Permit CITY OF TIGARD PLUMBING PERMIT
t• COMMUNITY DEVELOPMENT Permit#: PLM2020-00221
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/01/2020
Parcel: 2S 101 DA00101
Jurisdiction: Tigard
Site address: 13190 SW 68TH PKWY 200
Project: Aspen Capital Subdivision: VARNS ACRES Lot: 9
Project Description: Interior plumbing for TI:Caping(1)drinking fountain;Adding(5)2"floor drains/sinks,(4)showers,(8)sinks,(7)
water closets,and(1)urinal; Relocating(3)sinks; Installing(1)expansion tank, (5)primers,and(1)water heater.
Contractor: GRIDLINE PLUMBING Owner: PACIFIC NW PROPERTIES LIMITED PA
14844 SW 109TH AVE STERN FAMILY LIMITED PARTNERSHIP
TIGARD, OR 97224 STERN FAMILY LLC
6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 971-275-6167
PHONE: 503-626-3500
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 05/28/2020 $25.02
Specifics: 1 ea Expansion Tank 05/28/2020 $12.51
1 ea Fixture/Sewer Cap 05/28/2020 $25.02
Type of Use: COM 5 ea Floor Drain/Floor Sink/Hub 05/28/2020 $125.10
Class of Work: ALT 5 ea Primer 05/28/2020 $62.55
Type of Const: 11 ea Sink 05/28/2020 $275.22
Occupancy Grp: 4 ea Tub/Shower/Shower Pan 05/28/2020 $50.04
Stories: 1 ea Urinal 05/28/2020 $25.02
7 ea Water Closet 05/28/2020 $175.14
ea Water Heater 05/28/2020 $37.52
1 12%State Surcharge- 05/28/2020 $97.58
Plumbing
Total S910.72
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: Permittee 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 A.a •• (p • .04 r 2 _ . 5-A/ ,� s i7
Building Fixtures E(C_ lt)I1 Ill 1 It I I ,I I)vI ,
�'�L�V�rv�:..:� Rtrci�ed
City of Tigard 5� Permit l
;� 13125 SW Hall Blvd.,Tigard,OR 97223 1"AY 2 g 2n20 NanDase'''
- '
q�, O U U Plao Review
Phone: 503.718.2439 Fax 503.598.1 Other Perms No.: _0.
Inspection Line: 503.639.4175 Date Ry
Ilk.‘I.IIi iT\( Oi Date Ready/By: wn- El sec Page 2 for
Internet: www.tigard-or.gov '. ' Notified/Method: Supplemental information
TYPE OF WORK 11 L)II HR
�: FEE* SCHEDULE
❑New construction ❑Demolit'.1.. 'I-• R. ' '' For special information use checklist
7,5 j# r/J ) Description I Qty. I Ea. I Total
Additioro'alletation/replace sent ❑Other J/ / J New 1-2-6mI ty dwellings(includes]00 ft,for each utility connection)
CATEGORY OF CONSTRU (eye SFR(t)bath 312.70
❑ I-and 2-family dwelling ACommercial/indus 'al ^= 1 SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fires et prinkl r_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
--/7�3- 1 9D !✓ �� �rkwa Y Drywell,leach line,or trench drain 18.76
City/State/ZIP: /1 �/y- Q� 72.2
r•Y / .�}f�y� Footing drain(no linear ft.: ) Page 2
Suite/bldg./apt.no.4. oject name: 45 / / / Manufactured home utilities 50.03
Cross street/directions to job site: 1J<"'i,'I. )e' -0 Manholes 18.76
Imo 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.: 5/6 i 0/1- ik) i Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
pry1 y/-+� Clothes washer 25.02
�/e ),e) - 5- J� �_1-4 �/ �^ Dishwasher X / 25.02 2 s.Q,2
ADD - /24t/ -G,///,�i/e7t5') , S/174 '1 Drinking fountain 25.02
✓/47 owe,- rz mil . Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank )( / 12.51 /,2.5/
Name: Fixture/sewer cap 4 25.02 A5:az
Address: Floor drain/floor sink/hub ,( .5 25.02 'S,Al
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer x .S 12.51 �•,''.55
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory )(/j 25.02 s
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan X ' 12.51 ,5-0,eV
E-mail: --.._.. Uri K / 25.02 ' S-.4:1A.
