Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 00055
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012
Parcel: 2S 101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 460
Project: State Farm Subdivision: VARNS ACRES Lot: 9
Project Description: Remove and replace (1) dishwasher, (1) sink & (1) water heater. Add (2) ice makers.
Contractor: TAPANI PLUMBING Owner: GK TRIANGLE CORPORATE PARK III L
PO BOX 2350 BY THOMSON REUTERS INC
BATTLE GROUND, WA 98604 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 360 - 687 -3983 PHONE: 503 221 -1900
FAX: 360 - 687 -4494
FEES
Quantity Description Date Amount
1 ea Dishwasher 03/14/2012 $25.02
Specifics: 2 ea Ice Maker 03/14/2012 $25.02
1 ea Sink 03/14/2012 $25.02
Type of Use: COM 1 ea Water Heater 03/14/2012 $37.52
Class of Work: ALT 1 12% State Surcharge - 03/14/2012 $13.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
•
Total $126.09
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 ques . • • - o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued :.y: , r Permittee Sign ture:
Call 503.639.4175 by 7:00 a.m. for the next available inspe • n 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.
From: 03/12/2012 13:28 #923 P.001/002
Plumbing Permit Applicatih
Building Fixtures !!1999 roa OFFICE USE ONLY
MAR 1 3 20 Re eei vcd
City of Tigard _ �_, Permit No.: ' , 0 ii ■ .0405
•
13125 SW Hell Blvd., Tigard OR 97J� Y OF TI Plan Review /
C Phone: 503.718.2439 Fax: 503.598%14 ' + Daterty: Other Permit No.: , u ofolg 406 /0
T I G.t R D Inspection tine: 503.639 BUILDING DV.: Date Ready /BY: Ju El See Page 2 for
Internet: www.tigardor,gov
N otified/Method: Supplemental Information
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❑ New construction ❑ Demolition ' For special information use checklist
Description I Qty. I Ea. I Total
El Addition/alteration /replacement ❑ Other: New 1- 2 -famil dwellings gs (includes 100 ft. for each utility connection)
-,� .,rf r:� :.t ,,. .' w „ f ,CA7`.ECURY; OF CONS' ifCf1UN . 1 ,. .1 c y S FR (I) bath 312.70
❑ 1- and 2- family dwelling ® Commercial /industrial SFR (2) bath 437.78
0 Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other
Fire sprinkler ( sq. ft.) Page 2
. , t .y J :02 §ifE?1l=1F****O.011 ` ;,OCATION '. , ``� iti Site utilities:
Job site address: 13221 SW 68th Parkway Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: Tigard, Oregon 97223 Footing dram (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: 460 l Project name: State Farm Manufactured home utilities _ 50.03
Cross street/directions to job site: SW 68 Parkway and SW 66 Ave Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _ ) Page 2
Stonn sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: T ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
r% {x':,y;,'�>' 'xr, _ _. .t, - ='f'; a: Backwater valve
'��i1`� ;, :...,�.,, : wig 12.51
€;' 'DESCRTPCIUN' OF.:,W Kw.'.i;%" -
r : k .�'n :ni, a.fif,_ : ?j1, :� :, ° :':.P;•_ ... .,, ..•v :.. � ::r.��r„K,. .:.... r.� . .: ;.ia;., � ....,
Clothes washer 25.02
Remodel of existing office space
Dishwasher I 25.02 , o 9.
Drinking fountain 25.02
Ejectors/sump 25.02
may BIZ r ii - v ,:.tt,,9 "' - . _ ' $` - "7',:�,V, : ✓•�
... � 'd YPItOPSR1;Y`UWNEft;gF � sI <? , � T$NANT ' � Expansion tank 1251
as,
Name: State Farm Fixture/sewercap 25.02
Floor drain/floor sink/hub 25.02
Address: 13221 SW 68th Parkway Garbage disposal 25.02
City /State/ZIP: Tigard, Oregon 97223 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 2 12.51 A5.
` _ s:'''> i : . InterC tor/ a tta
:F =' � ®�'p��1�T; T ;.•i ®'�CON`F11CT.�'FLtSUIV`��,. eP grans P 25.02
Business name: Tapani Plumbing Inc Medical gas (value: $ _ ) Page 2
Primer 12.51
Contact name: Kurt Schmeusser
Roof drain (commercial) 12.51
Address: PO Box 2350 Sink/basin/lavatory 1 25.02 42 5 r
City/State/ZIP: Battle Ground Wa 98604 Solar units (potable water) 62.54
Phone: (360) 772 -2032 Fax: : (360) 6874147 Tub/shower /shower pan 12.51
E -mail: kurts @tapaniplumbing.com Urinal 25.02
c; k .v
;t :-'.. .-� - Water closet 25.02
:Y.. st
:
_� _... ,.., ' - Water heater 1 37.52 7 6 -
Business name: Tapani Plumbing Inc,
Water piping/DW V 56.29
Address: PO Box 2350 Other 25.02
City/ State/ZIP: Battle Ground WA 98604 Subtotal //a. 5g
Phone: (360) 687 -3983 Fax: (360) 687 -8147 -Al06 Minimum permit fee: $72.50 r---
Plan review (25% of permit fee)
CCB Lic.: 60958 7/05/ // / 3 Plumbing Lic. no.: 8S8'1dP 7J /` /ej/ State surcharge (12% of permit fee) ?,.5
Authorized signature: �("� �� ... TOTAL PERMIT FEE /A6,
Print name: Kurt Scbmeusser Date: 3 - - This permit application expires Ifs permit is not obtained within 180 days
after It has been accepted as complete.
'Pee methodology set by Tri -County Building Industry Service Board.
I. Buildi' Permin.PLMI:•Permn App.doc 1001 09 440.4616T(100: COM'wEa)
From: 03/12/2012 13:28 #923 P.002/002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
l -. ) >� - ..'.V:_ te -'r
;.Sf><r:,X7 _ ,.s:�: v '� �r'rf, r •- .,� ".. .
Footing :.... ........s_.,,,._... •�.,.:;�;... -,..,: . -. - .• -,y - :SuareFoo e: -�� -. ,Per: ..� :- �;� :::
drain - l" 100' too .. uiitF „ „ee -: ,ir_ , . r •:'rf- a,:.:;�1 <z..- ..::
50.03 �.. 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2.001 to 3,600 5169.69
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
Water Service - each additional 100' 37.52 V Medical Gas Systems:
Storm & Rain Drain - I st 100' 62.54
51.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 55,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
each additional $100.00 or fraction tnereof, 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 550,001.00 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 *.
_ ,. usntlf� ilrirttiire:_Type
y.
'1 Mini)
111g�Il�Sll8tiU11S,''
Rfptaed " -` Plan review i
ew s required for any of
.�wotk'PeiTo'fined; , ; , Cspped' Aadeb':Y- Rebate ". 9 y the following.
Baptistry/Font Please check all that apply.
Bath - Tub /Shower ❑ Any new commercial building with water service 2" and
3�uni/Whirlpool greater, except systems designed and stamped by licensed
Car Wash - Each Stall engineer.
- Drive They ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918 780 -0040.
Dishwasher - Commercial 1 1 ❑ 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"
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.
- Conunercial -food related
- Industrial -food related
Ice MachiRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non -food related l
- 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:
T:\ Projects\Active Jobs \State Farm- Tigard\Project Managing \Permits\PLNQF- PcmtitApp.doc