Permit n CITY OF TIGARD PLUMBING PERMIT
IN � 2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00005
T GARL) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/07/2011
Parcel: 2S113AB00101
Jurisdiction: TIGARD
Site address: 16101 SW 72ND AVE 130
Project: Siemens Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Interior plumbing: Relocating (1) 2" floor drain, (1) Ice maker, (1) sink, and (1) water heater.
Contractor: LEED CORP Owner: PACIFIC REALTY ASSOCIATES
12606 NE 95TH ST 15350 SW SEQUOIA PKWY #300
VANCOUVER, WA 98682 PORTLAND, OR 97224
PHONE: 360 - 213 -0969
PHONE: 503 - 624 -6300
FAX: 360 - 213 -0967
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 01/07/2011 $25.02
Specifics: 1 ea Ice Maker 01/07/2011 $12.51
1 ea Sink 01/07/2011 $25.02
Type of Use: COM 1 ea Water Heater 01/07/2011 $37.52
Class of Work: ALT 1 12% State Surcharge - 01/07/2011 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.08
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 or t 800,332 .
Issued B Permittee Signature: / / I
1
Call . 3 .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.
(TMLI)JAN 8 2011 14:10IST.14:10/84.-75000001908 P 2
FROM
CITY OF TIGARD PAGE 03/05
01/05/2011 16:11 503598 r
Plumbin Permit A *c ci,i I/ED , - i 1 3 4 C C) c2 10 I
Building Fixtures
JAN 6 2 011 if 1.
City of Tigard Received
Datem ; 0 111.1111111Moism
1 1 i 1312 7.3man.,39Ti
vil'll nr ,,i) 0
TI I G VI A S R D
I N Plan Review
0 t : OTher Pormit Ivo.: , „, / - , Li
Inspection Line: 503.639.4 s - •••
Date Itendy/By:
Internet; wvAv.tigardeor.gur
Notified/method NM a 313' igva Pft iZa z i nfiiinadon
;.t- H ' . ,::...'-:,:•'• - : .. • -. ;:f.....4 1 . 0 , 01 v #0 . dt-t!::-.',...-. 1 i . ,2: : . , •::::' : ±,' .. ; :: . 1 - :- ... : 1 ' ',.:, .;.:.„ :.t..,.....0 i
0 New construction 0 Demolition IMMIE122
Demi • 'on
wzrm EA Total
VAddition/aItcrationircplacement 0 Other
New 1- 2-Family dwelli L (includes )00 fl. for each utility connection
4- r.tifill***10.“ 1 0.00#0 : . .• ' . sFR (I) bath 312.70
El 1- and 2-family dwelling t Commercial/industrial SFR (2) barb 437,78
SFR (3) bath 500.32
0 Accessory building 0 Multi-family
Each additional bativIdtchen 25.02
0 Master builder 0 Other:
Fire sprinkler ( sq. it) Page 2
' " 400.
.1' ' .. :. .StiK. 1 ; ".,..o.. '• '', '" ^ ' ).: 001ktrittilt•r''''. ". : I .. .. . • i i !Milian
Job site address: i AO/ AI 0 We- Catch basin or area drain 18.76
Drywell, leech line, or trench drain 18.76
City/State/ZIP: / 1 ti ,f a le 9 .0
Footing drain (no. linear ft.: ____) Page 2
Suite/bldg./apt. no.; • Project non= c.,77101-S R. eabl Manufactured home utilities 50.03
Cross street/directions 1.0 job si -, .....
te: ...
Manholes 18.16 "
Rain drain connector 18.76
Sanitary sewer (no, linear 11: ___J Page 2
Storm sewer (ay. linear It: ____) Page 2
Water service (no. linear ft.: •__.) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.; Baekilow premier 31.27
'' ' .':: ::: : - •?.;_e::: :1(. , . - . . :: Backwater valve Mal
Clothes washer 25.02
70 05- atelsk es4 s'zvic 4/.J ''sr i viJ.
