Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT `' 'a _ Permit #: PLM2011 -00113
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/19/2011
��' Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 150
Project: Immunology Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project Description: Plumbing modifications for new tenant. 6/22/11, reprint to add (21 new lays & (1) relocated lay.
Contractor: ADDISON PLUMBING Owner: PACIFIC REALTY ASSOCIATES
27425 S BEAVERCREEK RD 15350 SW SEQUOIA PKWY #300
MULINO, OR 97042 PORTLAND, OR 97224
P
PHONE: 503 - 624 -6300
PHONE: 503 - 740 -8116
FAX: 503 - 632 -1168
FEES
Quantity Description Date Amount
1 ea Dishwasher 04/19/2011 $25.02
Specifics: 1 ea Floor Drain /Floor Sink/Hub 04/19/2011 $25.02
g ea Lavatories 04/19/2011 $225.18
Type of Use: COM 1 ea Water Heater 04/19/2011 $37.52
Class of Work: ALT 1 12% State Surcharge - 04/19/2011 $37.53
Type of Const: Plumbing
Occupancy Grp: 3 ea Lavatories 06/22/2011 $75.06
Stories: 0 12% State Surcharge - 06/22/2011 $9.01
Plumbing
Total $434.34
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. ou may o copy of the rules
or direct ques " UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: v _
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.
CITY OF TIGARD PLUMBING PERMIT
1111 I COMMUNITY DEVELOPMENT Permit #: PLM2011 -00113
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/19/2011
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 150
Project: Immunology Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project Description: Plumbing modifications for new tenant.
Contractor: ADDISON PLUMBING Owner: PACIFIC REALTY ASSOCIATES
27425 S BEAVERCREEK RD 15350 SW SEQUOIA PKWY #300
MULINO, OR 97042 PORTLAND, OR 97224
P
PHONE: 503 - 624 -6300
HONE: 503 - 740 -8116
FAX: 503 - 632 -1168
FEES
Quantity Description Date Amount
1 ea Dishwasher 04/19/2011 $25.02
Specifics: 1 ea Floor Drain /Floor Sink/Hub 04/19/2011 $25.02
g ea Lavatories 04/19/2011 $225.18
Type of Use: COM 1 ea Water Heater 04/19/2011 $37.52
Class of Work: ALT 1 12% State Surcharge - 04/19/2011 $37.53
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $350.27
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stat of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expir if Lvork is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you o f dlow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 • o. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
� /
I
PP
ssued By � ••�/ � 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.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE OM.)
J IVED
E `m' � Received � /��
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City of Tigard l Br
41/ 4/1P ( Penult No.. �f/J�/ ��6//
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13125 SW Hall Blvd., Tigard, OR 97� 6 2011 Plan Review n L[[ n - I f
Phone: 503.718.2439 Fax: 503.59 4 �g Other Permit No.: c a
TIGARD Inspection Line: 503.639.4175 CITY OF TIG TIGARD �y�sy: 4 /�� p_ Jucis: See page2 for
Internet: www.tigard- or.gov Notifi Me thod : ��a�( SupplementalInformation
TYPE OF SING DIVISION Vhf w�f/9-7/ FEE* SCHEDULE
❑ Ne construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling mmercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- 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: j"fi� fk . 22.'44 # & e. Catch basin or area drain 18.76
�r� 4,1
Drywell, leach line, or trench drain 18.76
City /State/ZIP: O
A/, /v � 0 � / �O� Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Projecfname �I�,1�j O / 7 y 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.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: 0° 1 11g "D7 cV ..2,00 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher i 25.02 Ow • DA
Drinking fountain 25.02
Ejectors/sump 25.02
OPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name: 7,41.c. C ) 5 -
Address: d oor drai� sink/hub ` 25.02 ; $ .O
Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
PLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: A Gv _/ -.-�_
Medical gas (value: $ ) Page 2
Contact name: Primer 12.51
...Or `
a /- '/L',/ Roof drain (commercial) 12.51
Address: ri!, ,< sin/lavatory ,O9 25.02 n S/ g
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax:: ( ) Tub/shower/shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
`` Water heater 1 37.52 37 Sit
Business name:c e6Vnw`Y.\ LA.-C.- Water piping/DWV 56.29
Address: Z74-2.c S s - LI Other 25.02
City/State/ZIP: (1,k.,,..\\,,,6 (-)9....., 9 4 ,-2- Subtotal 312.74
Phone: ( $t3' ,) CjZ- (l.. Fax: SOS) 63Z_1t Minimum permit fee: $72.50
CCB Lic.: (5y7 Ste} Plumbing Lic. no.: 3 -t.Q.cteg Plan review (25% of permit fee) ��'
- t o State surcharge (12% of permit fee) 7.53
Authorized signature: " {csl(t -Qi TOTAL PERMIT FEE 4 351). 2 ?
Print name: del y�, -t Date: T - s - l t This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri County Building Industry Service Board.
I:\ Building \Permits\PLMU- PenmitApp.doc 10/01/09 440-4616T(l0 /02/COM/WEB)
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 -1 " 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 100' 62.54 7,201 and greater $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' 62.54 $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 Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P 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 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",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following. Performed: Capped Added Relocate ew Q y ow g
Baptistry/Font Please check all that apply.
Bath - Tub/Shower ❑ Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash - Each Stall engineer.
- Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink C-2, l Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic -non -food q g
Disposal - Domestic -food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related -
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
3Lav -Non -food related $
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes i of sewer EDUs, a sewer permit will be issued and
Water Extractor � P
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http : / /www.tigard- or.gov /city_hall/ departments /cd/docs /PLMF- PermitApi2doc