CONTRACT'R Water closet a • 7 25,02 /76%f y
J ��� Water heater x / 37.52 37-5`Z
Business name:gliffirEEM/ Ml I/� ¢ fl!/.�AMI' Water piping/DWV 56.29
Address: 4/8 - /D ei���IIIIIIIIMI Other: 25.02
City/State/ZIP: / a►Q/" ' II, IIII Subtotal /j fill
Phone:(f j�f Z - Fax:( ) Minimum permit fee: $72.50 t)
CCB Lie,: 79/45 Plumbing Lie.no.:e p- �. Plan review (25%of permit fee)
/ �� Stale surcharge(12%of permit fee) 7 5
,.:- :S. ,.cal si6.,..L.,:- /`r �tt/..�_ 7
i� TGTnt_PERMIT PPE �L�'(/I,��t�
�Q, /�i Date: .-2�-jQ This permit application espires If a permit is not obtained within 1g0 days
after It has been accepted as complete.
•Fec methodology set by TO-County Building Industry Service Board.
Ilauilding\Pmoits\PLMII-PermitApp.doc I UMIAK 440-6167(10nn2/COM'WEa) 54
06) tN
.. -.
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 S 121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 S233.20
Sewer-1st 100' 62.54
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Whet Service- I,t 106' 6234 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-I st 100' 62.54 S 1.00 to$5,000.00 Minimum fee S72.50
Stone&Rain Drain-each additional 100' 37.52 $5,001.00 to S 10,000.00 $72.50 for the first 55,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including S 10,000.00.
Inspection of existing plumbing or for S I0,001.00 to S25,000.00 S 148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional S100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including S25,000.00.
Inspections outside of normal business 90.00/hr S25,001.00 to$50,000.00 S379.50 for the first S25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional S 100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr S50,001.00 and up $742.00 for the first S50,000.00 and 51.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
3NbiGiat. i '
Commercial Fixture Work:
Are you canning,adding or replacing fixtures? If`yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quaadty by Fixture Type Plan review is required for any of the following.
Fixture Type for feepMem Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Menai/Whirlpool engineer.
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
-Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 0 Any multipurpose fire sprinkler system.
-Domestic ElAny complex structure as defined in OAR918-780-0040.
Drinking Fountain 1
_lye Wash Submit 2 ate al Flans wiih any of ehtahwc:
Floor Drain/sink: -2"
Isometric or Riser Diagram
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach/Rehig.Drains Com en}ts regarding fixture work:
Oil Separator(Gas Station) 6 ?If Jra ��a� ,e_41
Kc ValileDum7,Iai /� �� ll , ArtPV/c}.vd✓a.WA$?/✓lf • 137-
Showcr.
t4takig
Sink: -Iav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service 1 *Note: lithe fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes
Water Extractor fees assessed tot the sewer increase must be paid before tiro
Water Closet-Toilet 7 plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PexmitApp.doc 08/04/2011 2
Plumbing Permit Application
Building Fixtures
-F.
