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Permit CITY OF TIGARD PLUMBING PERMIT Jp ;' '. COMMUNITY DEVELOPMENT Permit #: PLM2012 -00013 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2012 TICrl1RL? Parcel: 1 S136CD01002 Jurisdiction: Tigard Site address: 7910 SW PFAFFLE ST Project: Wenyi Jia Dental Office Subdivision: 2006 -016 PARTITION PLAT Lot: 3 Project Description: Interior plumbing. Other fixture includes (1) vac pump drain. Contractor: WOLCOTT PLUMBING Owner: PFAFFLE OFFICE, LLC 1075 W HISTORIC COLUMBIA RIVER HWY PCCC LLC TROUTDALE, OR 97060 915 NW TORREYVIEW LN PORTLAND, OR 97228 PHONE: 503 - 667 -1781 PHONE: FAX: 503 - 667 -9891 FEES Quantity Description Date Amount 1 ea Medical Gas 01/26/2012 $96.82 Specifics: 2 ea Backflow Preventer 01/26/2012 $62.54 1 ea Clothes Washer 01/26/2012 $25.02 Type of Use: COM 1 ea Expansion Tank 01/26/2012 $12.51 Class of Work: ALT 2 ea Floor Drain /Floor Sink/Hub 01/26/2012 $50.04 Type of Const: 2 ea Primer 01/26/2012 $25.02 Occupancy Grp: 5 ea Lavatories 01/26/2012 $125.10 Stories: 1 ea Water Closet 01/26/2012 $25.02 1 ea Water Heater 01/26/2012 $37.52 25 Misc Other Fee 01/26/2012 $25.02 1 12% State Surcharge - 01/26/2012 $58.15 Plumbing 1 Plan Review 01/26/2012 $121.15 39 ea Info Process /Archiving - Sm 01/26/2012 $19.50 $0.50 (up to 11x17) Total $683.41 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 questio UNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: (c.9.--""— 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. • 01/17/2012 12 :31 5036679891 WOLCOTT PLUMBING PAGE 01/02 Plumbin Per mitAppiicatio . , Building Fixtures 1 FOR OFIriCE 1.15E ONLY City of Tigard JAN 17 2012 Re v 13125 SW Hall 13tod„ Tigard. OR 97223 JAN : 1�� Permit No.; . pO Id -do I Plan Revla. 2 , - Phone: 503.718.2439 Fax: 5 03.592, r Other Permit . 1 Inspection Linc: 5036394175 D OF TIGARD Dn1c/ ._ - h Pi N��L /c - I e/ Of T i C r 1 R b Ins t 11 1 ! Internet www.tigstrtl or,gry BU L�ji� l� 01�1s�O . Data Rc /dy/ Fa See Page 2 for 0 Natf ned /Method: Su: lemental Information nrormntio>N p- `!J rss , ,p, ,1" 1, V x l d RfI4p' 9 li `E pf I I4 I`�tn 17,1 V` t y r �' q �p �i li lljl � 1 Ie l4 � qq "illi 2'I ;l ! i�, 1 r IN I ll i� �� S , t t � q � i 1 j 4 }11 ' 11 i' !.' i k : I ;1 '. 1111 4,.! l.' ! } t I 1 '"I; 1� t3 New i construction ,MtE ,"41 `Il ,li��ldi�' 1> � � C1 I ' l l : 4 I !�� � � t� t, � � . • 11,,I1� � :, T ,f N Fn � special lnfnrmatintt �� 1 �,E ,� { 3 °�.l pj i 1 ��'slj����xit7 4� ' l�rlj9 arse checklist; N Ei Description I Qty Ea, i Total N Addition /aheration /replacement El Other: - 1-2-family dwellings (includes 100 ft, for each utility connection) '1%i. ' ;I; ; r; mil ,I "''l l i' I; ,! I ;r,R it Iii C pin d :, , 1 I n ' 1 p iG SFR I ath 312.70 - S y iT, i���I� �,�i�f�i1 i;d�li?.' p�r li�kl� ��h� 1h�' q� hj � '�i , I � 1 �.. @ I 41 id') ? i (1 i ( b ( } � Pi 111 � ,� ;f 0 1- and 2- family dwelling L Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500,32 El Accessory building © Multi-Family - - - Each additional bath /kitchen 25,02 o 1Vlactcr builder ❑Other: Fire sprinkler ( sq. fl..) Page 2 — lillilll� " {� ( 11���7��{ blip {lail(i'.iN4lltlu,,, t „1 II,UI!; iii I �.!, A p o i 6 o . ro . �, qst '..4 : 1 11 1 ,1. Site utilities: _ • � p I Catch basin or area drain 1 8,76 Job site address: t,W Pfaffle St. ' / I 0 Drywall, leach line, or trench drain 18.76 City /State/Z_1P: Tigard /OR/07233 • ^ Footing drain (nn, linear R.: ) Page 2 - Suito /bldg. /apt. no.; [Project name: Dental Office Wenyi,ria Manufactured home utilities 50,03 Cross street/directions to job site: Manholes 18 76 ` Rain drain connector 18.76 Sanitary sewer (no. linear f1.: ) Page 2 — Storm sewer (no. linear ft,; ) Page 2 "-" - Water service (no. linear ft.: ) Page 2 Subdivision Lot no.: I +ixhtre or item: Tax map /parcel no.: Backflow preventer 2 31.27 (p, st7 �Il a�,l, { rtr l rll+e," ! I ", i'r; 9 { i x 0 (' Ill v l . {q {p } Backwater valve lllfrlr�:, it + 'ti� 4ili 1G" Ibi! if f�l 1 � { . �f �� �„ „111' . 1.. t M { e �? ir . R � � . ' ,I,1 i , . ,.: 1 �1� �61 _ 12,51 _ Clothes w 1 25.02 '2_ . 0), Tcnnnt Improvement for new Dental clinic. Dishwasher 25.02 Building Permit #BUP2411- 0()265 Drinking fountain 25 02 Ejectors /sump _ 2S 02 ll'zlill°jil(i'1�!' l� I. it "illlli gulf ;IR x 9ll:u '�u , liV •"tai Oi 1 !_( - c l i ti:Il 11 1 M �1�i> ine0,fl i � .. l I ll l '" }, I i i i'''., IR 25.02 it I ,) i � Expansion tank _ 1.�. 12 , 51 -L1g /— :L %l„il hp, :i0 f.1 „n, n�,,,� t �„rt,r a i'p ( I L Name: Fixture/sewer cap _ l�1! �7#9- Floor drain/floor sinkThub iV 25,02 -7S Address; r b �, ' . ( }fa Garbage disposal 25,02 City /State /ZIP: base bib 25,02 --- ^ Phone;; $) 2 0 (Ay - Fax: ( ) Ice maker 12,51 .�� {,j,11{ ilil 1� Jl LIAil�' 1 , ,1 i ' 1`I1�GI; ;�1lj ! „af �! •jd `'11111 ' ?10 e� t i t, 1 i "p Interceptor/grease p �. _.._.25.02 —. 1 cf m D tt c r S t'kxril�, � I , 1" ,i i,,_,.�:�1uaa,,,�u�i.��itrL l c tAtatra �,. ����� � iTil interce p sc q'n Business name; Medical gas (value: $ 6,699 ) .. I Page 2 �� �� Contact name; Pruner ' 12,51 °- - -- Roof drain (commercial) 12,51 Address: Sink/basin /lavatory — (/ /rs� 25.02 / City /State /ZIP; Solar units (potable water) 62,54 Phone: ( ) Fax:: ( ) _Tub /shower /shower pan 12.51 E-mail: 25.02 „4111 .' ll 1' � 1 iii �lla��ty i (I l il'i .liii l li 1 i 'i 'l� t l'` 1 P 1; I. °iki'il(l 1 +l %1' It . 4 , vl r l l . t I Water aloscc // . 2 5.02 S (. i 1 i , i rnI i �, { l — ”' f'� li 12 d1'11 p' ft ,, iV r � �� r 1:'1 7 i y '';,1: L,..,� �i1 ' , . 1111l;�. tolitstilll C(i,�i�LlOil ;i r y sift „1,,,,'ha,;.atil4.4ili di1 1,111V1� {� {f 91 ] „ila Waterh„tc 1 _ 37.52 37. .•ot Business name: Wolcott Plumbing Waterpiping/DWV � 56.29 Address: 1075 W. Historic Columbia River Hwy. Other: Vac Pump drain 1 ` 5.02 City /State /ZIP: Troutdale /OR/97060 - Subtotal r Phone; (503) 667 -1781 X307 Pax: (503) 667 -9891 Minimum permit fee: 572,50 CCI3 Lie.: 112220 P tmb' Q Lie, no,: 20 -824PB Plan review (25% of permit fee) State surcharge (12% of permit fee) t Authorized signature: ' /; TOTAL PERMIT FEE I Print name: Dennis L. Dunning - 'this permit application expires if a permit Is riot obtained within 180 days ”) niter it 1tnn been accepted as complete, ( i) i D Rai l✓ (1) f;7 c:l2 ^Fcc methodology set by Trt.County Building industry Service Board. 1:1Ouildlnp \Pttmits \PLMti- PrrmllApp.dpc 10 /OIAI9 440.4615't(lo /n2 /Comiwna) (,J Virei Cc -o S f Ci) L / /� '—. ',; � / /9, =c ~ , . �i)�f E-. 2 .°"_� . 01/17/2012 12:31 5036679891 WOLCOTT PLUMBING PAGE 02/02 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su pression Systems: � � 111 I'l$� "t �Vi'li � 111111) 11 {; � � I t' �4 '° '' "I i r1� iii' fin ;1 ! ii1„,1 I f � ;aril �� I �f,� �i�l' Ill It l�!ll al Ti I I � � � i' l r� l � y � y�� rl!!t 1 1 ` "N; { , {. ia; 0 ul you II IIt11t11S1 ! �t�d I _ . ,1, ,, .�.,.,i ,. si,111 {, e ii 1 e il,i k� 1' 1' � 11" 11� 1'1" h, t'I »I Footing drain • I 100' 50.03 0 to 2,000 $121.90 Footing drain - cacti 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 S stems - Walcr Service, each additional 100' 37,52 Rain Drain - 1st 100' 62,54 uy t " 1o'tlt S 1 i ,. ' I ';'.`,d.{ . 4 1 .91. a , NIffi dl i i tl,Iil iili il Storm & $1,00 to $5,000,00 Minimum fcc $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 II ` j . ', Ip , � °+ . ° 1PI � I i , ;i! t1Y { t! I 1 Tii T each additional $100,00 or traction thereof, to / a, ,I '7TII IJ ...0. )' �,IV „3 }f.��G'i - +t ell•I. {' 1'11Sit liJikl +f 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 traction 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: la 5'7'9 '—`/ 4 4 ©a 7 .2. S d - So Q 3 Q. - /‘. a 96) . P02, ■ .1111. Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "y s ", please indicate work performed by fixture. Failure t accurately report fixtures could result in increased se er fees*. .11, 1111.., „ 11 ,11, - - -- �, 11 11. , i ,.. , , 11 1111 ,,. 1111 �.. i �... .. 1 , .'i;l' I;ai � ;11,, .� 1. ',� � , i i nl l b � .W i ,.,; ,, i; . I jii i ii , l'r iiiiti " 1f irlitifti'i' 'I1;� lil i„ i t 1 ry� F,I :i`iiiiiii4..f " il (di'1: .11:.. !i ?l, iii a�I�IW ? :! ,, 11'11' lil'te' ; . ) .. '. 1' . XV/UG 'llii +;t l� finl� 1p 0 4 i� I 1 i �1 � I i -, 22; ', �1N 0 ; I a 11� l,, brvaltk Pl vi check all , � � I 1 1 1 II 1 1 1. 1 1 11111 11;1 i i. . ;i�Yr�i�k'f'itlutti9' d t �„ ,u�lU�ti;!I � , i " , e�, required for any of the following. Baptistry /Font at apply. El Bath -Tub/Shower _ Any new commercial building with water service 2" and - .locuzzi /Whir1u 11 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 OAR ,918-780-0040. Dishwasher - Commercial _ ® Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. 1?rinkin; Fountain ❑ Any complex structure as defined in OAR918- 780 -0040, Eye Wash Floor Drain /sink - 2" 3 . Submit 2 sets of plans with a of the above. -3" Car Wash Drain _. 1111 tllll l t1 1:� ll 1{h'"; .,i I, '�6 1f1,�. I'N,"wh R 1S" }t {+r ` ( CRI rif"' El;; F 'i i; li is 1dil r IC I atIN 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 lee Mach. /Refrig, Drains Oil Separator (Gas Station) Comments regarding fixture work: Rcc. Vehicle >?ump Station Shower -Gang , � Ill- -Stall SmklLav -Nan -fond related _ ti - Bradley - Commercial food related - Service Swimming Pool Filter -� ' Washer - Clothes 1. - — *Note: if the fixture work under this permit results in an Watcr Extractor • IM increase of sewer EDUs, a sewer permit will be issued and Water Closet • ' 4 toilet fees assessed for the sewer increase must be paid before the Li nal � Ell plumbing permit can be issued. MI 7 http: / /www.tigard- or.gov /city hall /.. , mi 9/Cd/docsLMF.cmiutAdoe / v�+ u" - d� P I S oinfh A 160 ?/ X 7�6 Y Pcr ge,ky / /d- /