Permit (261) CITY OF TIGARD PLUMBING PERMIT
1111 • COMMUNITY DEVELOPMENT Permit#: PLM2013-00278
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013
Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY D
Project: Rite Aid Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: Relocating and replacing existing drinking fountain with water cooler.
Contractor: CASCADE PLUMBING CO Owner: SN PROPERTIES PARTNERSHIP
2416 N HAYDEN ISLAND DR 1121 SW SALMON ST
PORTLAND, OR 97217 PORTLAND,OR 97205
PHONE: 503-289-7095 PHONE:
FAX: 503-283-9514
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 08/08/2013 $25.02
Specifics: 1 12%State Surcharge- 08/08/2013 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 08/08/2013 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ermittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures FOR OFFL(:ct t;si•: Otill
City of Tigard RECG FIV1 •,,-4 131:5 SW Nall Blvd,Tigard,OR 97223 �,�
111 Plan Rvvicw R Phone: 503.718,2439 Fax: SU3.598.1 2013 Welt : Other Pcmat No.: '67 /go f •.-CJd/ 2.
Inspection Line: 503,639,4175
I I e., 1 t� bate Ready Hy funs. fa Ste Page 2 for
Internet: www.0 rd-or ov
! F !II Notified/Method: f Supplemental Information
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❑ New constrvcuon ■ Demolition
„ Fo�ecial information uye dteck1L$
�-- I)ccc ri a<tt Qly. [ F741. vow
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�dd ❑Other: j New 1-2-family dwellings(includes 100 11.fire each utility connection)
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L,a t,,yia';•:II'd,(1r 11,,u11 n , ,i I,h 1' SFR 1 bade 312.70
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❑ 1-and 2-family dwelling
xnnarctal/intustriti SFR--(2)KIM ------
437.78
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---- --
Ft i3 tatt
500.32 Accessory buildin g ❑ Multi-family
•. _m. .---.---._ . - --_ _. - _ c n bath/kitchen 2 5.02
I
� ---,-----❑Master builder ❑Other: Fire
sprinkler( u).fl.) Page 2 1
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a • �catch beam or area'mitt 18.76
Job site address: jj�i� c C. 5�� �i ; l } t L_ 1
-' ' '" "" -I 6--'- .°-.- � -- " D ywcll,leach line,or trench drain 18.76 ----
City/Statc/ZIP: ' p ..-..- _ ».-.... ----
- 1 + ("` ,'/t. Footing drain(no.linear It.: 1 Page 2
Suite/bldg./apt.no.: Project name: ,)c.4_ 1 , Manufactured home utilities 50.03
Cross strut/directions to job site: ^^�^-i Manholes T�- 18.76 --�».
Rain drain connixtor -_ 18.76 --
--- -- .Sanitary sewia lob.(mein lt.--1 - -- - Page
_____...____- - _._....._.._.._.__. Storm sewer(no.linear ft,: Page 2
._...._._.._._,...----..--------- -`-- ---- II Water Service(no,linear fl,;`) Page 2
Subdivision: - Lot nu._-_-_ _J iI+xture or item: TM . »,.,_,»_._
Tax map/parcel no.I,..,......,..».__..»., . .,.........,.... .,...»,..,...,., ,..,.,,_ v Back flow}swatter -__ m � w., .,, 31.27 . ....-,.,,,,
r.•1Y;% ' .1.+_1,nCN7"Y?r„?!'1' ;�ij�.'{:,!;.rrr..°RY!r; ,n 1-721.���,y� ^,r 47,,;77;,�.•".'y^,C'T,'+�•,�T7,77 Y Backwater valve •112/,51.,
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� , i S ,,. ��:`"` i.lotheswasher µ25.U2
...t.:10 ,.. _ w i�h3u,..:. :_y_. �t� F C•:• Dishwasher --- 2.5.02 .,...,..,,,.... .,...
1
f f r ry. ..:rsrft> kas_ --. 11 G.�,1 f 7 Drinking fuuntninW»- l 25.02 L
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". J .4 � /•' [ r.t
Fjrorx/ amp 25
.1 2
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41 � r Cii A * •..;„4•“1•1.0:.10.•:at�,'r ' 'a;l� . to p 1 l.A.,:..' Expansion tank 12.51
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._...,_
Name: Fixtu rtlsewia cap 25.02
Addms: Roe,'drain'flonr sink/hub r 25.02
---W-•-_- -- --- - Garbage disposal 25-02
City/State/ZIP S .-W_r W- Nast bib ^mm 25.02--- ---
Phones _ .... - _.......�_
( ) Fax:( ) Ice maker 12,51
:.4 u'.t; -. �_
,f fuh ,i I� rr w-rn 7•777TR h l6 .,`• i-Y : / Interceptor/id-ease _5.( .lki.�):0 i)ir ll.iPa ?^ ftr±(iGal ) i wW.,:i ( L'.� „ , 1'' �,,V,HP ) t', ----------- -----__M_ .�.-.. .. .
. -`---
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medical gas(value:$ ) Pubs Z Business name:Same as below _ -
-
____
-. -.. Primer 12,51
Contactname: -__........,,....-.................... ..._,,.m-..._.,.,.»..»...»_.
,__- ---. ------ Roof drain(commercial) 12.51
Address: - -.. . - -- Sink/basin/lavatory _ 25.07. _. .». --
(;ity/Stat'Z1P: Solar units(potable water) 62,54
Phone:( ) Fax::( ) Tulvahower/show•erpaa �� . ,W 12.51 ---
E-mail: -- w. Urinal-- -. 25.02.
. . _ -
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,l5: Waft,'closet 25.02
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Wet^i1 Y' 37.52
'e tl' the
Business name:Cascade Plumbing Co .-..----
.. __. _ _ Water piping/7WV 56.29
Addfr+s:2416 N.Hayden Island Drive Other: 25.02 -
City/State/ZIP:Portland,OR 97217 _ M- ..»� µ,.... Subtotal
Phone:(503)289-7095 Fax:(503)283-9514 Minimum permit fee: 572.50 `'7).'LJs
--�- -""--"""°•'""------�""- Phan review (25%of permit faro)
CCB Lie,:120893 Plumbing Lic..no.:34-412PB -- •---- ,-,..,..,.,,-•...� .m..,.,__.,, » ._.-.. _
---............_-. _� _ 2 of^'^^^'•"^'�^' State surcharge(1_ P Q permit fey') .. '1
Authorized Sigrtatum: f., ...._...,...._.....................».»„»-...._...- ---- - r, �4
_.. `. . � -4� TO'fAl.PERMIT'1"[''{E } -J ,
rids petwtit attp(katlon expires if n permit IT not obtained within ISO Amyx
[Lint name:Crystal Junes Date: 6 p p
1�..._..._-__ v after it but beta accepted as complete.
tt''`` - •Fec methodotogy sct by i'rS-County Huitding luduitry Service homed
l'Aaatains∎Vtrtaits3'tM am KAN JU. RN f 440-ia I fa(10/O2,CUNIVEtf)
T(((0000•d bT36£82£OS o0 buigtttnTd aPsase3 HdOS:2T £T/L0/80
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:
']:', 0.ue Via .R esiders h al Fire Suppression Systems:
s:
$tii ' iii s, r eg!li ?° > . R;,= OtiL e ` tt l t tAa
i !, fi
Footiig drain-I M 100'
50,03 ... o to 2,000
...t. ..._..�....,_.._........... $121.90
.
"Foounx"du°n-cac""aa du onal 100' 37.52 2,00 l to 3 GOU $1 69,69
,...„,......,.-,...„.,.,m.,..................-
1,601107.200 _.. _ _,,.
