Permit ,, CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00007
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/13/2012
Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16195 SW 72ND AVE
Project: Option Care Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30
Project Description: Relocate (1) water closet, (1) lay, (3) sinks, (1) floor drain and (1) water heater.
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 236 -4152 PHONE:
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 01/13/2012 $25.02
Specifics: 3 ea Sink 01/13/2012 $75.06
1 ea Lavatories 01/13/2012 $25.02
Type of Use: COM 1 ea Water Closet 01/13/2012 $25.02
Class of Work: ALT 1 ea Water Heater 01/13/2012 $37.52
Type of Const: 1 12% State Surcharge - 01/13/2012 $22.52
Occupancy Grp: Plumbing
Stories:
Total $210.16
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 ' o'er • uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Noti ation Center. ose rule are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct • estions to OUNC by slli 0 .232 •87 or 1.800.3
Issued :;y: / I • / / ,, f( /7 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available insp= • date.
This permit card shall be kept in a conspicuous place on the job site un ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
:
III Vi City of Tigard Received Date/By: /A / Permit No.: 4111 2j-/ p /1-DQ(e7
v 13125 SW Hall Blvd., Tigard, OR 97223,,x, NI 1 3 2 012 Plan Review
. Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Penult No.: un. r
Inspection Line: 503.639.4175
TIGARD CITY OF TIGARD Date Read /B Juris: 65 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist
Description Qty. I Ea. I Total
Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION • SFR (1) bath 312.70
El 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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / G'/ ?6-5-- cc./ 72 - Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: 71'9 c?,„1 a/1_ S) , y t/
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: , Project name: 0,/- C,) ys . 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: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
n �
/ � G Clothes washer 25.02
oe ! a,e / - i k - C / - La (/ `1 . c' ' / 6, t/c ., ?/.1 ,- Dishwasher 25.02
IA a. a t°e1 / - / Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: .,:/ v 5-7- Fixture /sewer cap 25.02
Floor drain /floor sink/hub g ^ / 25.02
Address: / 573S 5' w Sep, 0/77J 3,-4 t4 y Garbage disposal 25.02
City /State /ZIP: 7`i y „; f /' cit S X12- t/ Hose bib 25.02
Phone: (S S) C&-c-° Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Oe /� (/ O /a ,, i 0 � �
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: ,1---e e Roof drain (commercial) 12.51
Address: / %', c . , x /y 7O I
Sink/basin/lavatory if 25.02
City/State /ZIP: / cy/ _ S 7 25' .3 Solar units (potable water) 62.54
Phone: ( rt-)) 7 `: - 5' 4/.9C Fax: : (5-6)) 2 $'',C - 221 g Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet / 25.02
CONTRACTOR
Water heater / 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( )
Minimum permit fee: $72.50
CCB Lie.: / Sy' q/ 9 Plumbing Lic. no.: 2 C_ 7 3 6 /-9,d Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature- 4 ,-- TOTAL PERMIT FEE PeR /O . /4
Print name: .S.?../ 42- //' Z c. - Date: /- 13 ,./ L 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(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' 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: Permit Fee:
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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
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 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 * . Plan Review for Plumbing 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'
Baptistry/Font ❑ Any new commercial building with water service 2" and
Bath: - 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
Eye Wash Submit 2 sets of plans with any 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 that meet the qualifications above.
Garbage - Domestic non -food
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
- 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
fees assessed for the sewer increase must be paid before the
Water Extractor p
Water Closet- Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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