Pt lit urrH t I a: u.1a
City ofTigard Received
14
�y Date/By: Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Iy14 i Y a 20'i , Nan Review
Phone: 503.718,2439 Fax: 503.598.1960 Date/By: Other Permit No.:
\�,l Inspection Line: 503.639.4175 Date Ready/By Jura: 0 See Page 2 for
Ilk. Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ' ❑Demolit For special information use checklist
Description Qty. Ea. Total
Additi n/altemtion/replacement ❑OtheryiF, New t-2-tamlly dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRU b1/ �j SFR(1)bath 312.70
❑ 1-and 2-family dwelling , CommercialJindustrial SFR(2)bath 437.78
S
0 Accessory building 0 Multi-family Each ad( bath 500.32
additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) _ Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /9D ��G/y Catch basin or area drain 18.76
City/State/ZIP: (}��t r Q/� /7ZZ Doting leach line,.e -f drain 18.76
/ Footing drain(no.I'.ear ft.:_) Page 2
Suite/bldg./apt.no. Project name: S' ,n / Manufactured..r� utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain r connector 18.76
Sant k sewer(no.linear ft.: ) Page 2
S. r a sewer(no.linear ft.: ) Page 2
ater service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or Item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
c Clothes washer 25.02
,��uzlD - y�'5 Al xi -el✓ ///Jp q Dishwasher / 25.02 -�
ADD - �/e id 1 i X i !S -J /t L 'i (. S Drinking fountain 25.02
`_!•/li/-� �OM Ejectors/sump 25.02
0 PROPERTY OWNER ❑ TR ANT Expansion tank / 12.51
Name: Fixture/sewer cap d 25.02
Floor drain/floor sink/hub 25.02 /KJ,
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
-
Phone:( ) Fax:( ,/
/ ) Ice maker 12.51
❑ APPLICANT /❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2 /� f
Business name: •
Primer !Po(•5-J
Contact name: Roof drain(commercial) 12.512.5 11
Address: Sink/basin/lavatory t7 25.02 20974
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 7 12.51 1 5Q,Oil
E-mail: /!�,lL
Water closet 25.022
co • aR 7.5,2
/ Water water / 37.52 3
IZEIFI f/ I, %eel. Mari Waterpiping/DWV 56.29
Address: SAlir•���DI r . 111111111111111 Other: 25.02
-a-1-,�Jf f. Subtotal
.. /)27 C� Minimum permit fee: S72.50
(
Phone: / ✓ Fax:( )
CCB Lic.: , /Q-J i - Plumbing Lic.no.: /j Plan review (25%of permit fee)
,'�� State surcharge(12%of permit fee)
.,,:: '':'. ' :.::... I t01AL l'hKMlI Fhb 1
Dater Thin permit application expires If a permit is not obtained within 180 days
Print name:
� , / r after It W been accepted as complete.
'Fee methodology set by Tri-County Building ladustry Service Board.
f:tBuldinglPeroas1PLMU-PenniApp.dec 10101*? 44a-46167(10m21CON/WFa)
•
•
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qa. Fee twl Total Square Footage: Permit Fee:
Footing drain-I'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,60D S 169.69
3,601 to 7,200 S233.20
Sewer-1st 100' 62.54 7,201 and greater S327.54
Sewer-each additional I00' 37.52
YYaici Service- iat" ' °L-"1 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(n) Tetal each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for S I0,001.00 to$25,000.00 S 148.50 for the first S 10,000.00 and S 1.54 for
which no foe 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 S379.50 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 S742.00 for the first$50,000.00 and$120 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
{ I I I {
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 Replete Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
Bath: Tub/Shower ._ greater,except systems designed and stamped by licensed
engineer.
-Jacurii/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
- tallThr as defined in OAR918-780-0040.
Cuspidor/WaterAspuator El Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain X
_ye Wash .,«,.:::: :�:::.:r:««, ««J«...::.
Floor Drain/sink: -2"
—
_ X/
3" Isometric or Riser Diagram
4„ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Dram that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice MachjRefiig.Drains g g
Oil Separator(Gas Station)
Shower: -Gang
-Stall
Sink: -lavBar non-food related t }(-
-Bradley,
-Corn/Serv/Util food related
-Service X / *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
ices assesseu for arc sewer increase urusl Vc alU ueiore Inc
Water Extractor p
Water Closet-Toilet 7 plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PemntApp.doc 08/04/2011 2
Plumbing Permit Application
Building Fixtures 1 uit ul 1 1( 1 i .1 u.1.)
City of Tigard Received
Date/Br Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223
one: 503.718.2439 Fax: 503.598.1960 Plan
view
Ph y Other Permit No.:
I,- 1 1, Inspection Line: 503.639.4175 Dote Reedy/By: hair lit See Page J for
Internet: www.tigard-or.gov Notified/Method: Supplemental informoaon
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For gecko!information useQty.checklist
Addition/alteration/replact ment 0 Other: Description I ' Ea. ' Total
New w 1 1--24 Wiu14Y tiweSkRs(includes 100 R.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling *Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other.
