Permit a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00349
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/17/2011
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 320
Project: Professional Eye Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Interior plumbing: Adding (1) breakroom sink for TI. 11/17/11, sewer credits applied from PLM2010 -00388 in full.
Contractor: ADDISON PLUMBING Owner: PACIFIC REALTY ASSOCIATES
27425 S BEAVERCREEK RD ATTN: N PIVEN
MULINO, OR 97042 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
P
PHONE: 503 - 624 -6300
HONE: 503 - 740 -8116
FAX: 503 -632 -1168
FEES
Quantity Description Date Amount
1 ea Sink 11/17/2011 $25.02
Specifics: 1 12% State Surcharge - 11/17/2011 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 11/17/2011 $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:4/ / Permittee Signature: j/ jut ' • - 4
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.
2-5 H D'1-0 1 ix)
t Plumbing Permit Application 5W/L .1 - lir
Building Fixtures City of Tigard �C FOR OFFICE USE S ONLY , ' • ' -
L`� Received ilk ?//1 /�-. '
Permit No.: G� )11.--0031.4 q
II 13125 SW Hall Blvd., Tigard, OR CI% a Q � Date/By: /1 ern 1
4 Plan Review
,; Phone: 503.639.4171 Fax: 503.5'x:. 960 '11 : �� Other Permit No.: ,,�� QQ a "l'3a
Date/By:
/ �Ir 1,1 ��
Inspection Line: 503.639.4175 P' Dat Read /B .t uns: ® Se Page for
.T "1G'ARD e �� lO Ready /By: g
Internet: www.tigard- or.gov 4,- V Notified/Method: r& Supplemental Information
- TYPE OF WORK C% 1, - -..1%, FEE* SCHEDULE
❑ New construction ❑ DeJ do For special information use checklist
``44'' Description Qty. 1 Ea. Total
® Addition /alteration/replacement El 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 ® Commercial /industrial SFR (2) bath 437.78
CI Accessory building SFR (3) bath 500.32
ry g ❑ M ulti- 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: 15350 SW Sequoia Pkwy. #320 Catch basin or area drain 18.76
City /State /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no1.33'yt � Project name: Professional Eye Care Manufactured home utilities 50.03
Cross street /directions to job site: SW Redwood Ln. 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: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Tl
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: PacTrust Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 15350 SW Sequoia Pkway #300
Garbage disposal 25.02
City /State /ZIP: Portland, OR 97224 Hose bib 25.02
Phone: (503)624 -6300 Fax: (503)624 -7755 Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Durus Construction, LLC Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Steve Adams
Roof drain (commercial) 12.51
Address: 15836 Upper Boones Ferry Road r
Sink/basin/lavatory / 25.02 �7 ` t) J.
City /State /ZIP: Lake Oswego, OR 97035 Solar units (potable water) 62.54
Phone: (503) 320 -8601 Fax: : (503) 684 -8144 Tub /shower /shower pan 12.5I
E -mail: steve @durusllc.com Urinal 25.02
Water closet 25.02
•
CONTRACTOR
Water heater 37.52
Business name: Addison Plumbing, LLC Water piping/DWV 56.29
Address: 27425 S. Beavercreek Road Other: 25.02
City /State /ZIP: Mulino, OR 77042 Subtotal AS 0 X
Phone: (503) 740 -8116 Fax: (503) 632 -1168 Minimum permit fee: $72.50 7a 50
Plan review (25% of permit fee)
CCB Lie.: 151754 Plumbing Lic. no.: 3 -449PB g
State surcharge (12% of permit fee) _ 70
Authorized signature: tA ,,y,♦ TOTAL PERMIT FEE g, , ea
Print name: Jay Moore Date: 11/17/11 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- PermitApp.doc 10/01/09 440 -4616T( I 0 /02 /COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
i tom - • .
-' .T.: a� ' ;;fir=:':: ^'r -�-�::,Fm -"T - - -> k ':; z ,�..,. .� ... _�- ,..,F.: _`
StelJtlities ro¢r >Qty , 4 Fce (ea) Total. = �. a �� � t ;;-:
�,�� .. � �� �. >� � .� �� :Square Footage:. -, �;. Perm><t <�Fee; ....,... �. ��.F�n >,fi
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 fl e h� �
P r :tF ;,
ee�,: :... ,: �F ..::._ . ..�
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
+': - each additional $100.00 or fraction thereof, to
O;t11erInspections. or = FeeS'r. -w. -> Fee ea iTotal
( �^ 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 90100/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 orfraction 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 * . Plan 'Review for`Plumb in `Installations' •
Quantity by Fixture:Type . Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply..
-Work'Performed:• Capped Added Relocate pp y'
❑ Any new commercial building with water service 2" and
Bapti stry/Font
Bash Tub /Shower greater, except systems designed and stamped by licensed
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918- 780 -0040.
Drinking Fountain S ubmit 2 sets of plans with any Wash p y of the above.
Floor Drain/sink: - 2"
3 " Isometric : or Riser. Diagram - •
4„ ❑ Isometric or riser diagram is required for new buildings
- Car Wash Drain
Garbage Domestic non - food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig, Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station _
Shower: -Gang
-Stall
Sink: - Lav/Bar non -food related 1
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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