Permit CITY OF TIGARD PLUMBING PERMIT
` Q • COMMUNITY DEVELOPMENT Permit#: PLM2009 -00315
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2009
Parcel: 2S112DD01000
Jurisdiction: Tigard
Site address: 15700 SW UPPER BOONES FERRY RD
Subdivision: Lot: 0
Project: Holiday Inn Express
Project Description: Install grease intercepter.
Owner: FEES
BHGAH TIGARD LLC Quantity Description Date Amount
BY BHG HOTELS, PO BOX 1670 1 ea Interceptor /Grease Trap 11/03/2009 $25.02
WILSONVILLE, OR 97070
PHONE: 1 12% State Surcharge - 11/03/2009 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 11/03/2009 $47.48
Contractor:
Plumbing
ROTO ROOTER SERVICE & PLUMBING CO
28655 SW BOONES FERRY RD
WILSONVILLE, OR 97070
PHONE: 503 - 692 -5959
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance • ' • 's suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ' otification Cente . hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or rect questions to OUNC • - • •g .246.6699 or 1.800.332.2344.
Iss d By: / 1 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plifmbing Permit Application ived l Q FOR OFFICE: USE ONLY
City of Tigard 5 ! t 7 0 9 ' Permit No.: 13125 SW Had., Tigard, OR 97223
C
Ph one: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
TI G A R D
Inspection Line: 503.639.4175 Date Ready/By: Z ed/Method: Pa 2 for
Internet: www.tigard- or.gov Notified/Method: Y Supplemental Inform
. TYPE OF WORK .. • . FEE' SCHEDULE " ..;,.. , .
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
Ilk Addition /alteration/replacement ❑Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
.'' OF CONSTRUCTION .. .• SFR (1) bath 312.70 •
❑ I -and 2- family dwelling [/ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB: SITE INFORMATION AND LOCATION Site utilities: .
Job site address: / S 7h ' D u 1 / t3n C$J- (evil lam!' Catch basin or area drain 18.76
Drywall, leach line, or trench drain 18.76
City /State /ZIP:
r15 at/LP t og- Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: G / »»9V /NA-) f kips Manufactured 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: I Lot no.: Fixture or item: .
Tax map /parcel no.: Backflow preventer 31.27
i. Backwater valve 12.51
DESCRIPTION OF WORK
• r / r Clothes washer 25.02
iNSlak( G,1 - t/M a� G I'4ctSe- fNleircraloK Dishwasher 25.02
I Drinking fountain 25.02
Ejectors /sump 25.02
.: ❑' PROPERTY OWNER` . I = '[J TENANT ' , Expansion tank 12.51
Name: / v v ij ' & / ( r ; Fixture/sewer cap 25.02
'V Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City / State/Z1P: Hose bib 25.02
Phone: (503 ) '1.3 9 1/ ( Fax: ( ) Ice maker 12.51
. .. •❑ 'APPLICANT . . a CONTACT PERSON . • Interceptor /grease trap 1 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: S car Nea,V,1 Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: (V/ ) 5 fr75 S Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: O 0 v Water piping/DWV 56.29
Address: 28+ Lac 5 - Sw T (se pv Feyr f rd Other: 25.02
City /State /ZIP: W) ISar It¢ pfl_ 61707O Subtotal .0
Phone: ( -irs) (0 9 z f s i Fax: ( ) Minimum permit fee: $72.50 ' l
CCB Lic.: /5 9 ff 9 Plumbing Lic. no.: 3 7 ( 7 Plan review (25% of permit fee)
State surcharge (12% of permit fee) Q', '70
Authorized signature: TOTAL PERMIT FEE 11 . LO
Print name: GO 1�G Date: / /- This pe rmit appl ic ation expires if a permit is not obtained within 180 days
S if a✓ i, /(� 9 after it has been accepted as complete.
J
'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 Qt'. ;Fee (ea) . Total.. Square Footage: . '. *Permit Fee :.
Footing drain - la 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 Systems:
Water Service - each additional 100' 37.52 ' •
Storm & Rain Drain - 1st 100' 62.54 YalUation: •' • Permit Fee:..', ' • :�:
$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 In's ec'tions'or Fees . ' Qty.: •Fee (ea) Total each additional $100.00 or fraction thereof, to •
p 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:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", Pla Review for .Plumbing Installations: ';
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantitrby (Fixture) WorkPerforined ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower 12 New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash - Each Stall El Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 780 - 0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash . 'Isometric or Riser Diagram '. •
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 " that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
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