Permit CITY OF TIGARD PLUMBING PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: PLM2009-00110
Date Issued: 05/06/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S113AB01400
Jurisdiction:
Site address: 7358 SW DURHAM RD BLDG G
Subdivision: Lot: 0
Project: CORAM
Project Description: TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY 1 ea Sink 05/06/2009 $16.60
#300 1 ea Lavatories 05/06/2009 $16.60
PHONE: 1 ea Tub /Shower /Shower Pan 05/06/2009 $16.60
1 ea Water Closet 05/06/2009 $16.60
Contractor: 1 12% State Surcharge - 05/06/2009 $8.70
DEAN WARREN PLUMBING Plumbing
PO BOX 14701 6 ea Minimum Fee Adjustment 05/06/2009 $6.10
PORTLAND, OR 97293 Plumbing
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 • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Cent- Those -. -s are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
■
I sued By: Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for an inspection that busin�ee
This permit card shall be kept in a conspicuous place on the job site untileompletion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
4 Building Fixtures FOR OFFICE USE ONLY
City of Tigard d Received
g Date By: d, Permit No.: , a/ �i�V ja
NI
v 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
S Phone: 503.639.4171 Fax. 503.598.1960 Other Permit No.� ij/If)�P
Date By "
Inspection Line: 503.639.4175 Date Read /By ntris
TIGARD and -or. ov Y ® See Page 2 for
Internet: www.t
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
11 New construction ❑Demolition For special information use checklist
Description I Qty. Ea. Total
Z Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ I- and 2- family dwelling V 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:
Fire sprinkler ( sq ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 7 3 q 5 w /wrti ?. '7 /4...-1. Catch basin or area drain 16.60
City /State /ZIP: 7•1'5 , d1 - y 7 2 ). Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: l Project name: c- (2,r0 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: I Lot no.: Water service (no linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
g -0 f I S / AA Backwater valve 16.60
19--d' / - 4,..0 ,, / - /-,7 y, Clothes washer 16.60
/,� ` (- S hw� i -- S x-A Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: i °:)`.'y- yriS?' Expansion tank 16.60 '
Address: / 3 5 S .- 5 ``t/ v G , „) i'. (.`o) V Fixture /sewer cap 16.60
City/State /ZIP: P c ;, / cy 2 c .- - j y Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16 60
Ice maker 16.60
n
Business name: / l CL "44,4' t7 fkl.,) 7 Interceptor /grease trap 16.60
Contact name: n �l' ,_, �2 J c .)6 Medical gas (value: $ ) Page 2
u •
Address: U / j ry .. /q 7 ej / Primer 16.60
City /State /ZIP: Pc4-1/.. O y' ) y 3 Roof drain (commercial) 16.60
Phone: 'c' ' F Fax: Sink/basin/lavatory 16.60
cs )) - 780 -5 v� � (5 3 ) ?9c - - . .; g og
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet , 16.60
Business name: ✓D+z (,�z / V- �1noc�i7 Water heater % 16.60
Address: ✓�� , ( ,I t ,y 7 r Othe f' /]�7
City /State /ZIP: Y�c.14 -L 02, c 7i > 3 "y Subtotal
r � Minimum permit fee $72.50 --7 Phone: (5r) ) .. O - 4 (9 6 _ Fax: Dt7 ) Ly E; -- ?Z Z% / Residential backflow minimum permit fee: $36.25
CCB Lie.: / 5 9/ y Plumbing Lic. no.: ;.' - 7 3 6 /'%3 Plan review (25% of permit fee) -{�'
State surcharge (8% of permit fee) S, 70
Authorized sigtr
ff n TOTAL PERMIT FEE q
Print nan) .. 2 , , L j Date: _� = ' G This permit application expires if a permit is not obtained within
`` f 180 days after it has been accepted as complete.
Zi' *Fee methodology set by Tri -County Building Industry Service Board
P\Buildmg\Permits \PLMF- PcrmitApp doc 12/27/06 440- 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' 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
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72 50 and including $50,000.00.
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.
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantal by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing , ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918 -780 -0040.
- Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial •
- Domestic J /
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
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
- Bradley *Note: If the fixture work under this permit results in an
- 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'l Building \Permts\PLM- PermitApp.doe 12/27/06