Permit (31) v111CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018 00181
TILaA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/26/2018
Parcel: 2S102AB05800
Jurisdiction: Tigard
Site address: 12345 SW MAIN ST, STE#201
Project: Tigard Chamber of Commerce Subdivision: 1996-026 PARTITION PLAT
Project Description: Interior plumbing for TI:CappingLot: 1
(1)garbage disposal;Relocating(1)dishwasher and(1)sink.
Contractor: THE TASK MAN LLC Owner: TIGARD AREA CHAMBER OF COMMERCE
15450 BOONES FERRY RD#9-365 12345 SW MAIN ST
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
PHONE: 503-351-3160 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 04/26/2018 $25.02
Specifics: 1 ea Fixture/Sewer Cap 04/26/2018 $25.02
1 ea Lavatories 04/26/2018
Type of Use: COM $25.02
Class of Work: ALT 1 12%State Surcharge- 04/26/2018 $9.01
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / IIIIIIIIIW permittee Signature:
____..z2.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures 'M E1 FOR OFFICE ISE ONE1
City of Tigard it
Received 2r
13125 SW Hall Blvd.,Tigard,OR 97223III Date/By: lac1$ 8�- Permit No.: „/y) �i
e Ill Dan Review it Y t �p'*(�J,��
Phone: 503.718.2439 Fax: 503.598.1960 D 2 ` ZD�� t t
Inspection Line: 503.639.4175 HV Cx Date/By: Other Permit No.:
r / C.b i�l
TIC ARD Date Read /B
Internet: www.tigard-or.gov f ri lb NoY y: Jur See Page 2I'or
` (1 tified/Method: Supplemental Information
TYPE OF WORKet V rVlS1ON FEE* SCHEDULE
aD New construction1 !* For special information use checklist
Addition/alteration/replacementDescription Qty. Ea. Total
0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-and 2-family dwelling '[Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other:
JOB SITE INFORMATION AND LOCATION Fire sprinkler( sq.ft.) Page 2
Site utilities:
Job site address: C ` , /„i Al S i F 24,1d
p Troup Catch basin or area drain 18.76
1yJ S+v ma,/ GC
City/State/Z1P: j �! D� q 7 Z Z Drywell,leach line,or trench drain 18.76
� �1 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:
Manufactured home utilities 50.03
Cross street/directions to job site: Cb a,rd 1F- u�
(j/� `fi A/ VPQr Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Subdivision: I Water service(no.linear ft.: ) Page 2
Lot no.: Fixture or item:
Tax map/parcel no.: Z £1278-a6ib Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
e01011-(2- Al�I(bCt- (ba-Se 5���� /11�� 1 Clothes washer 25.02
/ ,,�y d� � Dishwasher 25.02 ���,I
6 `�V`► pit-4411,0i
i �0 bPP l 5(4 6 • /7 Drinking fountain
25.02
Ejectors/sump 25.02
%PROPERTY OWNER ' I ❑ TENANT Expansion tank 12.51
Name: /, Fixture/sewer cap / 25.02 2,5;0,2..Address: jv 5 S eu/4 Floor drain/floor sink/hub
.��-- 25.02
City/State/ZIP: Garbage disposal 25.02
/ Hose bib 25.02
Phone:O �a``�-76,es Fax:( )
Ice maker 12.51
LICAPIT`_
` '�'� APP � ❑'CONTACT PERSON..; ",w ' Interceptor/grease trap 25.02
Business name: *� 4.c��_ Medical gas(value:$ ) Page 2
Contact name:
b(/ .Gic Primer 12.51
� CT-0
Address: /2_3T 5 S 1 Roof drain(commercial) 12.51
{�{CLlIY Sf1'�Q-i" Sink/basin/lavatory / 25.022..s---,0)„,
City/State/ZIP: K / e)� '77 2.2 3
`
'�., Solar units(potable water) 62.54
Phone:( )6,3 _/108-3 I Fax::( ) Tub/shower/shower pan 12.51
E-mail:f&x5 ,cPc /_ _ -_ Urinal 25.02
CONTRACTOR U•J`7 Water closet 25.02
Business name: Water heater 37.52
1 it" -a G.,`it'i)1v�A Waterpiping/DWV
Address: /U‘ (o7 6,.SLik- AZ.e_ V4Z 56.29
Other: 25.02
City/State/ZIP: 2.a.-1/,e_ 0629 ) oR C;7
Phone:(�j ) �� l Subtotal 1571.3r‘,l t)� /6(p/ Fax:( ) Minimum permit fee: $72.50
CCB Lic.: i 6-4 7 7 8/ �� /14/r�/ Plumbing Lic.no.: pe, //074/ Plan review (25%of permit fee)
Authorized signature: '�/�iie
State surcharge(12%of permit fee) - !JJ
TOTAL PERMIT FEELT 5V'7
Print name: -�, / l�1 j/ l j Date: '/ '/,3' This permit application expires if a permit is not obtained within 180 days
/!' tl after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building1Permits\PLMU-permitApp.doe 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(e8) Total Square'Footage: Prmit Fee:
Site Utilities oto 2,000 $121.90
Footing drain-1"100' 50.03
2,001 to 3,600 $169.69
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
ValuationPermit 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
each additional$100.00 or fraction thereof,to
Qty, Fee(ea) Total and including$10,000.00.
Other,Inspections or Fees '. . _
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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr 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*. Plan Review for Plumbing Installations
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 ❑ 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic VL210Ca.k 1
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3„ Isometric or Riser 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 1 v'errio/fit
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall �,b gM"���//
or^
Sink: -Lav/Bar non-food related S► °
-Bradley �.,�
-Com/Serv/Util food related
-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 plumbing permit can be issued.
Water Closet-Toilet
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:
12345 SW MAIN ST STE 201 , TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00181
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor