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Permit ` CITY OF TIGARD PLUMBING PERMIT ' III COMMUNITY DEVELOPMENT Permit #: PLM2011 -00358 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/20/2011 .TIGARD , Parcel: 2S101AB00100 Jurisdiction: TIGARD Site address: 12025 SW 70TH AVE Project: Dr. Sunil Thanik Subdivision: 1996 -024 PARTITION PLAT Lot: 2 Project Description: Medical gas only Contractor: WOLCOTT PLUMBING Owner: SUNIL THANIK 1075 W HISTORIC COLUMBIA RIVER HWY 470 SW 6TH ST. TROUTDALE, OR 97060 LAKE OSWEGO, OR 97034 P PHONE: 503 - 699 -6628 PHONE: 503 - 667 -1781 FAX: 503 - 667 -9891 FEES Quantity Description Date Amount 1 ea Medical Gas 12/20/2011 $322.52 Specifics; 1 12% State Surcharge - 12/20/2011 $38.70 Plumbing Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: • Total $361.22 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 I Issued By: �� / °ermittee ignature: / / /4 41111W _ • 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. Plumbing Permit Application --, 1 � Building Fixtures ` ' �� .F FOR OFFICE USE ONLY C o f Ti and 2 7-°11 E ie /Afffn p D / Permit No.: 1 hone S 50 Hall Blvd , Tigard, OR 97223 kl Phone: 503.71 R 439 Fax: 503.598.1960 2439 Other Permit No r !'�l"t� Date /BY %� -%6-// T.IGARD Inspection Line: 503 639.4175 C�T Or �y {s Dat Read /B 0 e 2 or Internet www.ttgard or.gov � j ,l C d tl�. Notified /Me thod' g" fie/ Suppl emental If formation VII .. �( Juris. - :, . _ - „ z :,...., : ,. 1.,:l ,� .. 7 YP E «O . W 012 . „ ,�'` .,, � x + . , t . ,� FEE *= ' SC1EAiJIE s ' ° :';:: �E special information use checklist. ® New construction ❑ Demolition Description I Qty. I Ea. 1 Total ❑ Addition /alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) _ , ;, a "'„ : EG • RY;=nF (CnNSTRU(TIONr =. = ;,',,w;.r .< �'a z *<,_;:?;<) _ SFR (1) bath 312.70 __� � �. �AT O ❑ 1 - and 2- family dwelling ® Commercial /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 34a#1,, ° ' _ :din ; -y.,. ',1:1 JOB; ITEiINFARNIAT&IO .._--.-...:. i4 Site utilities: Job site address: 1202.5 SW 70 AVE Catch basin or area drain 18 76 City /State /ZIP: TIGARD, OR 97223 - DON, 6 L � / �, rL I Drywell, leach line, or trench dram 18 76 Footing drain (no. linear ft.: ) Page 2 Suite /bldg- /apt. no.: i Project name: into-ROCK CREEK CENTER • Manufactured home utilities 50.03 Cross street /directions to job site: 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 1, .iii " ; ni �: t i ,x; 11 ,. Backwater valve 12.51 -, Vi= r," = ,D' SCItiPTTON :'OF 'WORK : :•. o pt, `, .. DENTAL OFFICE ` � Ni P „' „ 5 ,o' �t-y Clothes washer _ 25.02 Dishwasher 25 02 Drinking fountain 25.02 Ejectors /sump 25.02 :. a,-.;.;; >, ston tank T - �'��'�" � Ex an `°�° ❑ =PRCIKfti ' OW.NEI2'; 'TENANT :,1,.: P a _,. • �n± . � «a ia ,,.., " ; _�.,, ., > : �astr- , , -> �: �% � " "-�r�� � : rr::a,,e: =ta.��.,.�i .. . ... . - 1251 - Name: Fixture /sewer cap 25.02 Floor drain /floor sink/hub 25.02 - Address: Garbage disposal 25.02 • City /State /ZIP: Hose bib 25.02 Phone: ( ) ( ) Ice maker 05 12.51 Fax: ©. - . a� -1 "'AP - NT': t ��" r ` " sPA �T ^�P� �R �- �= Interceptor/grease tra � 25.02 , -4:: ° �s,;C C E St)N. P r��:;• -: E�,�:'?,.;'.- ,....�.. ..- ,,.�,.; .. ..,,,.. F, ��;,.,.'ifw, ^' ,. .. ...: �: ��L ;,..:.:.=.:•Rl.,�z >:'..: '. s� >,3 .,: -. ,... .- M,:.ize ?)i �M V' Medical gas (value $ I Page 2 72.50 Business name: WOLCOTT PLUMBING v Primer 12 51 Contact name: CLIFF BOWMAN - - Roof drain (commercial) 12.51 Address: 1075 W HISTORIC COLUMBIA RIVER HWY - Sink/basin /lavatory 25.02 City /State /ZIP: TROUTDALE, OR 97060 Solar ti, :otable water) 62.54 Phone: (503) 667 -1781 X381 Fax: : (503) 667 -9891 Tu. shower hower pan 12.51 E - mail: cbowman @wolcottplumbing.com Urinal 25.02 - ;; Water closet 25.02 CONTRACTQIt "�.: " " : :;: . - . ... .... ... . ..�_�� ._s.,. zr = =� .- .u. -. . • X'Att Water heater 37.52 3" Business name: WOLCOTT PLUMBING Water PP t m DWV 56.29 Address: 1075 W HISTORIC COLUMBIA RIVER HWY Other: 25.02 City/State /ZIP: TROUTDALE, OR 97060 Subtotal Phone: (503) 667 -1781 Fax: (503) 667 -9891 Minimum permit fee. $72.50 .. V Plan review (25% of permit fee) CCB Lie.: 112220 Plumbing Lie. no.: 26 -824PB ^ a J] State surcharge (12% of permit fee) Authorized signature: friple''- , TOTAL PERMIT FEE Print name: CLIFF BOW MA " Date: 12/2/11 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 -Pei rrnApp.doc 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: fee: (..; ea Total >e 3 S><te Utdihes: Q�• ? °`' .:� �;.r,: ��S uare�Fo' a �'Perit�Feei ��% n ,,.. w ay �:, .� -�:.. �:,� �.e � .ot ge " - ..... �� .... >:: <..� Footing drain - 1s 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`' - Storm & Rain Drain - 1st 100' 62.54 :.:� � .o�• ;.� :P�erm><t_Fee: .tis .;,_ �� $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 - -e - ' ` •'' , ' tv:a�; °Fee ea Total: . each additional $100.00 or fraction thereof, to >Other° F es e and including $10,000.00. ect>lonsDo� 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 sewer fees b Fixture ":T e :Quantity' by 3p P lan < Re , ,„, Plmb n fin x ��:.' .., .,, .� .. -....• , s Fixture Type for Replace / , York�Perforined Capped , E Added Relocate Plan review is required for any of the following. 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" _ Submit 2 sets of plans with any of the above. - 3" s: <a.'I. S0 met11C Or ''R ser llia" rani ' '> 3 Car Wash Drain ...... ....... Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings 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/Lav - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes p water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: K f h4c P.nca http : / /www.tigard - or.gov /city_hal l/ departments /cd /dots /PLMF- PennitAp jdoc