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Permit
CITY OF TIGARD PLUMBING PERMIT 1,- COMMUNITY DEVELOPMENT 1 Permit #: PLM2011 -00020 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 / p� Date Issued: 01/19/2011 Parcel: 1 S135AB04500 Jurisdiction: Tigard Site address: 10250 SW GREENBURG RD 125 Project: Carroll & Riggs Subdivision: LINCOLN BUILDING Lot: 0 Project Description: Cap (2) toilets & (1) urinal, add (1) clothes washer & (1) laundry tray, replace (1) toilet. 1/20/11, reprinted to add (2) capped lays, (1) ice machine & (1) new lay. - Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97280 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 - 244 -1900 PHONE: FAX: 503 - 244 -8825 FEES Quantity Description Date Amount 1 ea Clothes Washer 01/19/2011 $25.02 Specifics: 1 ea Laundry Tray 01/19/2011 $25.02 1 ea Urinal 01/19/2011 $25.02 Type of Use: COM 3 ea Water Closet 01/19/2011 $75.06 Class of Work: ALT 1 12% State Surcharge - 01/19/2011 $18.01 Type of Const: Plumbing Occupancy Grp: 1 ea Ice Maker 01/20/2011 $12.51 Stories: 3 ea Lavatories 01/20/2011 $75.06 11 12% State Surcharge - 01/20/2011 $10.51 Plumbing Total $266.21 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 r if work ts— uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility otification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -se -i:•0. You may obtain a copy of the rules or di ct questions to OUNC : • 03.232.1987 or 1.800.332.2344. Is ed By: r i l / �I� . ' Per Si. nature. � / Call 503.639.4175 by 7:00 a.m. for the next avatt3 • e 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. - CITY OF TIGARD PLUMBING PERMIT '� COMMUNITY DEVELOPMENT Permit #: PLM2011 00020 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2011 Parcel: 1S135AB04500 Jurisdiction: Tigard Site address: 10250 SW GREENBURG RD 125 Project: Carroll & Riggs Subdivision: LINCOLN BUILDING Lot: 0 Project Description: Cap (2) toilets & (1) urinal, add (1) clothes washer & (1) laundry tray, replace (1) toilet. Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97280 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 - 244 -1900 PHONE: FAX: 503 - 244 -8825 FEES Quantity Description Date Amount 1 ea Clothes Washer 01/19/2011 $25.02 Specifics: 1 ea Laundry Tray 01/19/2011 $25.02 1 ea Urinal 01/19/2011 $25.02 Type of Use: COM 3 ea Water Closet 01/19/2011 $75.06 Class of Work: ALT 1 12% State Surcharge - 01/19/2011 $18.01 Type of Const: Plumbing Occupancy Grp: Stories: Total $168.13 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 issuanc • ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Uf - Notification - ter. Those rules are set forth in OAR 952 - 001 -0010 t e . • 6 • ' -I0. You may obtain a copy of the rules direct questions to O - c. ing 503.232.1987 or 1.800.332.2344. I ued By: I 41/ / - 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. JAN/18/2011/TUE 05:26 PM POWER PLUMBING FAX No,503 244 8825 P. 002 , , Plumbing Permit Ap • lication Site Utilities FOR OFFICE USE ONL, ' City of Tigard r, cF\\V3 I E! , L= /r fm v 13X25 SW Hall Blvd., Tigard, OR 7 $ / / . a Q • Phone; 503.639.4171 Fx: 503. 8 460 Other Permit No.: `��`� D T I GARI) Inspection Line: 503.639.4175 \ % Aate Ready/By: hair 66 See Page 2 for tv Internet: ww.tigard or.gov 1 t , , Notified/Method: Supplemental Information `.ki ': + -.vT" r'r v? "!W ?t� - + :fl-g ;',.1 • W. p r.'