Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00082
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/09/2009
Parcel: 1 S 134AA01800
Jurisdiction: Tigard
Site address: 10170 SW NIMBUS AVE H3
Subdivision: SCHOLLS BUSINESS CENTER Lot: 0
Project: Kumon Math and Reading
Project Description: Install w/c and lay.
Owner: FEES
ROBINSON, CONSTANCE A & Quantity Description Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT 1 ea Lavatories 04/09/2009 $16.60
MGMT, 10240 SW NIMBUS AVE #L3 1 ea Water Closet 04/09/2009 $16.60
PHONE: 1 12% State Surcharge - 04/09/2009 $8.70
Plumbing
Contractor: 39 ea Minimum Fee Adjustment 04/09/2009 $39:30
BEAVERTON PLUMBING INC • - Plumbing
13980 SW TV HWY
BEAVERTON, OR 97005
PHONE: 503- 643 -7619
FAX: 503- 643 -7620
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
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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
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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
Issued By:
121S41/11\ Permittee Signature: n Q -; # VU p
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.
Rpr 08 09 03 : 32p Beaverton Plumbing Inc 5036437620 p . 2
.4."
Plumbin2 Permit A
Site Utilities PPlicallECEIVED , .
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FOR OFFICE USE ONLY
City of Tigard
AP'R - 8 2009
m '1 8.0 'zt ..j\ NTini N.-0_012m 7 COOS 2
a 13 125 SW 11:111 Blvd., Tigard, (11t 47.
N , „kin Rolm
7 ■ • Phone: 503.639.4171 Fax: 503.561()00 Oilwr remit Na .11
it isped ion I .i inc. 503.639.4175 Irt OF TIGARD Daicilly: ,
TIGARD pale It eadYMY: RI SeeYr, Z1, r
Internet: www.ttgarcl.orzov Bull ran DIVISION Not Illoi IIMut hod . m__,.[Supplemrilinl Informal kill
TYPE OF WORK FEE" SCIIEDULE
0 New construction El Demolition For vedal infirmatiun LISP ltheekat •
Description I Qty. I 1:ti. I Total
21 Addition/alteration/replacement 0 Other: - - New 1- 2-family dwellings (includes IOU R. lor each utility conneci ion)
.--..........--- ,
CATEGORY OF CONSTRUCTION srit (I) hath 244.20
-
El I- and 2-1bmily dwelling El (onimercial/iiithisirial SFR O.) bath 350.00
SR (3) bud' 399,00 .
0 Accessory building 0 Multi-family
Each additional bath/I:lichen .15.11(1
0 Master builder 0 Other;
Fire sprinkler ( sq. 0.1 f'agc 2
JOB SITE AND LocATIos siic mimics
._....„......_..........._
Jut, site address: 1017(1 NW NIMBUS AVE S1.1 11-3 Catch basin or area drain 16.60
Cily/Slate/Z11'; 1012 OREGON 97223 Drywell, leach line, or trench drain 16.110
Footing drain (no. linear ft _ .: ) l'al.:c 2
Suite/bIdg./apt. nu.: Project name: k(i\ION MATH A. III- „ ...,
------- Manufaciiired home alit es i 10.00
CIN)SS SVCCUdireCIIIMS 11) Nile: • -
Milliht)ieS 16.6(1
. .
Rain drain connector ' 16.60
Sanitary sewer (no. linear I).: ) Page 2
Storni sewer (no. linear II.; _ ) Page 2
Subdivision: Lot no.:
Water service (no linear ft.: ) Pae g 2
Fixture or item
Tax map/parcel no.; --.- _ ...
,..,,....„ Absorption valve 16.60
DESCRIPTION (W WORK _
Back flow pro/•wer Pape 2
__....... _
ADD ADA TOILET & LAVATORY Backwater valve 16.60
(Italie:, washer I 6.60
-7.
. . . . . ...._
Dishwaslier 16.60
Orinkinit, fountain 16.60
0 PROPEKIN OWNER 0 TENANT
1:,jectors/sunip 16.60
Name:
1.:spansion unit; 16.60
Address: _ l'ixture/sewer cap 16.60
- - -
City/Slate/ZIP: Floor drain/Iloor sink/huh 16.60
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•• --
Phone: ( ) l:tiN:( ) liar bage disposul I iti.oll
APPLICANT
Hose bill 16.60
ID ig] coNrAcr PERSON
Ice maker 16.60
Business liame: REA VETON PLUMUINC, INC
Intereepior/grease trap 16.60
Contact namc: CASEY STEPII ENS Medical gas (value: $ ) Page 2
- - •- . __.....
Address: 13980 TUALATIN VALLEY 1.1WI' Printer - 16.6o
--•----... - - - ....---
Cily/Slate/ZIP: BEA V ER'FON oREGON 9700.5 Root drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (S0.) 643-7619 Fax: : (593) 643-7620 --....-- _ .....-- I 16.60
'Full/shower/shower pan 16.60
0 BEAv1'LIIMB201:!AOL.COM
Urinal 16.611
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CONTRACTOR Wilier closet I 16.60 16.00
Business name: BEAVERTON PLUMBING, um,: Water heater 16,60
_....._...... . . .
Address: 13980 SW TUALATIN VALLEY IIWY Other:
. .
- --- - - - Nuntotat
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Cily/Slalcif,IP: RE,WER OREC ON 970115
Minimum pemnt ree: $72.50
72.50
TZne: (593) 643 Fax: (503)143-7620 liesideot la! bad:flow minimum permit IVC: $36.25
C'eft Lie.: Ill 2/4}t9 4 -k- Q et. 1 6 Plumbing Lie. no.: 34 - 7. t 1 ( ( Plan review (25% of permii 1)
State surcharge (12% of permii fee) 8.70
Authorized sign:min%
..
FO FAL iiiKrArr 100 it1.1)1.71)
Print name: TINA Ql !ELLA Date: 04/08/21109 TIA permit application cspires if a ixtrinit is not ohtuincd within
• 1110 days after it has been accepted Ill CIIIIII)1CiV.
'Tee methodology net by Tri-County Building Industry Service !loud.
cut.ilealp7Lii■iiwnsitt-rimitA I 2:27.171 445-11., i i.: I ( It/R.01-1/MAY1:11)
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Plumbing Permit Application - City of Tigard, •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty Fee (ca) Total Square Footage: Permit Fee:
Footing drain - I" 10)' $5.00 I) to 2,000 1115.00
'oulinc drain • each additional 100' 41,_40. 2,1101 Ii) 3.iill(1 $ I6 11.0O -...
3.601 to 7.200 $220.00
Sewer - I st 11)0' 55.00 7,201 undiruater `[3O7.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.(H0 Medical Gas Systems:
StCm�:
Watc, ticrvw -each uddut unnl 1110' 4(' Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55•(II) —
.$5,061.1)0 1.00 to $5,11(5100 Minimum Iw $72.50 __ I
Shunt & Rain Drain - each additional 11X)' 4(5.10 In S111,000.01) $72.511 for the.firsl $5,000.00 and $1.52 Our each
Fixture or Item 4(Y- Fee (ea) 'final additional $1110.00 or traction thereof', to and
_ 111
including $10,0110.00. _ _
Commercial Back Flow Prevention Device 46.40 $111,0111.011 to $25,(5.1111 _ $L45.501'nr the first $I0,000.00;md $1.54 for
Residential I)acklluw Prevention Device CaCh additional $)(5).011 or fraction thurol'. to
(Minimum pallid Ica $36.25) 27,55 and including, $25,000.00. _
Rion Drain. sin)'Ie li dwelling. 65.25 525.001.00 to 550.000.00 S379.50 for the lira 525,000.00 and $1.45 for
Inspection ul' existing plumbing or - -- ouch additional $100.00 or liactiuu filmy!: to
specially requested inspections - per hour 72.50 and including. $50,000.00.
Subtotal; $50.001.00 and up 5742.00 for the first $50.0[10.00 and $1,20 for
each additional $100.00 or fraction tltureol.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? lI' "vcs', Plat review is required friary orllie 1011ow(ui .
please indicate work performed by fixture. Failure to !'lease check all Thai apply.
accurately report fixtures could result in increased sewer fees *. El Any new commercial building with water service 2" :wd
Quantity by (Fixture) Work Performed greater. except systems designed and stamped by licensed
Fixture 'Type: Reptile.. engineer.
Previonc Copped Added FAistin6 ❑ New exterior plurnhinw site utilities for any complex structure
Iiiipiistry/Funl as defined in OAR915- 750 -0040.
I0(11 :I'uh /Shuwer ❑ Medical gas and vacuum systems For health care facilities.
- Jaeurti /Whirlpoxtl ❑ Any multipurpose Y D epoxy lira sprinkler system.
Car Was), -liaeh Stall ❑ Any complex structure as defined in OAR915- 750 -0040.
-Drive Thru
Cu Wa
spids /der Aspirator — Submit 2 sets of plans with any of the above.
I)ishwashcr - Commercial
- Lknnustie
Drinking Fottmi,a, Isometric or Riser Diagram
I•vc Wash ❑ Isometric or riser diagram is required for new buildings
Floor I)rmn /sunk - 2 " Ihdt meet the qualifications above.
--
Cur Wash Drain
Garbage - 1kuncoie Comments regarding fixture work:
Disposal -Commercial
- Indust' ial
Ice vtach. /Rc)iir, !)rains
Oil Separator (Gas station)
Rec. Vehicle Dump Statiolt
Shower -(long
-Stan
Sink -Bar/1,:ivatnry
- Bradley *Note: If the fixture work under this permit results in an
(.'onunerch,l increase of sewer FUUs, a sewer permit will be issued and
Service fees assessed for the sewer increase mast he paid before the
Swiu Paul Sauer plumbing permit can be issued.
Washer - Clothes
Winer hstractor
Water Closet - Todd
Urinal
Oilier Fixtures:
http: / /wwss,tigard- ur.gvvicity hall / department s / oil /dues/t'LMU- 1'crtnitAp�9t1v0
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Site Utilities — Plumbing Permit Application
Plan. Submittal. Requirements •
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map & tax lot tt ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
13. North arrow_
C. Scale (architectural or engineering only).
1D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS - Two (2) complete sets, civil eddy.
All details listed below shall be incoriwirated into the_phirnhing_plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) 1'ype of material.
rt) Slope of piping.
7) Manholes and field_ drains.
5) Cleanouts provided for each 1110 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) .Location of existing or proposed connection to a public sewer line.
13. Utilities plan showing:
1) Sanitary sewer line location, pipe size, type of materiel, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:''.fIuildingU'crmitsU'I.MI - I'CrmilApp.dvr 12/30/05