Permit CITY OF TIGARD B PLUMBING PERMIT
EIPII " It ' COMMUNITY DEVELOPMENT f Permit #: PLM2011 -00064
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 D ate Issued: 03/03/2011
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 400
Project: Micro Interconnects Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Interior Plumbing: Relocating breakroom sink. 3/10/11, reprinted for revision: breakroom sink is an additional
fixture.
Contractor: CASCADE PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES
2630 N HAYDEN ISLAND DR #3 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97217 PORTLAND, OR 97224
PHONE: 503 - 624 -6300
HONE: 503 - 289 -7095
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Sink 03/03/2011 $25.02
Specifics: 1 12% State Surcharge - 03/03/2011 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 03/03/2011 $47.48
Plumbing
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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. -; . - -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or d' -ct questions to 0 • . ' g 503.232.1987 or 1.800.332.2344.
I -sued By: /
y: / 1 Permittee Sig ature: Y o-,---L.____) i
Call 503.639.4175 by 7:00 a.m. for the next available inspection ate.
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 -00064
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/03/2011
Parcel: 2S 113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 400
Project: Micro Interconnects Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Interior Plumbing: Relocating breakroom sink.
Contractor: CASCADE PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES
2630 N HAYDEN ISLAND DR #3 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97217 PORTLAND, OR 97224
PHONE: 503 - 624 -6300
HONE: 503 - 289 -7095
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Sink 03/03/2011 $25.02
Specifics: 1 12% State Surcharge - 03/03/2011 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 03/03/2011 $47.48
Plumbing
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, 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.
mow
Issued By: r - rmittee Signature: .!' I
Call 503.6 •.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
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received I
11/4 n 1312 Sw Halt Blvd., Tigard, OR 97223 , t N Plan Review
Phone: 503 . 63 9.4171 Fax: 503,598l96 E, p Other Permit No.;
T1%i Inspection Line: 503.639,4175 i _ ` ,1„°T Ready/8y: turir: t'f Sea Page a for
A RU Internet: www tigard- or.gov , ' x , Notified/man,od: ' ',� j , Supplemenad information
2
TYPE OP WORK : : FEE* SCHEDULE
❑ New construction ❑ Demolition For 'pedal Information use clra/(Grf.
Description ( Qty. I Ea. I Total
0 Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 It for each utility connection)
CATEGORY OP CONSTRUCTION SFR (I) bath 312.70
1- and 2- family dwelling SF —
❑ g ❑ Commercia�ndustrial R (2) bath 437,78
❑ Aceea - Sory building SFR (3) bath 500.32
❑ Multi - family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other _ Fire sprinkler (., sq. It.) Page 2
, ;s JOB SITE INFORMATION AND LOCATION Site utilities:
lob site address: - 19nd * Catch basin or area drain 1 18.76
City/State/ZIP, Dtywcti. (tech line, or trench drain 18.. 6
',: '' Footing drain (no. linear ft: ) i Page 2
Suite/bldg./apt. no.: i! t re jec na me / __ JJ -- ' ' fir ' "°-
Suito/bldg a i a ' 11itie 1 0 („7�.1 t_on,'►dtIS {{ Manufactured home utilities 50.03
Cross stre:t/dire ons to job site: I Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _,,,) Page 2
'i° Storm sewer (no. linear ft: Page 2
Water service (no. linear ft.: _ ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer i j '
DESCRIPTION OF WORK 1 Backwater valve j 12.51 j
/_ 1 Clothes washer j 25,02
s p .rY1' G./
D 7G11 t _ lt". ici- inSl 1 Dishwasher 25.02
tp ' . • • I0. Dunking fountain 25.02
t I , 1, dam) -s4J 4 EjectorsiSump 25.02
■ PROPERTY OWNER • R' ENANT Expansion tank M 12,51
Name: Fixture/sewer cap 25.02
Ploor drain/floor sink/hub 25.02
Address ^ } Garbage disposal 25.02
City/State/ZIP; Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT . , ❑ CONTACT PERSON Interceptor /grease trttp 25.02
Business name: CASCADE PLUMBING COMPANY Medical gas (value: 3 .) Page 2
Primer 12,51 1
C ontact Warne: CRYSTAL JONES j
i~ — Roof drain (commercial) 12,51
I Address: 2630 N. HAYDEN ISLAND DRIVE #3 l Sink/basin/taeatory r 25.02 1 ] J 2.
r sty State/ZlP: PORTLAND, OR 97217 i Solar units (potable water) 62.54
Phone: (503) 289 -7095 Fax:: (503) 283 -9514 j Tub/showcr /shower pan j 12.51
E -mail: CASCADEPLUMtYAHOO.COM N ( W 25.03
CONTRACTOR I �Natct closet ! 25.02
Water heater i 37.52
Business name: CASCADE PLUMBING COMPANY water pipina/Li1VV 36.29
Address: 2630 N. HAYDEN ISLAND DRIVE 03 Other. 25,02
City /State/ZIP: PORTLAND, OR 97217 Subtotal
1
Phone: (503) 2$9 -7093 I Fax: (503) 283 -9514 . Minimum permit fee: $72.50 7� )
-�
t Plan review (25% of permit fcc)
CCS Lic.: 120893 i Plumbing Lic. no. :3A -412PB
State surcharge (I2% of pemtit tee) 4 3 . . 0
Authorized signature: I ak TOTAL PERMIT FE2
A LAI . AL _ e 0) 1, .t Vi • z0
Print name: CRYSTAL JONE k D This permit applirattoa expires Ita parade is nor obtained within iae says
actor it has been accepted as complete.