. . ?:4Z5i ' 5 ll:I' � i� ` :ZF r v `,Jl'1"'''-''''. 11.. Y ; f _ :�' g ;...", 3 t 7 - - sY c [tI } �� . Ftl. x M I i f�l` � ! !.' `fi C ' ` O� i17�f� h i � f 7 '. y . t , y,C . 1 %!p ,,, �`,• ��7£ ' !j � `� t "^-' , t _ x. ` “:7'. ( s r � . ' . k�.� . .r4. :4+�� I 0.,. r1i � +ik+ Rihl.�t w77r -?../n .:t nil' , 11.'m;k4 in £i''tM..::2.a :. - l�.r• , :7 slit ..X • 1] all ' " . G.�, ,�.a.. ^�. J L ' 2 ''''1 "' `f' ❑ New construction ❑ D }hi iti�rnkG Ilk 1` For spedalluformatlon use checklist rl , a Description 1 Oty. I Ea. L - Total ��, • Addition/alteration/replacement ❑ t>l1ior: New 1- 2- family dwellings (includes 100 ft. for each utility connection) <''r ,a . .1 wti, t } ri r: r. : : : :;`:ry • �,,F'` :� +., °'f 1 . 3''�x ^ a Pr '0 +h `"''``- "- � ",,.; - , ill6 SFR (11 312.70 - _ L,,,: .wl,7F.ru�sF• , ;.,�� . i? ,. th:r`r , �i+�b 1 : 1.V�x. - �^ .c.` �"�i_x ,i . � � . 1 ,y1..., - ❑ 1 - and 2- family dwelling ILL', SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building • Multi - family Each additional bath/kitchen 25.02 0 Master builder ❑ Other Fire sprinkler ( sq. ft.) Page 2 t% � ii "[?:` ell .y t ES , gil. r. ,,'�; y i r l „ Site utilities: • Catch basin or area drain 18.76 Job site address: q � G 77 � (,t j 6 r e , Q ,h ,, , S� D ell, leach line, or trench drain 18.76 City /State/ZIP: / f 1 �v Footing drain (no. linear ft.: ) Page 2 . 1 Suit .'ldg. /apt. no.: z r ` Project name: G / : G1a /' Manufactured home utilities 50.03 +s i r s 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 Lotno.: Fixture or Item: Tax map /parcel no.: / 35 t: ~e • Backflow prcventer 31.27 y k ti 3f x i m'"'' ^T tnrer r �r l 6 F <y. , }• , Backwater valve 12.51 '' ��1 } � ." w rtg « „u a c �'''� @a a ts:A s • s ,^,t t ry` f L. J.Y.... i ^J.d. '4A1 �R' 0� /H:fnk''. 1 5��f J4�.' • : '-"'x Clothes washer • _ I 25.02 2� " '" Dishwasher 25 -02 Drinking fount8in 25.02 Ejectors /sump 25.02 t s r } {��'u 3t ' r iJ ilk ' s¢ iffls� 'P F ; F E h IV. 4i n�.� ] id..�Wd'SV.�i4Stpr m' Expansion tank 12.51 - Fixture/sewer cap 25.02 Name: Floor. drain /floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State/ZIP: Hose bib 25.02 Phone: ( ) . Fax: ( ) Ice maker 12.51 E t`".,` , 4 j;1;,t, 1 ° � 4 f s le� cSn 11 uk; " c " ¢ , t w t F iw s . a 1�'+1[. -i,z. ,,,, t.r .:. '7 ,(. .tis• '.vs..?i.2r r•La� =IA..... T 3 19 i .. " S Medical gas (value: $ ) Page 2 Business name: l' CV✓ '�, 1' ` h Interceptor /grease trap 25.02 12.51 " Primer 1 t 2 Contact name: y� ■�'■ r) T) R oof drain (commercial) 12.51 Address: !' ,' J 61 S ink /basin/lavato ry - 25.02 City /State/ZIP: 1 t; (r• C4 TJ 'r'v Solar units (potable water) 62.54 Phone: ( ) . 4_- t U`) Fax:: ( ) �' q c%(::(7 r., Tub /shower /shower pan 12.51 Urinal i 25.02 2._-.7 Q `-- E r "`� a r Z r s,^^ - rj,. i� ' 1 6u" r. ■fY ©a :Yd�.. �, x, A ' fit' m 1 / 4 ,. „, , :era,o , + „` . � ?t g 4, • • Water closet 25.02 L' T L^ia. ';':: 'iT: '.ii.'' tadkt thS' _ ✓i '• ,. � .i. • ._ r.._. aTW1a,', ," ti•,... ''.• ". Water heater 37.52 _ . Business name: - ` P t . ` iniv.A Water piping/DWV 56.29 - �ailress: LP(0.1 I \-1.4 ) -' . AT. '1 -J.-Other . U1.tu11.W'" --/- - 25:02 - e ...-6-= , -2--- r City /State/ZIP: 0 1 -7 �l *� S ubtotal l� • . 