Permit .' ; CITY OF TIGARD PLUMBING PERMIT
` - • • ' '•- COMMUNITY DEVELOPMENT Permit #: PLM2009-00219
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/13/2009
Parcel: 2S113AB01400
Jurisdiction:
Site address: 7358 SW DURHAM RD BLDG G
Subdivision: Lot: 0
Project: CORAM
Project Description: Relocate (1) laundry tub.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
#300 1 ea Sink 08/13/2009 $16.60
PHONE: 1 12% State Surcharge - 08/13/2009 $8.70
Plumbing
56 ea Minimum Fee Adjustment - 08/13/2009 $55.90
Contractor: Plumbing
DEAN WARREN PLUMBING & REMODELING
INC
PO BOX 14701
PHONE: 503 - 236 -4152
FAX: 503 - 296 -2218
Type of Use: COM
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 w.. • spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Not -lion Center. hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dire questions to OUNC b •Ili , g 503.246.6699 or 1.800.332.2344.
tss „d By: 1 fr 1 / , Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that b ess day.
This permit card shall be kept in a conspicuous place on the job site . • it completion of the project.
Approved plans are required on the job site at the time of each inspection.
- Plumbing Permit Applicaai •'
H L(..) 5 ea,.. V U FOR OFFICE USE ONLY Received 1.1h
City of Tigard r 2009 Date/By: D � Y p I I I Permit No.: . 1#0609.-• co ..t
. a 13125 SW Hall Blvd., Tiga O R A
Plan Review
Phone: 503.639.4171 Fax: 50 1 'v 8.1 Date/By: Other Pe mit No.:
I
Inspection Line: 503.639.4175 i TIGARD Date Ready/By: Notified/Method: Ju ethod: (lJ� El See Page 2 for
TIGARD Internet: www.tigard or.gov BUILDING DIVISION ^_ g
Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist
Description I Qty. Ea. I Total
181.-Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
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"• ,V �ti:1 I s • :C�'r1�TEGORYx;OF- CONSTRL9 `� '� < ~'°'"'" SFR 1 bath
`` r -:r .. 249.20
❑ I- and 2- family dwelling ,Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
=t " * ti` ::' =<.q' :,; ,r s: ' x,::" .,,a�;w ww r ._�.. .T fz `..: Fire sprinkler ( sq. ft.) Page 2
4, ...r �$ 4_ �`" JOBeS [NF ORMA'ITOIV AND . LO O C A TTT ON" ;ti ( ' x '
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/ � __ Si te utilities
es
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Job site address: 7 rr-C g w /7c.- A J .ti, 6. , .i Catch basin or area drain 16.60
City /State /ZIP: fG, - 9 ) 2-2'1 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: l Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.:
J H .r,t �:„ F:- :,, •- , .,,, Absorption valve 16.60
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=,,,.t we "�: r 1;, bESCRiP1 /ON , _ F / QRK „f - $ 4 , z. ° , Backflow preventer Page 2
it C Ca?L � v '7'L Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
.
.., . . ,, - • `..„ ,r.1. . s, n,,, °vr w .
,:v :,.� »_ ., �,, ,:: o" - - .7<', Drinking fountain 16.60
N.: ;4; FRO.r . I R I ® 1VA' ,a" , :sY `
°� *' � � ��; �"_ �' a ��. ,, �a r.. �� ...� ,.�,�;,�: <,:3���?�°:,... >. Ejectors /sump 16.60
Name: At t 7 e J Expansion tank 16.60
Address: / tj ' 5' C/ S c,..- /9,...p. 4a-epic-rt.. Fixture /sewer cap 16.60
City /State /ZIP: /Or+ tye Cit. ,,1 yl/ Floor drain /floor sink/hub 16.60
( )
Phone: ( ) Fax: Garbage disposal 16.60
l „'t'f.._'A,l , .hw: f ;: T. 3,,, `_ '4Zii ff.V.k u.: V L •:...., g61 - Hose bib 16.60
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® AP - AN Tr f �; i.?. �, ®tCO -:-.„ - ; -t�P•ERS,ON ` k'.:
..: _.,, -,� :au •': _. „ eoi Ice maker 16.60
Business name: /0 ezw- 1.....-.44. A / Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax::( )
Sink/basin/lavatory 1 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
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..�; �� ;'..-- . �':�;��.: �: tt` K= �; ���u r-��= .�.- �,.fl�.�:�;w - "m. x, >'�= - ,'4,, , e.-3 , ,,f: .. _ .:a�'�"��;:�ti Water closet 16.60
Business name: /D.- (,t./dyyw.. "4 ,-. ) ) G.- /6,n p,-./o / Water heater 16.60
Address: P• Ct.- AcJA /L/ '70 / Other:
City /State /ZIP: Port- CA .. 9 7J- S 3 Subtotal
Minimum permit fee: $72.50
Phone: ($ / ) - 7 50- g 4 G Fax: (S2')) 2 S 6- 12-/ g Residential backflow minimum permit fee: $36.25
CCB Lie.: / 5 9/ 1 Plumbing Lic. no.: 2 6 -7 3 ('y/3 Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature:
TOTAL PERMIT FEE
Print nar` A alt"
Date: $ -/ 3_0 4 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\PLM- PermitApp.doc 12/27/06 440- 4616T(IO /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
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.'`�, a Qty � .? �ee Cea) � "� tBI -' :�"� *�',�. :..:_ �"�s�'��'
�� ..v Sq uare F ootage, �'ermit Fe n ,.
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00
Medical Gas Systems:
Water Service - each additional 100' 46.40 F
> ,>e,'
Valuathon..q =- Prmit ee ., << x.: n` m
Storm & Rain Drain - 1st 100' 55.00 ,.��t,..M.. _�.<.... ,.
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
e���.Fe(ca)
_ additional $100.00 or fraction thereof, to and
Qt "'Totala,�
ItXti�eE
UOl Yteill .,t >fi��_,,, .s_, w, °?i* ..' _ rA '�;°::s including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? "yes", - tx,: > g;rt u , ." .�i': ;sA s 5a ;:'.v s > " . " Y; ;= «r. � :;:" . ` '
. If yes tj�lari, = lZe%ieti f0i' P1u ° bin i2stalla lol
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.
} I = 1 '' ;Quart " Viatliiiii Wo 050formeil ❑ Any new commercial building tY Y ( ) � Y with water service 2" and
Fixture Type µ r . nRe tace�,, greater, except systems designed and stamped by licensed
.0C ?Capped, ek ded ,„ engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru 1=I 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 1 q « � ometrc oi :D °iagrau%k = �
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory *Note: If the fixture work under this permit results in an
-Bradley
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i'\Building\ Permits\PLM- PermitApp doc 12/27/06