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Permit CITY OF TIGARD PLUMBING PERMIT I COMMUNITY DEVELOP Permit #: PLM2011 00289 Date Issued: 09/16/2011 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 1S126BC01506 Jurisdiction: Tigard Site address: 9020 SW WASHINGTON SQUARE RD 450 Project: River City Travel Subdivision: Lot: Project Description: Relocate fixtures for TI Contractor: GRIDLINE PLUMBING Owner: WISCO REAL ESTATE EQUITY FUND I 4343 SE 37TH 1501 SW TAYLOR ST STE 100 PORTLAND, OR 97202 PORTLAND, OR 97205 PHONE 503 -771 -8790 PHONE. FAX. FEES Quantity Description Date Amount 1 ea Dishwasher 09/16/2011 $25.02 Specifics: 1 ea Floor Drain /Floor Sink/Hub 09/16/2011 $25 02 1 ea Primer 09/16/2011 $12.51 Type of Use: COM 1 ea Sink 09/16/2011 $25 02 Class of Work: ALT 1 ea Water Heater 09/16/2011 $37 52 Type of Const: 1 12% State Surcharge - 09/16/2011 $15 01 Occupancy Grp: Plumbing Stories: Total $140.10 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 th- - =. adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 Y% may obt. n a copy of the rules or direct questions to qUNC by calling 503 232.1987 or 1 800 332 2344. Issued By: -'r _ Permittee Signature: / Call 503.639.4175 by 7:00 a.m. for the next available i s . - c ∎ on a te. 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 RECEIVED FOR OFFICE USE ONLY liii City of Tigard Received G DateBy `/ / 6/7 Permit No/CG 4 0// #70 y 'I 13125 S W Hall Blvd , Tigard, OR 97223 P 16 7011 w6 / Phone 503 718 2439 Fax: 503 598 1 DDate/By e . Other Permit Naga /9// 6, /6 Inspection Line 503.639.4175 Date Ready/By iun See Pa e 2 for T1G nRD Internet: www.tigard - or gov CITY O TIGARD Notified/Method i(o- ® Supplemental Informat ot TYPE OF W ��LDING DIVISION FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Descri.hon St . Ea Total ddition/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 i i i ercial /industrial SFR (2) bath 437.78 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 LO ATION Site utilities: Job site address: ?2 ` � � 4 / r ) J • d/ Catch basin or area drain 18.76 City /State /ZIP: / ��r/ 7 ( d1 (} I / Drywell, leach line, or trench dram 18.76 ss-y� 7 / 6 Footing drain (no. linear ft.: ) Page 2 Suite/bldg./apt. no.: ! /Were/ Project name: .77/111/1/ Manufactured home utilities 50.03 i. Cross street/dire s to o site: / Manholes ■ 18 76 t� 0 e -� f Zk /� /� Rain drain connector 18 76 7 ; c � / — �{ ; / © Sanitary sewer (no. linear ft ) Page 2 D A ( il), "C 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 /� /�� 1 Clothes washer 25.02 L ' / � / r r / `—' — Al Oh /) //✓ Dishwasher /� . 25.02 2 �,d .4. / ' ' /tea, r � � ys � t .— / ° 7 ' tite - ' Drinking fountain 25 02 Ejectors /sump 25 02 El PROPERTY OWNER I ❑ TENANT Expansion tank 12 51 Name: Fixture /sewer cap 25.02 Floor drain/floor sink/hub )' / 25 02 c3/"Jit01, Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12 51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02 Business name: Medical gas (value. $ ) Page 2 Contact name: Primer › - / 12.51 a. 5/ Roof drain (commercial) 12.51 Address: `' ` / Sink/basin/lavatory 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12 51 E -mail: Urinal 25 02 Water closet 25 02 /CONTRACTOR Water heater X / 37 52 37, 5_ Business name: „/” c: ////1 . e t /i/pt Cl) Water piping/DWV 56 29 Address: 3 5 //AI.�2� Other: 25.02 _ City /State /ZIP: l�� 7 69 (/L 4 2Z 2i Subtotal /25 /Phone: () 77/ -`7o 6� 7! Fax: ( / —/D Minimum permit fee. $72 50 ,/ CCB Lie.: 7./ O / ,1 lumbing Lic. no.: , W Plan review (25% of permit fee) + State surcharge (12% of permit fee) /5' r 0 / Authorized signature: ore / ��� /// TOTAL PERMIT FEE �G/� r , Print name: , /t , ( )' v f ill 1 1 _ Date: / _ // This permit application expires if a permit is not obtained within 180 days (/ !° ' after it has been accepted as complete. *Fee methodology set by Tr,- County Building Industry Service Board i \Budding\Permiis\PLMU- PermitApp doe 10/01/09 440- 4616T(10/02/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 & Ram 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 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 se e *. Quanti b Fixtur• , le Plan Review for Plumbing Installations Fixture Type for r /'' ' Plan review is required for of the following. Performed: Capped Added Relocate ew a any 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 - 2" 1 Submit 2 sets of plans with any of the above. -3" 4 Isometric or Riser Diagram required Wash Dram ❑ Isometric or riser diagram is uired for new buildings Garbage - Domestic—non -food g 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 Sink/Lay - Non -food related - Bradley (p - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and Water Extractor wer p WaterCloset- Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures I:\Building \Permits \PLMF - PermitApp.doc 02/24/2011 2