b
,,1,,CONTRA ,R Water heater / 37.52
Business name:
�i/ia/1),6I/7 - ("re- , i/70._ Waterpiping/DWV 56.29
Address: / Cj r5 v /0/f Other: 25.02
City/State/ZIP:6 /aC kaiv 4-3_5 i O) 976/5 Subtotal
Phone: Fax: Minimum permit fee: $72.50
(l 75s,7 /-r / umbing Lic.no. G�J R� Plan review (25%of permit fee)
CCB Lic.:
-
---,.------.-' Pr State surcharge(12%of permit fee)
Authorized sign
e____--- TOTAL TOTAL PERMIT FEE
Print name: - Date://,_/ /7 This permit application expires if a permit is not obtained within 180 days
L% yN U 1/ 7 / 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:
Qty. Fee, Total uaree-Foo e: Permit Fee:
Site Utilitres . �q
Footing drain-151 100'cM 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. Fee(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
(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
i
accurately report fixtures could result in increased sewer •es*. '.Flat#Review for Plumbing Installatio
Quantity by Fixture Typ= Plan review is required for any of the following.
Fixture Type for R ' aeel Please check all that apply.
Work Performed: Capped Added •elocate ❑ 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 ❑ 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" Isomeric or tisgr.Diagram
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 Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-foe• related
-Bradley
-Com/Sery it food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool F.ter increase of sewer EDUs,a sewer permit will be issued and
Washer-Cloth:: fees assessed for the sewer increase must be paid before the
Water Extract',
Water Closes -Toilet plumbing permit can be issued.
Urinal
Other F. tures:
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:
15900 SW 72ND AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2017-00459
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor