Permit (281) ,, CITY OF TIGARD PLUMBING PERMIT
'"I ' COMMUNITY DEVELOPMENT Permit#: PLM2016-00186
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/06/2016
Parcel: 2S115AB01901
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY
Project: Harsch Investment Properties Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: Repairing 100 ft.of water service.
Contractor: DETEMPLE COMPANY INC Owner: HARSCH INVESTMENT PROPERTIES
1951 NW OVERTON ST 1121 SW SALMON ST
PORTLAND, OR 97209 PORTLAND, OR 97203
PHONE: 503-227-2641 PHONE: 503-242-2900
FAX: 503-274-7686
FEES
Quantity Description Date Amount
100 If Water Service 04/06/2016 $62.54
Specifics: 1 12%State Surcharge- 04/06/2016 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 04/06/2016 $9.96
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 question- o •• C by c. g 503.232.1987 or 1.800.332.2344.
Issued By: i Permittee Signature:
111111111
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
Ste UtilitieVittis FOR OFFICE USE ONLY
Cityof Tigard44INIT
Received /�/' �,/_
g 16 Date/By: y /t� 1.77.......,
Permit No.:PL ,'�/4-W/i4
13125 SW Hall Blvd.,Tigard,OR 97223 6 el
Plan Review
Phone: 503.718.2439 Fax: 503.598.1 � Date/By: Other Permit No.:
Inspection Line: 503.639.4175 ( N%.'
T I G A R D GG 1 1 Date Ready/By: Juris: 10 See Page 2 for
Internet: www.tigard-or.gov �} Notified/Method: Supplemental Information
_.; FEE* SCHEDULE
❑ New construction 1111 W molition For special information use checklist
Description Qty. Ea. 1 Total
5i2�(Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑ Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
I SITE INFORMATIONTAND LOCATION Site utilities:
Job site address: c- Catch basin or area drain 18.76
f 6 -o 1,.1 PA G�1 L �t ti tN a� Drywell,leach line,or trench drain 18.76
City/State/ZIP: -ri J a �( / o R / a V4f 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:
Manholes 18.76
SEr Gorrr� o-� �k�
C O frP f t.X .. br' (11 n C -1-Le-Sack...) M Orn i ri , Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: il)v') Page 2 6,),.221.--
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
N OF WtRI( Backwater valve 12.51
.. _ t,,717 .... ,"'-o - - Clothes washer 25.02
E x-i-e.ri 0 t., )ex:+Zf Se -v L.it- C't?Pat r. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
APROPERTY OWNER *. 'I^ z, « , , Expansion tank 12.51
Fixture/sewer cap 25.02
Name: tf arSG h /4 vey-iM Esn-/- Pf-Opeel(e_s
Floor drain/floor sink/hub 25.02
Address: 1102 I Sw „S'c-I fr.a n C+, If'IOC Garbage disposal 25.02
City/State/ZIP: Po r t I g not. / o R l 97,203 Hose bib 25.02
Phone:(503)a'1a - ;2100 I Fax:( ) Ice maker 12.51
_ W z ,,,,..,,a13,4040cr mSQN. Interceptor/grease trap 25.02
Business name: De-j-e_oh 91..t,_ Co' P Medical gas(value:$ ) Page 2
1 f,it-
Contact name: Primer 12.51
N t u k Sbt.-,n k I 1 n Roof drain(commercial) 12.51
Address: 5 G 3(., N C Ha 3 See 1 o St. Sink/basin/lavatory 25.02
City/State/ZIP: P,r+1 d / O R q 4.a_1 3 Solar units(potable water) 62.54
Phone:(Co 3 ) y 41 -SA Y x_ Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: rt ,r,'I,rtn K hn t@ oi-e-f-t l z. t:0,-n
25.02P. gi t t ater closet
',`, _ _. ,.,%.,' .t.,'.•.,t K
Water heater 37.52
Business name: Dcre.,sspie Compo,nlot,. Water pipingDWV 56.29
Address: 5436 N E Ha s.5.,.„1 D 5-,i:-/ Other: 25.02
City/State/ZIP: Por-f lsr,d/012 7 7 7.2 l 3 Subtotal 602.5i
CC-
Phone:(5 0 3) ax-4,_a ty I Fax:( ) Minimum permit fee: $72.50 ��
CCB Lic.: a,10 Plumbing Lic.no.: a.6_a 5 pg Plan review (25%of permit fee)
s%'!� State surcharge(12%of permit fee) $ G?
Authorized signature: �-.//
TOTAL PERMIT FEE j3'i a p
Print name: N i C k. S k .n K I i n Date: 4/05/it, This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\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:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain- r' 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 6a 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
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
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: j U5-1
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 Replace! Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath Tub/Shower
0 Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 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 OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
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
-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:\Users\nshanklin.DTML\Downloads\PLMU_PetmitApp.doc 2