3 ` / L� (Y c Minimum permit fee: $72.50 �' Zi ( Phone: ( ) ��' : - 14 y . Fax ( ) Plumbing Plan review (25% of permit fee) /- g Lic. no.: � " _ 1 '-y,`.` State surcharge (12% of permit fee) i 8 O ova Authorized signature: ,A..4.4- %ti,.e,/�,.i TOTAL PERMIT FEE C Thi permit appl ication expires if a permit is not obtained witbi 1$ days Print name: I . (. --t- &- 1 •. -7`' '1 Date. • l I' i f alter it has been accepted ae complete I *Fee methodology set by Tri- County Building Industry Service Board. l: �HuildingiPOnnit81P1 ,1•da•Pem]itApp,doo 10 /01/09 440 - 61bT(101071COM/LVEB) JAN /18 /2011 /TUE 05 :27 PM POWER PLUMBING FAX No, 503 244 8825 P. 003 -f P lumbine Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su . 1 resslton S stems: F ,_. ? _ ,f L! y 'c.. ✓' °. ^v� t te r.: } -,y' re�^T�T�;^.'2^,,7",: ` - ^ - -.. c� t, n z ��� 1- a pt � M r�. 'Yv s r �v n � 1 �. I 1. F, l rfaq y ; `I � i. r}1.r f it•(�P�r_ 714 1 47 «, !:hi!� +'" f- e � .1 - �� V .J r_ K.P 0 E i Y 1 ;:g,ay" tot, `(``( ,, �_ '� •_�,. .F� -3 T .�J'1 f { v� ;-' i.S x 21 AI JL nJ... Footing drain -1 100' 50.03 0 to 2.000 $121.90 Footing drain - each additional 100' 37.52 .11111 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 S stems: Water Service - each additional 100' _Milll - ', t':' ` >� 7 ii ,; ?. y � ° '• °c+E i t _ f' '-' f `=! vw'a «. ''v :i �:n _�?.- -.k.�l Storm & Rain Drain -1st 100' 62.54 $5,000.00 . 0 _ $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 r r lj ` , i t 0 j each additional $100.00 or fraction thereof, to l �t Vii. ��ilsj li%�c - � ii �� 7 L..; ='4� 1 ',.� + „ti. �5.. �'; 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 char:e -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 ch. • • - 2 hours) each additional $100.00 or &action thereof, to Rcinspection Foes 90.00/hr and including $50,000.00. Additional plan review fbr revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for minimum ch n _e -1/2 hour) -_ each additional $100.00 or fraction thereof. Subtotal: � Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", L-117-1:=,,,2J y ; r r � � ,`rl j el 1`' }• -�1 i�1 . please indicate work performed by fixture. Failure to Plan review is required for any of the following. accuratel re • ort fixtures could result in increased sewer fees*. Please check all that apply. .s a a F +bh h J c�r it z 'c i.0',6TTe ' '� 11 i"u3' 3 e i i it - ❑ Any new commercial building with water service 2" and , ;01s 1 . r iF ,W , ",, a�"�I .r - Si • , „ , e _ a ` �+'i , � ) j ,. ! . y k ,,• pr 4 ? . greater except systems designed and stamped by Iicensed . �3 t' c aiYY#�,"dllr+.ic�' K' % =`�� ,.,^,1.ak .,,� j'ab , .w's; . engineer. Baptistry/Fon ❑ New exterior plumbing site utilities for any complex structure Bath - Tub /Shower . - as defined in OAR918 -780 -0040. - Jacuzzi/Whiripool _ ❑ Medical gas and vacuum systems for health care facilities. Car Wash -Bach Stall ❑ Any multipurpose fire sprinkler system. - Drive Thru ❑ Any complex structure as defined in OAR918 -780 -0040. Cuspidor/Water Aspirator Dishwasher - Commercial Submit 2 sets of plans with any of the above. - Domestic _ m mein • Fountain E , w-7t �Zr�- - ,I, t' 5 - Eye Wash j �'«" v� ^ xTf{ ._ ° f' ,.l..