Permit (258) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00532
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/21/2017
Parcel: 2S112AB02300
Jurisdiction: Tigard
Site address: 14150 SW MILTON CT
Project: Medical Teams International Subdivision: BONITA INDUSTRIAL PARK Lot: 5
Project Description: Relocate on break room sink.
Contractor: CASCADE PLUMBING CO Owner: MEDICAL TEAMS INTERNATIONAL
15765 SW 74TH AVE PO BOX 10
TIGARD, OR 97224 PORTLAND, OR 97207
PHONE: 503-289-7095 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 12/21/2017 $25.02
Specifics: 1 ea Sink 12/21/2017 $25.02
1 12%State Surcharge- 12/21/2017 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 12/21/2017 $22.46
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20 I
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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: e"AI .� /
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 ApplicaNECEIVED
Building Fixtures um 01.1 1( I. ISI O'sl ,
City of Tigard D E G 1 $ Z017 Received
4 Dat:z; /2/Z//7 ' Permit N/�'�fr702vi -00592_
11111 13125 S W Hall Blvd.,Tigard,OR 97223 (� �g
0 Phone: 503.718.2439 Fax: 5c oFi lIGARI,f Date/Be,.tew Other Permit No.:
Inspection Line: 503.639.4175 y
T 1 e, \r.I) I Date Ready/By: Suns- ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
ElAccessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler p ( sq.ft.) Paget
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:14150 SW Milton Ct Catch basin or area drain 18.76
City/State/ZIP:Tigard Or 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:NW Medical
Manufactured home utilities 50.03
Cross street/directions to job site: End e4 L T 97'95 /4/T, Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:�) Page 2
Storm sewer(no.linear 0.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Relocating one break sink Clothes washer 25,02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap I 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
-
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Quality West Plumbing Medical gas(value:S ) page 2
Contact name:Bekka Greer Primer 12.51
Roof drain(commercial) 12.51
Address: 15765 SW 74th Ave#1104
Sink/basin'lavatory I 25.02 I
City/State/ZIP:Tigard Or 97224 Solar units(potable water) 62.54
Phone:(503)2897095 Fax::(203)2839514 Tuh/showedshower pan 12.51
E-mail:CascadeplumCyahoo.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Quality West Plumbing DBA Cascade Plumbing Water pipingDWV 56.29
Address: 15765 SW 74th Ave#1 104 Other.: ' 25.02
City/State/ZIP:Tigard Or 97224 Subtotal
Phone:(503)2897095 Fax:(203)2839514 Minimum permit fee: 572.50
CCB Lic.:204392 if Plumbing y.ji,b3,,,,,...„Lic.no.:PB1528 Plan review (25%ofpenult fee)
State surcharge(12%of permit fee)
Authorized signature: •
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO days
Print name:Bekka Greer Date: 12/18/2017
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I.nuildinP Pcnuits PIAlt i•Pcrmit App dot 10 01 IIs 440-46101(10 02 f0M1 WLR)
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 Fee:
Footing drain-I"100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 5169.69
Footing drain-each additional 100' 37.52 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
Fee(ea) Total each additional 5100.00 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 S100.00 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for
Added RRelocate Plan review is required for any of the following.
nt
Work Performed: Please check all that apply.
Baptistry/Font
0 Any new commercial building with water service and
Bath -Tub/Shower
- greater,except systems designed and stamped by licensed
ioWhirlpool
Car Wash -Each Stall engineer.
-Drive mm 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 OAR9I 8-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain 0 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 1
-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:
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