Permit CITY OF TIGARD PLUMBING PERMIT
-R. COMMUNITY DEVELOPMENT Permit #: PLM2009 -00190
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/15/2009
Parcel: 2S 113AA01100
Jurisdiction: Tigard
Site address: 16596 SW 72ND AVE, BLDG# B11
Subdivision: OREGON BUSINESS PARK I Lot: 0
Project: Spec Space
Project Description: Replace existing fixtures.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
#300 2 ea Floor Drain/Floor Sink/Hub 07/15/2009 $33.20
PHONE: 2 ea Primer 07/15/2009 $33.20
3 ea Lavatories 07/15/2009 $49.80
2 ea Water Closet 07/15/2009 $33.20
Contractor: 1 12% State Surcharge - 07/15/2009 $17.93
LEED CORP Plumbing
12606 NE 95TH ST
VANCOUVER, WA 98682
PHONE: 360 - 213 -0969
FAX: 360- 213 -0967
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $167.33
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 -0100. You may obtain a copy of the rules
or direct quest' C by calling 503.246.6699 or 1.800.332.2344.
Issued B : / f/ Permittee Signature:
- / 4.
CaII 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.
r r :ROM (WED>JUL- 16 2009 12: 62 /ST. 12: 51 /No. 7600000376 P 3
Plumbing Permit Application
Building Fixtures RECEI '.1)1( ( >11.1(i 1:si: II\I.)
City of Tigard d Q p
ty ll telly: 7 /( O( Permit No.: f-ev !(�
• 13125 SW Hall Blvd., Tigard, OR 97223 JUL 15 2 jj n, Review
g Phone: 503.639.4171 Fax: 503.598.1960 D ale Other Permit No.: /3, J , 9Z� ' 7
Inspection Line: 503.639.4175 R
. 1 I t i A it l) (� , Re /Metho furls See Page 2 for
Internet: www.tigard-or.gov
CITY OF TIG''
fied/Method: S n � *mental information
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❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
Pd Addition /alteration/ •placemen ❑ Other: h New 1- 2- family dwellings (includes 100 ft. for each utility connection)
a - 'A' : t Syr i t yn�' f r•: N ?, t + ' ��.
;�.7,.(, -'1; }?;: - :" y .;,;'..i i;.• ' : � ; .I.:r�n :r. SFR (1) bath
,. ,.....�i`+ °:'en'._ ,_ .s:.:r,.. � 1 r ; .x ` ,. � , .r,. > • >,�31�a a�`:, ... O 249.20
❑ 1- and 2- family dwelling 'Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
, .t��: i�. y ! iaz�?•` m� d ,,, .: u: •.,`, nw,�: qtr ,+mow Fire sprinkler ( sq. ft.) Page 2
., s: - 'c✓ c: a^3: 7•- •:w� "' .', „1 •,ai iA-,, V..Yr�,ir41,; -k Site utilities
Job site address: /6 5 9 6 S A .., , 'to ts - j Catch basin or area drain 16.60
City / State/ZIP: 7)0 0)C.- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 440677 sS/YrS Footing drain (no. linear ft.: , ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _J Page 2
•
Storm sewer (no. linear ft.: ) Pagc 2
•
Subdivision: (Lot no.: Water service (no, linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
t t,> ^� �x[}Ny,r��y�'�yy q� r v -ac =�n = _, y4T � z;. , ��,m��� A ,,, Absorption valve 16.60
.; f 1 .II3� 1 itti ?I; &"l+l. D 0 t . r 12F� i
`;;, `� r• - °';�,.�r'..�:.:;,�r / � ► �t��C�r,�n:. n:» �n�.. .:;x,,,u ?ifs'.' f '-` Backflow proventer Page 2
lea !' ' ' 47 3- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
4ij %j��*y yam` ; :,: .f,,,l• �g r ,; M4 3�74s;'; ir' v�r'' r • {•f-. , t Drinking fountain 16.60
t, ; :..:.�.,: _ .. :,•.;•r... .,... E actor s m
r " 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain /floor sink/hub .2 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
. , •• i A li t � . - e 1 ...ti ,' . ' e `4"4Z I `.s _>', Hose bib 16.60
:� 14
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer a 16.60
City/ State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 3 16.60
E -mail: Tub /shower /shower pan 16.60