-r'Y.r.',t c C} (X� t 1 iS z v ? Floor Drain/sink - 22"� ❑ Isometric or riser diagram is required for new buildings - 3 that meet the . ualifrcations above. Car Wash Drain Garbage - Domestic - Disposal -Commercial Comments regarding fixture work: - Industrial Ice MachiRefrig: Drains Oil Se.arator Gas Station Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Par/Lavatory - f5radley -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 Wnsher-Clothes plumbing permit can be issued. Water Extractor / Water Closet - Toilet 7 . Urinal I . Other Fixtures: % AA. id - 441.9 4 l Qil>ci [5 ' http: / /ww ti gard- or.gov crty alUdepartments /cd/does/PI,IvtU- PermitA.pQdoc Accumulative Sewer Tally Parcel # r1" 2t - ` r :. ' " Tenant,Name` 'Carroll 8e Riggs. ° * * *CREDL1sS * * *;' • 1 _ "„, - '":"1 This SWR# - N /AY.. " . ''„k ,,.. Sifc ddress:: 1'0250.;SW Grenbuig,Rd #425 .' , .r ,, -` ° t , < This PLM# ; 2011 -00020 , .. -', `''" . Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off #s count # value #s values Baptisery /Font 4 0 0 0 0 0 Bath - Tub /Shower 4 m. 0“;m-; P; ° 0 0 0 0 - Jacuzzi /Whirlpool 4 .:., 0 0 "' 0 0 0 Car Wash - Each Stall 6 0 0;t 0 0 0 - Drive through 16 - • 0 , " ' ° 0 ... 0 0 0 Cuspidor /Water Aspirator 1 ^.. `, .. - „ 0 - .,' >.� 0 ' 0 0 0 Dishwasher Commercial 4 0 =' -`' 0 -- 0 0 0 - Domestic 2 =, 0 '' ' 0 - 0 0 0 Drinking Fountain 1 0 ,, 0 ` 0 0 0 Eye Wash 1 0 _ , 0 .'' `, 0 0 0 Floor Drain /Sink - 2 inch 2 i 0 =• - " °,' ;,, ' 0 > „ 0 0 0 - 3 inch 5 0 0 0 0 0 - flinch 6 0t ' 0 0 0 0 - Car Wash Drn 6 • 0 • . 0 . ' . 0 0 0 Garbage Disposal - Domestic (to 3/4 l-IP) 16 0 . , :I--.• 0 y . - 0 0 0 - Commercial (to 5 1 -IP) 32 0 0-• 0 0 0 - Industrial (over 5 HP) 42 , ' . , 0 ,t,I''r . 0 F 0 0 0 Ice Machine /Refrigerator Drain 1 .. _ 0 0 0 0 Oil Sep (Gas Station) 6 0 - 0 0 0 0 Rec. Vehicle Dump station 16 - • . 0 ,.. . 0 0 0 0 Shower - Gang (per head) 1 0 a.- 0 . 0 0 0 • - Stall 2 0 ,' 0 0 0 0 Sink - Bar /Lavatory 2 0 0 0 0 0 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 0 0 0 - Service 3 0 0 . 1' 3 1 3 Swimming Pool Filter 1 0 t ' " 0 0 0 Washer - Clothes 6 0 ;:',, 0 ; '11:i: , 2 6 1 6 Water Extractor 6 0 `„ 0 .•. 0 0 0 Water Closet - Toilet 6 ',2—:.." 12 0 -2 -12 Urinal 6 •' 0 1 6 0 -1 -6 Previous EDU Count „ , 0 0 Capped EDU Credit . . , 0 'TOTALS 0 0 3 18 2 9 -1 -9 Current Fixture Value -9 divided by 16 = -0.6 Current EDU 1 EDU = S 4,100 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -9 divided by 16 = -0.6 over (under) $ (2,460.00) Enter EDU Change Here "° .,',;0'.6';'' . Notes: ***CREDITS*** Authorized Name /Signature: Debbie,Adarnski , .. / /! '',''n r -' Date:, ` '1"419/2011 ' J ' '" ' . Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges. ' I:ABuilding \ Sewer Tally \Scwerl'allySheet- 3600.xls 06 /25/08 J AN /20 /2311 /THU 12 :48 PM P0lEE PLUMBING FAX No, 503 244 8825 P. 001 Plumbin • Permit A . a lien o I n ` ) ' p2/LrnOt Building Fixtures )„,-... i 6 FOR OFFICE USE ONLY City of Tigard JAN 2011 y ZN � Received Permit No,: P ZO1 I - 0402 0 I : v 13125 SW Ha11 Blvd., Tigard, UK 97 Date/By: Plan Review Phone; 503.639.4)71 Fax: 503,598.1960 OtherPennitNo.: � 1i T OF TI G A D Da Rea TIGA RD inspection Line: 503.639 S a Date Ready/By: nods' IZI See Page 2 far Internet: www.tigard -ortgg I I, la rt ilginm Notified/Method: Supplemental information ' I, Alit. ^n w ^awn• � i'`rra ..;�7 ,, , r'^ ^ "�'�i *Enl"z. "ig'^ fn M"` ^b .A cr,,. t. �;,1"� � ., tit .. ,`� �r.;^h r .d, }t r''aTP ,�TITi�� �.