Permit CITY OF TIGARD PLUMBING PERMIT
° • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00157
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/06/2012
Parcel: 1 S 135AB01006
Jurisdiction: Tigard
Site address: 10500 SW GREENBURG RD 200
Project: Mutual Fund Store Subdivision: ASHBROOK FARM Lot: 6
Project Description: (1) sink, (1) lavatory, (1) dishwasher, (1) water closet and (2) sewer cap for TI
Contractor: CASCADE PLUMBING CO Owner: LINCOLN CENTER LLC
2416 N HAYDEN ISLAND DR BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97217 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 289 -7095 PHONE:
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Dishwasher 06/06/2012 $25.02
Specifics: 2 ea Fixture /Sewer Cap 06/06/2012 $50.04
1 ea Sink 06/06/2012 $25.02
Type of Use: 1 ea Lavatories 06/06/2012 $25.02
Class of Work: 1 ea Water Closet 06/06/2012 $25.02
Type of Const: 1 12% State Surcharge - 06/06/2012 $18.01
Occupancy Grp: Plumbing
Stories:
Total $168.13
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 questions to OUNC ALALL1 by calling 503.232.1987 or 1.800.332.2344. Issued By: Jn . „ t Permlttee Signature: D4 ' 1 pp / t1`ro D 1 4
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.
•
Plumbing Permit Application
r , Building Fixtures FOR OFFICE USE ONLY
" City of Tigard Received +t,')t 57
u Date/By: Permit No.: o't/ QDI
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Pernt Pxi ` 00/ci
T I G A R D Inspection Line: 503.639 Date Ready /By: Juris: H See Page 2 for
Internet: www.tigard or.gov
Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ Ncw construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
'ddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I -and 2- family dwelling commercial /industrial SFR (2) bath 437.78
Accessory building SFR (3) bath 500.32
❑ rY g ❑ Multi - family
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE 'INFORMATION AND LOCATION Site utilities:
Job site address: I 05 00 SW breen bur Q._al Catch basin or area drain 18.76
City/State/ZIP: aA 02.
Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2
-
Suite/bldg. /apt. no.: aat7 Project name: (y‘r� -l-V a t_ curia Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Fax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
J I O r „ } 4 „ l _ oom Si l ., n ^ J Clothes washer 25.02
/� � (,(� ,, ,�/,(,C,1- � � -1 W /� ' � (/� �,' Dishwasher 1 � 25.02 95. C3a
'�'^^^�''' p
S11 i tato , I � w J a 1 Ct _ Drinking fountain 25.02
l_ th) v f 1 Q4,1 Sql 1r 6oci ki LQin Ejectors/sump 25.02
❑ PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02 SA, o y
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /State/ZIP: I lose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: CASCADE PLUMBING COMPANY Medical gas (value: $ ) Page 2
Contact name: CRYSTAL JONES
Primer 12.51
n ) , drain ( I,:.: ial) 12.51
Address: 2630 N. HAYDEN ISLAND DRIVE #3 / Sink/b: il/ ' a r 25.02 50.04
O o O4
City /State /ZIP: PORTLAND, OR 97217 olar units (potable water) 62.54
Phone: (503) 289 -7095 Fax: : (503) 283 -9514 Tub /shower /shower pan 12.51
E -mail: CASCADEPLUM @YAHOO.COM Urinal 25.02
CONTRACTOR • Water closet (, u /28.02 e 9, Oa
Water heater 37.52
Business name: CASCADE PLUMBING COMPANY Water piping/DWV 56.29
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Other: 25.02
City/State/ZIP: PORTLAND, OR 97217 Subtotal Vev e
Phone: (503) 289 -7095 Fax: (503) 283 -9514 Minimum permit fee: $72.50 (5042,
CC'B Lic.: 120893 Plumbing Lic. no.: 34 -412PB • Plan review (25 % of permit fee) ( g,D I
6 )104- State surcharge (12% of permit fee) , Authorized signature: ill n C TOTAL PERMIT FEE y�n
Print name: CRYSTAL JONES (CX
Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete. / 13
„ � p�,Q /„ n 2 _ L . / / c I/ [ .Fee methodology set by Tri -County Building Industry Service Boar 9.
I \ Building \Permits \ - U� rnitiApp.d /01/0 I 440-4616T( /OJCOM/WEB)
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 - I" 100' 50.03 0 to 2,000 $121.90
Footing drain - each 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 Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, 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 $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:
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 * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for an y of the following.
Work Performed: Capped Added Relocate
Please check all that apply.
Baptistry/Font
Bath Tub /Shower ❑ Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool 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 OAR918- 780 -0040.
Dishwasher - Commercial ❑ 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"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic- non -food q g
Disposal - Domestic -food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related ' r/
- Bradley
- Commercial- food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet 1 ✓ - fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Documents and Settings \Cascade Plumbing\My Documents\DownloadgPLMU- PermitApp.doc