Permit (33) °Plumbing Permit Anplicatioln '! 'j
Building Fixtures I c.It Oh 1r icr; USF. (iNLI
City of Tigard MAR 6 �O Received 3a2t /s ' PermitNyDL 12o,t_ 2/3-3
14, 'a 13125 SW Hall Blvd.,Tigard,.OR 97223 Plan Review -��/! 19003
Phone; 503.718.2439 Fax: 503.598. 960'Il i Date/BY; Other Penni !
Inspection Line: 503.639.4175 a 1 1` TIC Utt /�/ loris EI See Page 2 for
1'1 C;A rt17 Date Ready/B} /-Z g
Internet www tigard or gov er s V a Notilied/Method:'
Supplemental
Spp km¢ntaInformation
Crmation
I � ti_ . rt, lFmvk tt' { pM�w4e y� r r- �c _ '47-,:l-' tt1l, * 3flll�l ` u#, 7t 1;:''''''','
i..a
u;.r4:rS � ui�J'�4ki"f$. „414ai lutkEliAittitf11�f:iSti2 ,iliti7lil�fliI31LAE1�iiHa:m :..;7.;, .pt.rifi45. i,l,,,v ,';,,t, 1 �4 Jr lfY 'ftM7�' i„ n. 7, 'I' '' ' i'lY..
'ilI•t.
[)New construction ❑Demolition r1' /Z' /^s f> KrFor;pedal irfjorm:Mien use checklist.
Description ( QtY. I Ea. I Total
El Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
• I �.ilE 1 Iq 7 ,4 i,'+• '',,.011;,'„ t >`i tl t'k 74 If t�"11 fr�lil
l.•;,,,,,44:s ,'4g. * , 1 'is i} ' .4?`t-:� edr s ?A. ,�" 2i41 5-12i4145it ,' !1;21L-.Cf l 2r.224"'
C'UR�'1`2 `,
SFR(I)bath .. 312.70
El i-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq-$.) Page 2
1 1' 1L4Sl '•(li ., ,.^.';'''''
1 44«,816 Ui hit : t L C"' r ,I nyl; M�`{ ;M l 3 i. �r,...
b �,a �,, l l'•t ,tt n @4r, t ty' l,?tr s n1 fL Site utilities:
l" ';t.r'iew...a-,.si '2Tn NA,1-444147.1/4 �i .�' y;2'.� -r,�S,�'MJllS�r..,.. ,',A',.'Ju ��l .EI{.:`
Catch basin or area drain 18.76
Job site address_9735 SW Shady Lane
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 �Fo�oting drain(no.linear ft.; ) Page 2
Suite/bldg./apt,no.:201 Project name: "--671/6-7-1) .SC CTP -col7It,lbthnufactured 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: Lot no.: Fixture or item:
Tax map/parcel no.: Y Backflow preventer 31.27
1 lire! A + 'r +tiff & 'r: r, 1 n c t i'''' r iL,,Lii ly r fm o-q k Backwater valve 12.51
r 1S' i + t 8��,my1 li,14STt f4 Y ��' '�Y�,.a�'N:. j , i. a
rf+��'' l�r �7(f 1�:R}�a,}�� 4nr.l''.Y.I�X�r �'R,�1?��(�'�',GA...r�'n: � `.�ii�:':w':vL'a .'_�i, ��.�t.rf!a M 1 t4 It' i Clothes washer25,02
Rough in and finish for 2 lava and move rough in and set finish for 1 lay Dishwasher 25.02
Drinking fountain 25.02
yyii tt Ejectors/sump 25.02
y 4 r 3:'. r „�..fit 4 ie, uun y„• 'R:Rilli g i ilii S>1IIT'i'<° Expansion tank
.,.l�flliii + 1•,,.7.' F4IF ,`�'v' E l''Rt4P' o-. Nil. !':1..+rl ri¢ P 12.51
." Fixture/sewer cap 25.02
Name:
w,... - -- Floor drain/floor sink/hub 25.02
Address: --
Garbage disposal • 25.02
City/State/ZIP: dose bib 25.02
Phone:( ) Fax:( ) gy�p$ Ice maker 12.51
ft.' jf ,'a`ii ( a IO'iii'i'r tl 3 4 r,t?Ctii ' ail @' ,1Its 7 „int ,ry 0,'4Ji interceptor/grease trap 25.02
Business name:Cascade Plumbing Service Co. Medical gas(valve:$ ) Page 2
Primer 12.51
Contact name:Lindsey Long Roof drain(commercial) 12.51
Address:PO BOX 112 Sink/basin/lavatory 3 25.02 75.06
City/State/ZIP:Woodland,WA 98674 Solar units(potable water) 62.54
Phone:(503)544-7454 Fax;:(360)841-8298 Tub/shower/shower pan 12.51
.-,- Urinal 25.02
E-mail'CaseadePlumbingService®gmailcom
