Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00368
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/08/2011
Parcel: 2S 113AB00600
Jurisdiction: Tigard
Site address: 16125 SW 72ND AVE
Project: St. Jude Medical Center Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30
Project Description: Install (1) additional hand sink.
Contractor: TERRY MASSEY PLUMBING Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 2407 ATTN: N PIVEN
CLACKAMAS, OR 97015 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 997 -0324 PHONE:
FAX: 503 - 655 -7065
FEES
Quantity Description Date Amount
1 ea Sink 12/08/2011 $25.02
Specifics: 1 12% State Surcharge - 12/08/2011 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 12/08/2011 $47.48
Type of Use: COM 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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: • • tee _Signature:
41140;14 /
Call 503. • •y 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.
FROM :Terry Massey Plumbing FAX NO. :5036557065 Dec. 06 2011 03:13PM P2
Plumbing Permit Application
Building Fixtures C.i. V N i i,i; i,t 1. R. 1 t tit_ 1).1 )
1 . City of Tigard 6 ti0 LiLI Received 0 r itNo.: r t , e -00- •
13I25 SW Hall Blvd., Tigard, OR 9 223 Plu R evie :�:o•���/ �:
w
Phone: 503.718.2439 Fax; 50.3.598.196b r. R ovic .r � Other Permit No� pa�,���
,. Inspection Line: 503.639.4175 GP ��
i' i (, A r 11 W`C1 `S \Ot Di" Re416By t,a;: B See Page 1 For
Internet: www.tigard -or.gov 0 • Notified/Method: Se . •,�. enrol lnfonnation
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l� � w. u::4^CU,�.c.;atG n.�'h:'1rrvY�:h...•'�✓Sx `1?n "+ @A
F ar special luformation use check! ^ _ \
❑New construction ❑ olitircrt ()Cf./i
_� - - Description I Qty. I . Ea. L Total
0 Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft, for each utility connection)
11 +V,T.f� p(4 15 ,i;',c �,h' W 64^ a `• W1 5f t5 ',; S ! 1.',1'141.11.:'.
' d V
' � � � + ?'�� �� s �� ,.� �� `��` "Eps'^ wW'� :"�� . :..r• SFR(1)bAtb 3!2.70.
O I- and 2- fancily dwelling ® Commercial /industrial SFR(2) bath 437 -78 T)
In Accessory building ❑ Multi - family SFR (3) bath 50032
t ��
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fine sprinkler (- sp. !t) Page 2 `•
, ' h, 5 1° 6 + * 1+N � r , .iiitt4i k . , rM . f '^ d "R 4 ti i Site eitiiities; `
na Catch basin or area drain 18.76
Job site address: 16125 SW 72 Ave
City /Statc/ZTP: Tigard, OR 97224 Drywelt, leach line, or trench drain 18.76 IR
Footing drain (no. linear tt; _,,,,,)) Page 2
Suite/bldg. /apt no.: I Project name: St. Jude Medical Center Manutlictured home utilities 50.03 ,
Cross street/directions to job site: Manholes 18-76 'J
Rain drain connector 18.76
Sanitary sewer (no. linear ft.:... _ ._) Page 2
Storm sewer (no. linear A: . Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: "Lot no.: Fixture or item:
Tax map/parcel no.: o 1 / /34 ('iCe- l3aekflow preventer 31.27
` f e , a y ' ! + ° 1 { , * ( (�,� (+ t Backwater valve
12.51
',i...1‘,;./"f •; *';'1? " 7 :IQ N�{ . ,alio V ' E t �� .. , ,}Y^kr :3. C 9 -". ,„' ' ", �' Y' w�
�f•. rG � a�rAr R:. T a:' f ud,.IVVan ,(8!! t1. +
additional hand sink Cl othes her 25 -02
M...� ..,_ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
y i1 F3, 7t�k pt' t v1, , .,qt i ; ` 5 r , , 4 N E r ? R , , Z + M f ' 1 ' W , r :. i q iy i k Expansion tank 12.51
s a" "ff r, k . t . k ,A, , m. u„ L ax a. 1. , . 9}, A it i. ,+r �, J , R
Name: Fixture/sewer cap 25.02
- Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: _ Rose bib 25.02
Phone: M ( ) Fax: ( ) Tee maker 12.51
II : Y ' (J ke !i+ .rt r Y vlww2 6H r a 'id. .i +r t 0.6 . 'JA �• .. In� /!use 25.02
$.tl;r� 1 �.� � �m.4c. bJ; :.,;� nw .'+. ,. N .. Yti �at' ��a L�
Business name: Terry Massey Plumbing Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Jamie Massey Roof drain (commercial) 12.51
Address: PO Box 2407
Sink/basin/lavatory 1 25.02 25.02
City/State/ZIP: Clackamas, OR 97015 Solar units (potable water) 62.54
Phone: (503) 997 -0324 Fax: : (503) 655 -7065 nib/shower /shower pan 12.51
E -mail: mtjmaseey @comcastnet Urinal 25.02
q , y :i'p,� "�?,', :r yin; ! ?�° "; C` : " :+y,',,'.1?y;it ?„' ;.., ,. , :.rt..o �r •., ,• y ;.n : ^q; :a ' i•. �; Lr,(r "' , i Y;. ': ' 1 L '➢° ; Water elaset 25.02
1� X��''ii,, , : r J .�'{ C r ih rra 1•W R,yyyR+'RM
r�,iPr,Nf , r 3 " 4� r,: rue; ,. ,... ,,wt ,, .4,,'..t!..,,,.. . , .. A rick P l d 4,... ti?r! at& ∎,1 :? , • i� . Water heater
37.52
Business name: Terry Massey Plumbing Water piping/DWV 56.29
Address: PO Box 2407 Other: 25.02
City /State/ZIP: Clackamas, OR 97015 Subtotal 25.02
Phone: (503) 997 -0324 Fax: (503) 655-7065 Minimum permit flee: $72.50 72,50
(25% agent* fee
C CB Lic.: 151 756 i iy ,.