— p i,ettst , a - �/y,r .Fee methodology set by 'Fri-County Onitdu ;g h,dtatry Service Board
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Plumbing Permit Application
Building Fixtures ..,,..,:--'1, , - , '' FOR OFFICE USE ONLY
Received
City of Tigard Q Permit NP,:
111 131 SW Hall Blvd., Tigard, OR 9 223 � ' ` r 11 Date/By e� /I /1 &Tr �[ �► 3e1 1' veklCo1
a Phone: 503.639.4171 Fax: 503.598,1960 n Plan Review 7
s t. :T k 0 Date/By: Other Permit No..
Inspection Line; 501639.4175
T I ii A } D g CA 1 ■ O �r• V .-: I� -' c No ti ed/Me J t SSu Page 2 for
Internet: www.ti rd - or. lemental Information
ov • TYPE Or WORK ` 3\ .. FEE * SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. 1 Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 H. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (l) bath 312.70
I and 2-family dwellin
❑ y g ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building SFR (3) bath 500.32
❑ M ulti - 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: 1 /biz. Catch basin or area drain 18,76
CitylSlate/" /IP. �/� ,. f f U Drywcll, leach line, or trench drain 18.76
't Footing drain (no. linear ft.: ) Page 2
Suitc/bldg. /apt. no.: rOlect name: Nut;t"D ` t i ,( Manufactured home utilities 50.03
Cross street/dime ens 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
DESCRIPTION OF WORK Backwater valve 12.51
n (2 ` Clothes washer 25.02
.Ilr1b 14J)d ' 4 ltixl''f7�I7 i Dishwasher 25.02
'Peet -k-r OC>/Yt Si t Tell-" Drinking fountain 25.02
Ejectors/sump 25.02
mm
❑ PROPERTY OWNER, I •. ❑ TENANT Expansion tank 12,51
Name: Fixture/sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: ..- l
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: CASCADE PLUMBING COMPANY Medical gas (value: $ ) Page 2
Contact name: CRYSTAL JONES • Primer 12,51
Roof drain (commercial) 12,51
- Address: 2630 N. HAYDEN ISLAND DRIVE #3 Sink/basin /lavatory i 25.02 j 0 2
City /State/ZIP: PORTLAND, OR 97217 Solar units (potable water) 62,54
Phone: (S03) 289 -7095 Fax: : (503) 283 -9514 Tub /shower /shower pan 12.51
E- mail: CASCADEPLUM@YAHOO.COM. Urinal 25.02
Water closet 25.02
CONTRACTOR Water boater 37.52
Business name: CASCADE PLUMBING COMPANY Water piping/DWV 56.29
Address; 2630 N. HAYDEN ISLAND DRIVE #3 Other: 25.02
City /State /Z1P: PORTLAND, OR 97217 Subtotal
Phone: (503) 289 -7095 Fax: (503) 283 -9514 Minimum permit fee: $72.50 7,p -50.
CCB Lic.: 120893 Plumbing Lic. no.: 34-412P8 Plan review (25% of permit fee) ...
State surcharge (12% of permit fee) $
Authorized signature: t# TOTAL PERMIT FEE g'( .7,0
Print name: CRYSTAL JOKE D ate: This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
r {"y l `o y,,, p "Fee methodology set by Tri Coanty Building Industry Service Board.
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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 - l" 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 300' 62.54
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - Ist 100' 62,54 Medical Gas Systems:
Wafer Service - each additional 100' 37.52
Valuation: Permit Fee:
storm & stain 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 Fee Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
p and including $10,000.00.
Inspection of existing plumbing or for 510,001,00 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 ", Plan 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.
Quantity by (Fixture) Work Performed ❑ 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
-Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
(3at1, - Tu pool as defined in OAR918- 780 -0040.
-,ia b/Shower
Car Wash if W St ❑ Medical gas and vacuum systems for health care facilities.
-Each Stall hru 0 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 Comments regarding fixture work:
- industrial g
lce Mach. /Refrig. Drains
Oil Separator (Gas Station)
Roc. 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
plumbing permit can be issued.
Water Extractor p g p
Water Closet - Toilet
Urinal
Other Fixtures:
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