Dishwasher 25.02
/La' ' • : J I 9 • r ow Ole Drinking foumain 25.02
Ejectors/sump 25.02
CIPRO Iftt.q i ,Ittikili. .:. Expansion tank 1251
Fixture/sewer cap 25,02
Name:
Address: 12 : 1 111111 25112 rilffn
Garbage disposal 25,02
City/Statc/Z1P:
Hose bib 25.02
Phone: ( ) Fax ( ) Ice maker Ea 12 MEM
9figNiZEgi...4,16F.,=n2 Interceptor/grease trap 25.02
Medical gas (value; $ ) Page 2
Business name:
Primer =MEM
Contact name:
Roof drain (commercial) 12.51
Address:
Sink/basin/lavatory 111111 25.02 /MEM
City/State/ZIP:
Solar units (potable water) 62.54
1tone ( ) Fax: : ( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
" :".. 1. 1t:it I tt7kv /4 -1,i.0.. 1 8 . 11 411VOitflO'k,*;,.gn:,..ii.7.0:1*,: . ...,:,, , . : ;:,:..t77.7,.::: Wetcr closet 25.02
Water heater NEM 37,52 3
Business name: Lb77) 47e •02417
Water piping/DWV 56.29 - Address: "ii, 0 i i ce- - 5-7 7 o veg-- (../ 4 0 Other: 25.02
Cit"/State/ZIP; 4 EA 4 Art& Subtotal E N) .O7
Phone: (AT? ) Ate - 4969 Fax: (lio ) 1/1- .07,‘ Minimum permit he: 572.50
CCB Lie.: , g/ /.2 INIIM EMIZIII Plan review (25% of permit fee) ram
State surcharge (12% of permit fee) V . IP
Authorind signature: ...4.
'TOTAL itut FEE r/......;
L Print name: _ 7.--&-p exerke,3 I Date: /....5.71 This Permit arpagatusa ceplree if R permit P not obtained' lid ; ISO days
attar it Ina been aecepted as complete.
*Foe methodology set by Tri-County &AIN Indwery Service Board
1 : 4 M 11 . 1 meTemthebV40-hretitA Fi pdo 1 nfo VO9 44e.eoleT(10102/COMEWER)
FROM (TNU >JAN 8 2011 14:20/5T. 14: 18 /No. 7500000808 P 3
01/05/2011 16:11 5035981960 CITY OF TIGARD PAGE 04/05
Plumbin kermit Anplic lion - City of Tigard .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site T;Itilities • Q tr' Fee (m) To , _Square Footage: Permit Fee:.
Footing drain - I" 100' •
50.03 0 to 2.000
$121.90
-
Footing drain - elicit additional 100' 37.52 2,001 to 3,600 $169.69 r
Sewer- 1st 100' 62.54 3,601 to 7.200 $233.20
Sewer - each additional 100' 7,201, and heater 5327.5
31.52
Water Service -1 at 100' 62.54
Water Service - each additional 100' 37.52 Medical Gas Systems:
Storm di Rain Drain • 1st l00' 62.54 Valuation: Yli�rml+C Fee
Storm & Rain Drain -tech additional 100' 37,52 ,--- _..$ to $5,000,00 Minimum fee 872.50
$5,001.00 to 510,000.00 $72.50 for the fiat $5,000.00 and $1.52 for
Other I1oiap_ections or Fees • Olt'. ' ' Fee (e :) Total each additional $100.00 or fraction thereof, to
inspection of existing plumbing or for and i $10,000.00.
which no fee is specifically indicated 90.00/hr $I0,001.00 to $25.000.oD $148.50 for the first $10,00 cad 51.54 f or
(minimum charge -112 hour) each additional $100.00 or fraction thereof, to
inspections outside of normal business 90.00/hr and includes $25,000.00.
hours (minimum charge - 2 hours) 525,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1,45 for
hours
Fees 90.00/hr - each additional $100.00 or fraction thereof, to
and including 550.000.00.
Additional plan review for revisions 90,00 ' $50,001.00 and up ' $742.00 for the first 350,000,00 and 51.20 for
minimum charge - i2 hour
.
, each additional SI00.00 or 1±action thereof.
Subtotal: 1 —
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", Plan Review for Phuthbina,Iielotalkifollrs •
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.
Quand by (Fixture) Work Performed ❑ My new commercial building with water service 2" and
Fixture Type: Rrphce greater, except systems designed and stamped by licensed
Previous Cooped r Added gxle It wg_ engineer.
Baptistry/Font
Bath -Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
- Jacuzzi/whirlpool Tub/ 1 as defined in OAR918- 780.0040.
Car Wash F Stall _ ❑ Medical gas and vacuum systems for health care facilities.
-Drive Thru - ❑ Any multipurpose fire sprinkler system.
Cuspidor/water Aspirator — ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit a sets of plans with any of the above.
Drinking Fountain
Lye Wash ❑ Isometric or riser diagram ► _
1 : ii detrie ofi et:.. : •' .; .. "
Floor Drain/sink • 2"
- 3" agram is required for new buildings
- a^ that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- industrial Comments regarding fixture work:
Ice Mach./Reftig. Drains X
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
' Sink - Bar/Lavatory - -
- Bradley X —' —
- Commercial *Note: If the fixture work under this permit results in an
- Service - increase of sewer EDUs, a sewer permit will be issued and
Swinintin Pool f'W
wisher Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be Issued.
Water Closet - Toilet
Urinal
Otter Fixtures:
I:\ Building \Permits\PLMF- permitApp.doe 2