Permit CITY OF TIGARD PLUMBING PERMIT
III
111 ' COMMUNITY DEVELOPMENT Permit #: PLM2011 00099
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2011
Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 306
Project: Advanced Acupuncture & Oriental Medicine Subdivision: TIGARD MEDICAL MALL Lot: 0
Project Description: Remove and replace sink.
Contractor: CASCADE PLUMBING CO Owner: MCFADDEN, ARTHUR L
2630 N HAYDEN ISLAND DR #3 BY ERIC SKLARZ
PORTLAND, OR 97217 621 SW MORRISON ST STE #800
PORTLAND, OR 97205
PHONE: 503 - 289 -7095 PHONE:
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Sink 03/30/2011 $25.02
Specifics: 1 12% State Surcharge - 03/30/2011 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 03/30/2011 $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 quest UNC by calling 503.232.1987 or 1.800.332.2344.
C r 04(1/rkt—A-4a-P Issued By Permittee Signature: C es /
i --___J
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.
Plumbing Permit Application ' ,
Building Fixtures - - FOR OFFICE USE ONLY
City of Tigard MAR 3 2 Receive a c:..) � .) 0 20 Ar Permit 140,; 3 (, /9tj ,— ems.
w ' 13125 SW Hall Bfvd., 1'i�ard, OR 97223 Date/By: Review _ •
t illl
Phone: 503.639,4171 Fax: 503,598.1960 Date: Othcf Permit No.:
Inspection Line: 503.639,4175
T1. GARD BUILDING' l Date Ready /By: Lurie Sec Page 2 for
Motif ed /Method: Internet: wvvW.tlgard-Or.gov Supplemental information
•
TYPE OF WORK FEET' SCHEDULE
For S•ec,al Information use ckrck list.
III Ncw construction ❑Demolition Descri.tion ME Ea. Total
Fddition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR. (1) bath - 312.70 M
SFR (2) bath 437.78
❑ 1- and 2- family dwelling commercial /industrial -
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: _
" Catch basin or area drain 1$,76
,l ob site address: (� sh ��� Drywcll, leach line, or trench drain 18.76
y City /State /Ll P; ri q411CO, I T Footing drain (no. linear ft.: _ ) Page 2
Suite /bldg. /apt. no.: . O Project name: 4 c w I #1 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.: ) MN Page 2
Subdivision: • Lot no.: Fixture or item:
^ Tax map /parcel no.: Backflow preventcr 31.27 EMI
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
AIN Wr]it_. Dishwasher ME 25
Drinking fountain 25.02 MEI
Ejectors /sump 25.02
❑ PROPERTY OWNER " ❑ TENANT • 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 NM
Phone: ( ) Fax: ( ) Ice maker 1 12.51
❑ APPLICANT ❑ CONTACT PERSON . interceptor /grease trap 25.02
Business name: CASCADE PLUMBING COMPANY Medical gas (value $ ) Page 2
Primer 12,51
Contact name: CRYSTAL JONES _ Roof drain (commercial) 12.51
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Sink/basin/lavatory IIIIII 25.02 Wirgn
City /State /ZIP: PORTLAND, OR 97217 Solar units (potable water) 62.54
Phone: (503) 289 -7095 Fax: : (503) 283 -9514 Tub /shower /shower pan 12.51
" Urinal 25.02
E -mail: CASCADEPLUM@YAHOO.COM
- Water closet 25.02
CONTRACTOR
.-. Water heater 37.52
Business name: CASCADE PLUMBING COMPANY - Water piping/DWV 56.29 -
Address; 2630 N. HAYDEN ISLAND DRIVE 43 Other: 25.02
City /State/ZIP: PORTLAND, OR 97217 Subtotal
Phone; (503) 289 -7095 Fax: (503) 283 -9514 Minimum permit fee: $72.50 ,a• . 50
Plan review (25% of permit fee)
CCB Lie.: 120893 Plumbing Lie. no.: 34 -412PB n
1
State surcharge (12 %ofpermitfee) 1'.10
Authorized signature: .it 0 . � >Q TOTAL PERMIT FEE ' 1
_ I Thia permit application expires if a permit is not obtained within 180 days
Print name: CRYSTAL JONES Date: after it has been accepted as complete.
I
1� '� , Fee methodology get by Tri- Cou�rty 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 - I' 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 0 w $169.69
3,601 to 7 7,20,200 $233.20
sewer - in 100' 62 7,201 and ;rcatcr $327.54
Sewer - each additional 100' - 37.52
water Service • 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52 Valuation: Permit. Fee
Storm & Rain Drain - 1st 100' _ 62 $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
Q ty. F ee (ea) Total each additional $100.00 or fraction thereof. to
Other Inspections or Fees 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 -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 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.
accuratell report fixtures could result in increased sewer fees' Please check all that app €y.
Quantitxby (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 , . engineer.
(3aptistry /Font . _ ❑ New exterior plumbing site utilities for any complex structure
Bath -Tub /Shower as defined in OAR918..780 -0040.
- Jacuizi /Whirlpool
Car Wash -Each Stall CI Medical gas and vacuum systems for health care facilities.
-Drive CI Any multipurpose tire sprinkler system.
- D Tara Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Cuspidor /Water Asp
Dishwasher •Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain .
Eye Wash Isometric or Riser Diagram
Floor Drain /sink - 2" 1 ❑ 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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