�d�+,F9:11: , iJ.� y ' to F •�', 11 '0: � / �1 .' lA . 'ra a' a � U E' 'N" ! A 1 . "r' :7 :.e WN�- ,. + r �+;1, . ff Y 4 t YJ ,,�! 1 I G , y q i . .µ (, k l Y kk. r 1tr n( uu '" } i iwl z 4:4W -:f "' {k V y-ah - FI C.1.4 : t : ko �..w.L4 n . I ?, Z'jir IG *_'l1i'k�:1:!�i.'t! --,, �t�.�`- ,- ,,1 -,' i^ �x-J..∎ , Q 7 � y' �,».i .. 1 x =, m .l1xi.,.c�2�l�t,.• ' � ..^( � �� ..� r , t zua.�F s�i r. �I � • �3.;t�' •! "� .. ;!, � �?"'n:ee}1� � s�"'1'Y�'�,�,::�w..:r,�.:>�' .. ❑ New construction (] Demolition For specie information use clrecklisl. .a.• - Description + Qty. + Ea. i Total t • ddition/atteratien/t ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) ._ r tiW r1 u1 4 i kF.71 ,F C 1 l sj y 't , i 1 r r ,7 * f p i P ia'' %� " '"t'' ' ��r rM ,+ � 4 r .. - _ ipifr r l i ° :t3 ti .,,',,.G+„114,t,",i �i�,,A ' 7 f ,., ;t'. -. a'.- ,�a SFR (1) bath 312.70 0 I• and 2- family dwelling Ii7 . o mcrcial /industrial SFR (2) bath 437.78 0 Accessory building ❑ Multi- family SFR (3) bath 500.32 Each additional bath/kitchen 25,02 0 Master builder 0 Other; - 2 r »n a w,�n., ,�. :xr� ^j�.��t^� �' . �th?"rrt';r::"* n °v3a'F1 v§ a 4 r �, Fire sprinkler �„•,..._ sq. ft.) Page ∎ r� r k ,,' `r ki ~, G1F , r F �S TR ra he d I ;11 1p N•� if 6; V w; w' . f 1 ,3 Site utilities: Job site address: I Catch basin or area drain 18.76 Ik City/ State/ZIP: /� i s-y - ( Drywcll. leach line, or trench drain 18.76 110_ '�' ? Footing drain (no. linear ft.; ) P 2 C Suiic ldg. /apL no.: j)__ Project name: Cam 1 I t E tei 9A) Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 -., _ _ _Rainulrain.conn_ector - - -_ - -- Y 143 -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; fax map /parcel no.; Backtlow preventer 31.27 "� ��`, *. "' W + i 1 Backwater valve " «ka } +?;'rt ; 6 1i W., Al,....( 12.51 e .1 °" - y Clothes washer 25,02 Al _ ,. . /. /..' 1 a 1 `, ' Dishwasher 25.02 ...,_ _9 ! :,All I LadV 10,2.1 ..a Drinking fountain - 25.02 F / a Ejectors /sump 25.02 r w1 G EX� `.`ti, M a'«v n It a 1'y 2.51 F G "� C "r, tir".c 1, tr : „ .�; , t `9� t.,, I , �".` , Expansion tank I P Fixture/sewer cap 25.02 Floor drain /floor sink /hub 25.02 Address: _ _ _-. ; I ./. 1. _ 1 t% Garbage disposal 25,02 City /State/ZIP: ii ' r !A.. , .. .) . '' i0�' Hose bib 25.02 Phone: ( ) Ice maker / 12.51 12 .51 .. , 1� alrs� _ p, ne •n , (pr• ,,.:.,� - ' . Ba a k Q {�/ s> r i• p, ,�T p y 1 Interceptor /grease trap 25.02 Medical gas (value; $) Page 2 Contact name: Primer 12.51 -A 0 1►�, ,.0 Roof drain commercial) 12.51 Address: i s?. Sink/basi lavatory 25.02 `j 6 biv Cit /State /ZIP: Y V ' C 1 2 . a Solar units (potable water) 62.54 Phone: ( ) ij l.- I CI 0 O I Fax: : ( ) t.4 - Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 vvF r`r a{ t , r413 r+ r Water Closet 25.02 c t;y ) li'&!! , a sa e `r ' ' , 14 ii t iaa Water beater 37.52 Business name: _ - Water -piping /1)Wv - �G4- Address: Other; 1 25.02 City /State /ZIPS Subtotal ? Phone: ( ) Fax: ( ) Minimum permit fee: 572.50 CC13 Lie.: 69. Plumbing Lic. no.: 34-150P-6 ____ Plan review (25% of permit fee) State surcharge (12% of pen mitt fee) 10 S 1 Authorized signature: ` f TOTAL PERMIT FEE qgg ir Jay R ),s cJ s This permit application expires if a permit is not obtained within 180 days Print name: ' I . Date: ' J / / 9 after it has been accepted as complete, "Fee methodology Set by Tri -County Building Industry Service Board. 