Sewer•1st 100 62.54 7,201 and reatcr I S327.54 ^^
»
Sewer-each additional 100' 37,52
Water Service-It 100' 62.54 Medical Gas
Systems:
Water Service-each additional 100' 37.52 t « '" rhi;i�7„
� 7A;∎;0 ," ^_..^'"» 1Z
':.t ....,...7
_ qua ow ` i er tt nee" . L Storm&Rain Drain-tit 100' 62,54 1170 to£5,000.00 W mm IV Minm fee 57250
Storm Nc Rain Drab -c-a sh
additional 100' 37.52 55.001.00 to 510,000.00 572.50 for the first£5,006.00 and S 1.52 for ..
''iii-h":.
m S -,tuy 1S O xi-W.77,
fiO4� } each additional bI(1(i.t)U or fraction thereof,to
_w.. and inetudi2s19,000.00. ^-_ »-.....-
-Inspection of existing plumbing or for $10,001700-to 553707'00 514$.50 for the first 510,000.00 and 51.54 fen
which no fen is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
m(minimurn charge- 1/2 hour) ___.,__..._. _. ,_ and including.$25,000.00.
Inspections outside of normal business �90.00/hr• 1 $2S,001.00 to$SO,000.00 5379.50 for the first 525,000,40 and 5174 fcrr �
_incurs minimum chyme-1.htrurs) each additional$100.00 or inaction thereof,to
Rcincpectinn pose 90.00/hr and ineludin'550.000.00.
Additional plan review for revisions - 90.00/hr 550,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge- 1/2 hour) -» 1_-__ each additional 5100.00 or fraction thereof
Subtotal:
Commercial,Fixt,Irc Wgr :
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*.
Q
usiititr br F,*.__ ___ t'-;I '+l A flew tiii thil.l ling t.#11 lnns P ,
iixiure''yryte hot , » ;(,,r!tt;
• t^ dried Relocaic Phut review is required for any of the following.
'WoriE renormoti. ,rx �,,.. ..
r-- - --------� ---- Please check all that.apply.
1?i7iiii7try/font
Bath -Tub/Shower ❑ My new commercial building with water service 2"and
-Jacuzzi/Whirlpool
-*° '_—" "'�-�'-�'— greater,except systems designed and stamped by licensed
Car Wash -Each Stall _ -' engineer.
Drive't?trtt 0 New exterior plumbing site utilities for any complex structure
Cum idor/Water As.irator »._.� MM as defined in OAR918-78Q-QQ40,
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic `"�°""' """'�' ❑ Any multipurpose fire sprinkler system.
t)rinkitigwt•'ountsio 0 Any complex structure as defined in OAR918.780-0040.
~Frye Wash
Floor Drain/sink -2" Submit/sets of plans with any of the above.
-3"
4.. 'i e`'('t;�'i�;"�'di(;`ltiS!`lr n,..!�',ISCrI',�1f`,�y'�ilr•'!r';i;;.w pri•'r;•', ':oy.�..i!N�r.f: :�i."j°?l�"�i':I`:uvr'a;, I � �r�'r;t:`n
i' l,. bt'.,L ti,il iiiir c':�46tits h�h��l�+�s� 7 r�{,-.
Car Wash Drain w....�». ._. .T ;l t 6,, r e ', >tay r my
-., ❑ isometric diagram is required for new buildings
Garbage -Domestic-non-food c or r {�
Disposal -Domestic.-food related that meet the auifications above.
- Commercial-food related
-Industrial-food related
_ e M ._.. r..._ -
-1ceMaeh./Rettig.Drains
L,c 1 Stparatex((:;as Station)..- t Comments rC ardin fixture work:
Rec.Vehicle Dump Station
Shower -Gang
Sink/Lav -Non-food related .. ..,,.,.....»»,..,..w..,,,,w..................N,,,..»..�_...W�,.,
-Bradley -- N..---
-Commercial-food related .�.._._._-.,
s'wimrninYuc,ll ilterr _.__. G *Note: If the fixture work under this ermit results in an
-Washer (:lothos p
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 Flamm:
C.1UserslOw ncr\Downleads\PLMF-PcrmitApp(I).dac 2
ZO'd bTS6£8Z£OS 03 buiqunTd apB0s133 wdOS:ZT £T/L0/80