sa s , •� , t "� Urinal 16.60
;t� t..:'is. \.Si .r SA"7, ..itx S ra: - i ` . w .' .. ,,,, ::',. , . l�'r` W s>�
..,;‘...,,,,..,.,::.&.::::; ' .e3,. ' },.. .•.� .•ri•..4�_a.:ta<urw�'I: ` ... 1r -. � .f{i.��... r'..`.t•:.a ater closet 16.60
Business name: L.E•a71, `ieykr i Water heater 16.60 iir?-`1°
Address: 416 L1 6 A_. rSfr 9 S C r �6 Other:
City / State/ZIP: t/P 4,¢ r�i'ml Subtotal
Minimum permit fee: $72.50 v
_Phone: (760) >-i3 -ewr7 Fax: (360) It 3 -aF y _ Residential backflow minimum permit fee: $36.25 / ..' • -
CCB Lic.: `e/ p /.. Plumbing Lic. no.: /,g •5 '., Plan review (25% of permit f ee) 113
Authorized signature: - State surcharge (12% of permit fee) _ j
-� _ TOTAL PERMIT FEE %- Print name: )7 .Zt r As46 jtt/ Date: --/S c7 This permit application expires if a permit is not obtain ■ wit n
180 days after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
11Building \Permiu\PLMF- PermitApp.doc 12/27/06 4 40- 4616I110102/COM/WEB)
/ le ( 1
VROM (WED >JUL 16 2008 12: 64 /ST. 12: 153 /No. 7600000376 P 2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
• p� r '�J�'Ynt.r {.. r�:�'a /•.`.s�' • - vf.'
r:sx t es st S? °a ,'' p ?y i ,'fit i�• I�t�U , c: ` t i +� ~" �• :s ;F j
' Pd. A' ev. ' � :a''" :54x
Footing drain - I 100' 55.00 0 to 2,000 5115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 5160.00
3,601 to 7,200 5220.00
Sewer - 1st 100' 55.00 7,201 and greater 5309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas S stems:
Water Service - each additional 100' 46.40 w-rr n
» C+ys)�',`•�:. ' 4t��'�'�1? Fp . ^ ., 7 , y k� r.,y : � ? � : •
Storm 81 Rain Drain - 1st 100' 55.00 Diu s 4d.x'. .,. . ..>"1C.71;': Z
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 55,001.00 to $10,000.00 572.50 for the first 55,000.00 and 51.52 for each
additional $100.00 or fraction thereof, to and
.�.. c:..:.:�.:<.4 . ,. .•:y,,.x+ ...�•�a,.� :G =f4., ; :T 'Fk r..�. including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to 525,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee 536.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 525,001.00 to $50,000.00 $379.50 for the first 525,000.00 and $1.45 for
Inspection of existing plumbing or each additional 5100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal:
550,001.00 and up 5742.00 for the first 550,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Commercial Fixture Work: K'�'`_: emta
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accuratel re r ort fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
" y,.7W � , , s , greater, except systems designed and stamped by licensed
.. - w;0 yt; 4, ;:; ; rt ': ii' ,' :' u�:._tL S Y1. ::LtM7 !i�:.. 29X.4.:tL'_ia:4 -
; /4:4'4' `l hi <„ {: �: Sri- ";K engineer.
. , .a r,
s A n. ,. r ^ ,:; { d a t ,s ,: a :. ❑ plumbing any P
�;i'3'S�iS9at:... = %i'i� :.�-- :.�.�'t�oe �� v' *�i. �. New exterior lumbin site utilities for an complex structure
Baptistry/Font as defined in 0AR918- 780 -0040.
Bath -Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in 0AR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial d
•
- Domestic �* y` " + l iii, � j ..` 4 �, 3 s5 i t r�• ?F .: L ti . .t i 1 1 4 . `t1• �v
Eye Fountain
y • Isometric or riser diagram is required for new buildings
Y
Floor Drain /sink - 2" a that meet the • ualifications above.
-3
-4 „
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory A 3
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor _
Water Closet - Toilet
Urinal
Other Fixtures:
i. ■BuitdinidPermils\PLM- PermitApp doc 12/27/06