1:1Buil01ng1pe miu\PLMU.PermiiApp .006 10/01/09 44046i6T(10 /02/COMPWEH) JAN /20 /2011 /THU 12:48 PM POMEA PLUMBING FAX No, 503 244 8825 P. 002 P1um0412 Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential + Fire Su ression S stems: w: .: n,,,, ur b � `.:.'; 1 fir mi f� [ , r ' Y ' 7 7. , r,4 �! If ' - zr :',, r, v , r �nw .r^ I �r ,.x m :! � T '� - T ���.s ', { e r r �'1' r tl �., , r 0 l � ` .J.�.:w.0 ,. ,,.e ,� ! I�! r { i sf a m�} �s 'N ti y u l ;� .� i� 4 ± 1 Ti '7 y t i o i ur N t M "'ir . ;.r `r � .. _ :� t [['' I [[ .7 7 � , �� , 1 r °, i, � 1 � r �,!�.� ' ;i I N ���'" � 1 �MV W.N..r ` �4 : 1 ,?.'r "" a *,.✓ � �. r _tr;ftrrri d:. �� C� a - � .� "� �' ", >!R. , ti M•ks 1�. <,� x....�.°ea ,`r � � � J�vi � eaP� r ., ,.P �:;3.,. :�. .a ii Footing drain - l' 100' 50.03 0 to 2 000 $121.90 Footing drain - each additional 100' 37,52 2 001 t 3 600 $169.69 3 601 to 7 200 $233.20 Sewer -1st 100' 62.54 7 201 and Jeerer $327.54 Sewer - each additional 100' 37.52 Water Service- 1st 100' 62,54 Medical Gas S stems: Water Service each additional 100' 37.52 ' °x �+rv»ri F V-rn ti ,..r�. ,r3 +tlrr�` rt Storm & Rain Drain 1st 100' 6234 $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 y �.` far ^,c rc 111 ro, Mf ,, p p ., I 1 � nfilf FLE Kt W yl 1 7 3 ' ;1,� each additional $] 00.00 or fraction thereof, to Q `a '. ) andincludin• $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/ht each additional $100.00 or fraction thereof, to (minimum charge -1/2 hour) and includin • $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 ch. _e -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 ", 1 , .' e 4z, e lf • ,� I, please indicate work performed by fixture. Failure to plat review is required for any of the following. accurately report fixtures could result in increased sewer fees * . Please check all that apply. '1.r'' ' Y : n ' ' iilll°° , 0 Any new commercial building with water service 2" and it M 'ii N e � FhfiA b YOb , , r r M it - ' . J M. .MM F' 1 " n , ,3 4 (6 , � „M l � 3 ' '. e 1 greater, except systems designed and stamped by licensed t ;N far r J w, o nfi engineer. Baptistry/Font El New exterior plumbing site utilities for any complex structure Bath -Tub /Shower as defined in OAR918 780 - 0040. - Jacuzzi /Whirlpool El Medical gas and vacuum systems for health care facilities, Car Wash - Each Stall Drive Thou ❑ Any multipurpose fire sprinkler system. Cuspidor /WaterAspirator 0 Any complex structure as defined in OAR918 780 - 0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. rn Drinking Fountain Eye Wash Id,te t44,1il at 1 !i ' ,b- ., 1J4,•.,,'�.. y ;�" . ii .•ar•;,tc n, ,,, ''i wI r' k7 .,,. .�`dades•',��. es� �,x '1 "k00,Ir � Floor Drain/sink - 2" N 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 Se arator Gas Station Rec. Vehicle Dump Station Shower -Gang - -Stall ----- - Sink •Bar/Lavatory - - -I - Bradley . - Commercial *Note: If the fixture work under this permit results in nn - S ervice increase of sewer EDITS, 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:(',Q � - http:// vvww, tigard- or departments /od/docs/PLMF_PermitAp{SR,doc _......._...._..., ........