Fire sprinkler(_sq.ft) Page 2 ,
JOS sax INFORMATION AND LOCATION Site utilities:
Job site address: /9D g ,x4� Catch basin or area drain 18.76
/ ( r�� 97Z2 Catcall,leach line a trench 18.76
City/State/ZIP: I
/ Footing drain(no.linear . ) Page 2
Suite/bldg./apt.no: Project name: 7 //
> �n ( �/ �L... Manufactured utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain ' connector 18.76
'terry sewer(no.linear ft:__) Page 2
{ Storm sewer(no.linear ft.: ) Page 2
f Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: / Fixture or Item:
Tax map/parcel no.: BsrYflaw pteventcr 31.27
DESCRIPTION OF'WORK Backwater valve 12.51/J� " Clothes washer 25.02
1�7 20 �i 1 X'�j"v�/�/,s y' Dishwasher x l 25.02 ��
A1D17 /!e iJ 7 /Il 71f/! S -/t t- �n Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER d TENANT Expansion lank X/ 12.51 /a,3
Fixture/sewer cap 25.02
Name:
Address. Floor drain/floor sink/hub CS` 25.02 J��✓p
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:S ) Page 2
Primer j 12.51 62.5j1
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory rp 25.02 70 4
Ci /State/ZIP: 02014
�`� w
tY Solar units(potable water) �l 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan Y 12.51 50,01 f
E-mail: CO /;.. : / 2 .M / W,
Water closet }/7 25.02 ,
t Water heater 37,52 37
Business name / ♦ �i/ M �%ea. � e� Water piping/DWV 56.29
Address: 9 2111E�i�6/ Other: 25.02
IEMEar 1 -d-,---1111M1111271M,AIIIIIIN Subtotal
Phone: r. (p Fax:( )
penult
/)
75- Minimum fee: S72.50
•
CC: ic.: �_ Plumbing Lic.no.:- Plan review (25%of permit fee)
/ 5
,'�� State surcharge(12%of permit fee)
::::.:.: i...a....W.. i I lulnL.mural l tr:c ) I
Print name, / „it 11111. Dater A.�-` i This permit application expires If a permit k rat obtained within 180 days
after b bra ben aaeapted m compkte.
*Fee methodology ass by Tri-County Building Industry Service Board
tlBunainalPm tsIPLMTr-PamtApp.doc 10/111g9 410-4616T(IONNCOM/WEB)
Plumbini: Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee teal Total Square Footage: Permit Fee:
Footing drain-1`100' 50.03 0 to 2,000 S121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 S233.20
Sewer-1st 100' 62.54 7,201 and greater S327.54
Sewer-each additional 100' 37.52
Ware]Service-isa iw 62•"' Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Stoma&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 S5,001.00 to S 10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(oo) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumhing or for $10,001.00 to$25,000.00 S 148.50 for the first S 10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to S50,000.00 S379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional S 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 S742.00 for the first S50,000.00 and 51.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
. . I I I
Commercial Fixture Work:
Are von capping,adding or replacing fixtures? If"ves",
please indicate work performed by fixture. Failure to
accurately report fixtures could result In increased sewer fees*. Plan Review for Plumbing Installations
by Fixture Type Plan review is required for any of the following.
?Wane Type for 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
-1acuri/Whirlpool engineer.
IDCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
CuspidorlWaterAspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain X 7
Eye Wash x' /
Floor Drain/sink: -2"
3 Isometric or Riser Diagram
Car Rey Drain Isometric or riser diagram is required for new buildings
Garbage -Domestic non-rood that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice MachJRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Shower: -Gang
-Stall
Sink: -LavBar non-food related X-.a
-Bradley
-Com/Serviutil food related
-Service *Note: lithe fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes
Water Extractorfees assesseu fur time sewer Werease must ire paiti ueiure sire
Water Closet-Toilet rj plumbing permit can be issued.
Urinal 7
Other Fixtures:
I:1Building\Permits\PLMF_PermitApp.doc 08/04/2011 2