Plan review (
Plumb Lie. no.; 3-480PB h hii -- )
Authorized signature: State surcharge (12% of permit fee) 8.70
�L TOTAL PERMIT FEE 81.20
This permit liratlon e><pfr Ira permit is not obtained within 180 days
Print name: Terry Massey Date: 1216/11 app ,titer it has been accepted as complete. f //
'Fee methodology get by Tri.County Building Washy Service tdomd.
FROM :Terry Massey Plumbing FAX N0. :5036557065 Dec. 06 2011 03:14PM P3
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sur r ression S stems:
.f�, 1 . . e y 1 y K -:.sv . t d c1 l r '1'� D
i''.':;;;,'.'4.1,7?,', , ilX� Cy t u l r r �,
' tJ t 4k •i , t L. _ �' r �'� Ciri�w d _..: .. }I'�1, x S e.a.. a r i.i ., ..-,,„'S�' .+il k t .. 3n6r. 4iii
Footing drain -1" 100' 50,03 0 (02,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
likaill
Sewer - I st 100' 6.54 3,601 to 7,200
7,201 and s -- lIZERMIMMINIMEMINEMOM
Sewer - each additional 100' 3752
Water Service 1st 100' 62.54
•
Medical Gas S stems:
Water Service - each additional 100' 3732 4 KtL r ,7 j ; � 21.1:! at .�,,,T��",�,` `J' + a J , a ' ,� ,rS k i t
$torn d2 Rain l i' , Ii v �3. ' ,1M1.....; n"„`.'.' "itg ':. ,,: t'1l., ,�?•s t 1 o .`,: ;�
?rain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 t 4n nl $5,001,00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
rif l 0 11 y. i :. ., j . ,. b r _ s 1 4 %. 'r i .� r ? r' of r y each additional $100.00 or fraction thereof, to
,� ,wwa. ° -,fl .d r 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 fcc 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 eh- - 2 hours each additional $100.00 or fraction thereof, to
Rcinspection 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 *.
! ' ^�� ^ ' u 'i • - „ �'g" f., do ,f '.' 57 , 7i "vs^. 5,x.757, �' �3({F;d95;, ktr t YT ' rn 1P "i'hy'�tv
'r � t , i �Y 1' d q"P ; t ,.,, 7 4 / 19
C �,: t � 4 , �� � ' e ' r; � �Q!� ' ''�✓ �' ; -: , �CF ��mel:, i3; �Y. xa 'u2i1�.a.�r�.ui�au,...A.e., `.v�..x in ..,a ,,. ,., l,.A ",ni
Oa t 1) lore(" ' P ; Plan review is required far any of the following.
• -, 'kTisfmcmedi ,::: t, Agl!Igt,, Y,KiSUC Please check all that apply.
Baptistry/Font - -
Rath - Tub/Shower 0 Any new commercial building with water service 2" and
Jacuixi/Whirlpuol greater, except systems designed and stamped by licensed
Car Wash - Each Stall cttgmccr•
-Drive Thn: ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in 0AR915- 780 -0040.
Dishwasher - Commercial V ❑ Medical gas and vacuum systems for health care facilities.
- Domestic 0 My multipurpose fire sprinkler system.
Dri • _ Fountain ❑ Any complex structure as defined in 0AIt918 -1$0 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
4„ k aM e _.v p xS�J"'X' TDR c t , ,.'7'? A r ( li ,v r 6 ',f P V
t ;�v °�j k- 4 w :9.1:, ;t1 .:. ^te ', r.. w", Y .q i
.� ,Fr ,t `�' h r R , 4
Car Wash Drain uZS b� . w -m l �� ,. r nary a1m YU ,:n .r, . n .:. l t ..r , nd�. +a ,,, ,
Garbage - Domestic -nom -food ❑ Isometric or riser diagram is required for new buildings
Dispersal - Domestic -food related - .. that meet the 4 ualifications above.
- Commercial -food related
- industrial -food related
Ice Mach./Rcf Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station Additional hand sink
Shower -Gang - - _ ,
- Stall - _
Sink/tav -Non -food related - 1
- Bradley
-Commercial -food related
- Service -
s n Pool Filter 'Note: if the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Wane= Closet - Toilet fees assessed for the sewer increase must be paid before the
Urin
4 _ - - plumbing permit can be issued.
Other Fixtures: