Permit CITY OF TIGARD PLUMBING PERMIT
NI COMMUNITY DEVELOPMENT Permit #: PLM2009 -00118
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/13/2009
Parcel: 251118801500
Jurisdiction: Tigard
Site address: 10362 SW MCDONALD ST
Subdivision: Lot: 0
Project: Washington County Detox Center
Project Description: ADA upgrade to bathroom.
Owner: FEES
WASHINGTON COUNTY Quantity Description Date Amount
FACILITES MGMT, 169 N FIRST AVE MS42 1 ea Floor Drain /Floor Sink/Hub 05/13/2009 $16.60
HILLSBORO, OR 97124 1 ea Primer 05/13/2009 $16.60
PHONE: 1 ea Lavatories 05/13/2009 $16.60
1 ea Tub /Shower /Shower Pan 05/13/2009 $16.60
Contractor: 1 ea Water Closet 05/13/2009 $16.60
CASCADE MECHANICAL SYSTEMS INC 1 12% State Surcharge - 05/13/2009 $9.96
275 SE 4TH AVENUE, PO BOX 399 Plumbing
ESTACADA, OR 97023
PHONE: 503 - 630 -4492
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $92 96
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 -0100. You may obtain a copy of the rules
1 �
IssL d By: Permitted Signature: �I 0, 11i V —
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
03/12/2009 10:06 FAX VI 001
Plum bin Per A I1CA tio1<1 I E)I: 01 h; l tit: ()NIA
Building Fixtures ReCOived � � ' is x4--)i PtrtttitNo.: ►o'wo9 —ao /S
City of Tigard 1 2 '6n Date /kiy: /
.1 13125 SW Flail f31vd,,'fil ard, Oli 9722 Rec Review Oilier Pcrtnil No.; /
S p Dine /R J ur i s: I Ste Page 2 for
a Phon 503 (19 5 3 F4 503 598-1960 1 Y4 y El See information
i D�tc Ready /l +y:
Internet: Li 503- -or.go 75 00
f t Ci A l: L) Notified/method: ,
interact ww,v,tigard ar,gov t1' - --� DTI;* SC- 111:1)ULf?
i ('YI'h. Of WORK Po special info�ntal ►oe use checklist �J �— 0 Demolition _ F Qt) L f a T ota l _
- New Construction — ,— �. Description
Other: New I. aa'a dwellings (includes 100 it for each utility l )nnBChOn)
1dilitiou/alterationheplacentcm d ---__ 24c).20 �_ _
SFR (1) bath
CATEGORY OF CONSTRUCTION 350,00 _ SPII (2) bath
Commercial /industrial _ 399,00
1" and 2 family dwelling _ SFR (3) bath
D Multi - family _ 4500
[] Accessory building Each additional bath /kitchen
�� —' Page 2
-- ❑Other: Fire sprinkler (^ .- sq, R)
❑ Master builder _.
— . — .1013 SITE INFORMATION AND 1.0CA'FION Site utilities 16.60 _ ti Catch :basin or arch drain .
Job site addl'GSS: 16.60
I }rytvell, tench litre, o r trench drain
p age 2
City/State/ZIP: a l Fooling drain (no, linear R.: ) 2
1 � i10.0 —
Suite/bldg./apt. /bldg. /apt. nn -: Project narnc: Manufacture h ome utiliti
16.60 _
Manholes J ---
Cross 0t1 t /dirccllans to job Rile: '�� I6.60
Rain drain connector ^ -•
Sanitary sewer (no, lines --)
Page 2
Storm sewer (no. linear R.: __j
I 2
-- ' — Water 5erviee (no. linear IL: =)
Subdivision: " 1.ot no.: Fixture or Item -
—. � Absoil)lion valve
16.60
Tax map/pa e:el on.: Pate 2
�� DFSCltlt'T1ON OF WORK I3ac:kflow preventer e
Backwater valve
6.60
I c. 1 x(l!l — l - t= m Clottteswasher 16,60 —
16.60
p isltw „ tihcr
.—
I6.Gn Drinking fountain ���
0 TENANT 16.60
—
pR(li'ERTY OWNClt I jc�t"rs /sump —.
� 16.60
��,, ��` F:xpanawn tank
Nainc: W i, � O 01 16.60
� lrC /SCWCr ca /
Address: r + ■ I �� l/ . Flxlt 16.60
Floo d r a in /liner sink /hub Ill
. — ► 16.60
City /Slate /'L-1P' ii 11�.. Giirhage dISPUS1II
Fax: ( ) 16.60
Phone: ( ) • Hose bib
� ■ •
C "PACT PERSON �J 16.60
0 APPLICANT ,O -. ' Ice maker .
(co 16.611
���..1 " ..
Bits — s name; interceptor/grease trap I )16. 2
_ Medical gal (value $ , )
Contact name: 11� �� —
Prilt♦Ct
\ � _ --•'
Add1'css: drain ___1-7_,_----I166:.456-°0
—
\�� Ryuf drn1I6.(i
('ily/5latc/ �^ n Sink/ba5io/lavatory r
( lG GO .
Vox: � I'ub /shvwcr/showeI pun
p-mai ( :
—„ -�-- � 16.60
U rinal
1. hlall: ,, �� - - -,�^ 16,60
... Water closet till —
CONTRACTOR � IG.60
_ { / r+ Wtl[Gf heater Bttgi,tess name: ('_r i `—'�y 7 T . W threr —.
3 1 — tiubtnloli
C^1 minimum permit t ee: 572.50 Z 60
City/State/ZIP: oi & _ �- 1 / Residential bnckllow minimum hermit tee. $36.25 (1 c--) F � — _ y
Phone: ( r ) z Pla rev iew (25% permit fee) o `�” � � °
`� � e71 L Plumbi Lie, m).: 3 State surchar (12% of permit fee
a Cc►i 1.ic.: _
�/ 1 (� foTn PERMIT I'D:. ��. ___ lel
Authorized siinalure: 1 SP _
_. �� S ii c � " � t g permit application expires I f a permit is tint obtained Within
(r � � D11G: l U 1$0 days after it has been accepted as complete.
Print saute: C CIA Tl � * Fee m ethodology set by'Fri- County Building Industry Serv Board -
440.161( 1) IOlnx)COM/Wf+n)
i m u ltdieg\Pennioeuvr -ae m,tnpa Eno 12/21/05
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" 100' 55,00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower f • ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
- Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" 1 that meet the qualifications above.
-3"
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory 0
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet 1
Urinal
Other Fixtures:
is\ Building \Permits\PLM- PermitApp.doc 12/27/06
Accumulative Sewer Tally Parcel #
Tenant Name: This SWR#
Site Address: This PLM#
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery /Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 1 4 0 - -
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 1 2 1 2
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1 4 2 4 1 0
Current Fixture Value 0 divided by 16 = 0.0 Current EDU 1 EDU = $ 3,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 0 divided by 16 = 0.0 over (under) $ -
Enter EDU Change Here
Notes:
Authorized Name /Signature: Date:
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \Building \Sewer Tally \SewerTallySheet- 3100.xls 06/19/08 1
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