Permit . e
CITY OF TIGARD PLUMBING PERMIT
m COMMUNITY DEVELOPMENT Permit #: PLM2009 -00205
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2009
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 90
Subdivision: Lot: 0
Project: Island Tan
Project Description: TI Adding (1) w /c, (1) lay, and (1) w /h.
Owner: FEES
13500 PACIFIC CORP Quantity Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS
INC, 21500 HAGGERTY ROAD, SUITE 100 1 ea Lavatories 07!28/2009 $16.60
PHONE: 1 ea Water Closet 07/28/2009 $16.60
1 ea Water Heater 07/28/2009 $16.60
1 12% State Surcharge - 07/28/2009 $8.70
Contractor: Plumbing
BEAVERTON PLUMBING INC 23 ea Minimum Fee Adjustment - 07/28/2009 $22.70
13980 SW TV HY Plumbing
W
BEAVERTON, OR 97005
PHONE: 503 - 643 -7619
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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)
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 adopte..: • the Orego
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obt • c of th-
or direct que ions OUNC by calling 503.246.6699 or 1.800.332.2344. / '4/
Issued By: ' I Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.. for an inspection at business .ay.
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.
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Plumbing Permit Application puria309. Go2oS
RECE IVED I.oR OFFICE USE ()NIA'
City of Tigard Received n �/I,, "1 a ,
g Date/By: / �lJ D Permit No.: • r ' -, i- I . • -
q 13125 SW Hall Blvd., Tigard, OR 3
e M.I9 3 2009 Plan Review yo a i 7 I
Phone: 503.639.4171 Fax: 503. 6 they Permit No. t
Date/By: /
Inspection Line: 503.639.4175 C ITY OF TIGARD Ready /By: Vait/ 9 El Page ] s' e2 for -
TIGARD DateRead B
Inlemel: www.tigard- or.gov Notified/Method: Su lementalInformation
TYPE o� bG DIVISION .
t °D
• FEE* SCHEDULE
12 New construction ❑ Demolition For special information use checklist
Description I 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 249.20
❑ 1 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION - Site utilities
Job site address: /3 5 -6 � � C • Catch basin or area drain 16.60
City /State /ZIP: . T� 0� 7 �3 Drywell, leach line, or trench drain 16.60
Suite /bld /a t. no.: , / . \ Footing drain (no. linear ft.: ) Pa e 2
g. p 90 Project name: I � A 1V g
Manufactured home utilities 1 10.00
Cross street/directions to job site:
/ �/� Manholes 16.60
4 'i- c / / 9%i et f /fiC?" Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: CC Lot no.:
Water service (no. linear ft.: ) Page 2
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Tax map /parcel no.: (d 1 a(eQO CI O 300 Fixture or item
Absorption valve 16.60
DESCRIPTION 'OF WORK Backflow preventer Page 2
A?c /, C/ 6 1 1 Backwater valve 16.60
Nom - � � J Clothes washer 16.60
Dishwasher 16.60
• . ' ❑ PROPERTY OWNER . ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax:: ( )
Sink/basin/lavatory / 16.60
• Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
ONTRACTOR / Water closet / 16.60
Business name: /�G �iwrit-� �/re6Ne Water heater / 16.60
S vv
Address: p D ,. Z / Other:
City /State /ZIP: �1 / /� 1� /?/N) 0,e 97°7/ Subtotal
C � 'Minimum permit fee: $72.50 70? 50
Phone: ( 9 ,1/ ..1 Fax: ( ) Residential backflow minimum permit fee: $36.25_ _
CCB Lic.: 57/ 0 of lit (i O Nu. bing Lic. no.: z4- /..j C Plan review (25% of permit fee) -e;'
Authorized signat or-
7 �t State surcharge (12% of permit fee) C. 70
- TOTAL PERMIT FEE 4576049 Print name: • /,dA/a .1 • Date: 7`�0, This permit application expires if a permit is not obtained within
l 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board,
I:, Building \Permits\PLM- PermitApp.doc 12/27/06 440- 4616T(10/02 /COM/WEB)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities . Qq. Fe (ea) Total • . Square Footage: Permit Fee:
Footing drain - I 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 Sys tems:
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.
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Perforined ❑ Any new commercial building with water service 2" and
`Fixture Type: 'Replace greater, except systems designed and stamped by licensed
Previous Capped . Added Existing. engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram •
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 qualifications meet the ualifications above.
-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 I *Note: If the fixture work under this permit results in an
- Bradley p
- 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
Urinal
Other Fixtures:
i;\ Building \Permits\PLM- PermitApp.doc 12/27/06