"¢Pr M llllnll .iii Iit , i ?k' I A, .6.�+4 1 r Rit 'µvotn ,I3Sl , . Water closet 25.02
1ia'. P =t ,. ltkib ":..iLli3 . :.:4.1'',,
i.litP Water heater 37.52
Business name:Cascade Plumbing Service Co. Water piping/DWv 56.29
Address:PO BOX 112 Other: 25.02
City/State/ZIP:Woodland,WA 98674 Subtotal
Phone:(503)544-7454 Fax;(360)841-8298 Minimum permit fee; $72.50
Plan review (25%of permit fee)
CCB Lic.:120893 PlumbiLic.no.:34-412PB -
r� State surcharge(12%of permit fee) q t 0/
Dtre �� A
Authorized signature: (77rr�(( TOTAL PERMIT FEE r4/t 0 7
Thls permit application expires if a permit is not obtained within 180 days
Print name:Lindsey L�
/ �7ate:3/26/2018 after it has been accepted as complete-
'Pee inetbodology set by Tri-County Building lodustfy Service Board.
1:\auilding\P6+mitsU't.MU-yermitApp.doc 10!01/09 440-461GTO o/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sup•ression S stems:;.h.,„ ua r. (` �r� n4 " dkd " d t� i. dd11��Emt t.{ „,`Y4; i ” irl
an
'v A +
Footing drain-1"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 S stems:
Water Service-each additional 100' 37.52 1?. { 9F iar ,«bt,?ruGa� °ya nfrn � x
thrStorm&Rain Drain-lst 100' 62.54
$1-00 to$5,000.00 Minimum fee$722.50
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
i'° '�', i;, "•,r" "1s? each additional$100.00 or fraction thereof,to
a °a �' � ° 7.p:l+i t } {?+ k Irtllva r} 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$1,45 for
hours(minimum charge-2 hours) each additional$(00.00 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 charg2 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*.
.' iii
i;
.'+.�e.,.i..: �,�dr:��1�S: r :+ ;So a r1iRqz 4�r.i2. ° Eyln,y,,t�t4 '�i. T� „'#;; t•, } �'�'3y1't1+.1i '(P� fl
@r, .tR,3'Y 7S r1�t}uniir " c ,1� • g a,� } �..i4” .}l �J r.,lt'� -. r• ..�,Gn•;.�aY',S_. i1tKt!f +
f.. t.' ° ,y} f In�,r:t' Q t.°a wmn sk P ,A �A�n�„i� n° .r., kd,.n r.�iM•.,�.r. m.rtu1 ,ddi�'.�wi mi�r R,*� °.
w;t 'aM ? ''!i'16',r int i °1 I Plan review is required for anyof the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
-Jactuzi/Whirlpool — greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer,
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator - as defined in OgR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-DomesticCI Any multipurpose fire sprinkler system_
Drinkin_Fountain .- ❑ Any complex structure as defined in DAR918-780-0040,
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4"
Car Wash Drain ., : } i hc .,
' 14:0.1x:1., alum 1k tit 1".•tfi} i .,
Garbage -Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestio-food related - that meet the qualifications above.
-Commercial-food related _
-Industrial-food related
Ice Vlach./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_
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal ,--'_ plumbing permit can be issued.
Other Fixtures;
C:1Users\Gary Long\AppData\Local\Packages\Microsoft-MicrosoftEdge_lwekyb3d8bbwelTempstate\Downloads\PLMfrPermitApp.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9735 SW SHADY LN 201 , TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00133
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor