Permit •
CITY OF TIGARD PLUMBING PERMIT gin COMMUNITY DEVELOPMENT Permit #: PLM2012 00112
I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
T
Parcel: 2S110DC00500
Jurisdiction: Tigard
Site address: 11455 SW SUMMERFIELD DR
Project: Schwindt Medical /Dental Office Subdivision: WILLOW- BROOK -FARM Lot: 17
Project Description: Interior plumbing for new dental office. Medical gas done under separate permit. 3/6/13 REPRINT permit to
correct description
Contractor: CASCADE PLUMBING CO Owner: CDBK PROPERTIES LLC
2416 N HAYDEN ISLAND DR 11565 SW DURHAM RD BLDG F 100
PORTLAND, OR 97217 TIGARD, OR 97224
PHONE: 503 - 289 -7095 PHONE:
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/27/2012 $31.27
Specifics: 1 ea Clothes Washer 06/27/2012 $25.02 .
1 ea Dishwasher 06/27/2012 $25.02
Type of Use: COM 4 ea Floor Drain /Floor Sink/Hub 06/27/2012 $100.08
Class of Work: ALT 2 ea Hose Bib 06/27/2012 $50.04
Type of Const: 1 ea Primer 06/27/2012 $12.51
Occupancy Grp: 2 ea Rain Drain - Single Family 06/27/2012 $25.02
Stories: Dwelling
12 ea Sink 06/27/2012 $300.24
3 ea Water Closet 06/27/2012 $75.06
1 ea Water Heater 06/27/2012 $37.52
1 12% State Surcharge - 06/27/2012 $81.81
Plumbing
1 ea Backflow Preventer 02/27/2013 $31.27
0 12% State Surcharge - 02/27/2013 $3.76
. Plumbing
Total $798.62
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 by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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 .. \ l i .'
Building Fixtures FEB FOlt OFFlCt: US1'', ONI.,v
City of Tigard B 2 7 2013 Recai'od Permit No.:
Uatc/ : _ _ .. -- "�
M 13125 SW Ha11 Rlvd., 'Tigard. OR 972 P ►an Rev ;ew Omer p ar,,, ; , � „
a Phone: 501639,4 17 t Fax: 503.598. Tl OF TIGARD 131 R ti v:
inspection Liner 503.639.4175 BUILDING DIVISION �� " � Juti a See Pa & e 2 for
t' f a 1;. D Date heady /I>y -
Internet: www,tigard- or.gov Ncait'icd/method: I. _ _ " supplemental Information
. • 'TYPE :'
OF WORT ' J- . . Demolition FEE* SCHEDULE • ' "
• d *few construction -- 1 ,, ,•,•, Fur e,. . ' elan OHrtarroa use
c hecklist .
_ v Dcscri
_ 'Total
ptio . ,,. �Y• I E. �.
!41! ddition/alteratlon/replaccmenl 0 Other: New I. family dwetlin• (includes It/0 ti. for each utili connection)
" - CATEGORY OF CONSTRUCTION SFR (1) bath µ 312.70
SFR (.} bath Ini 437.78
0 I. and 2- family dwelling p � 1 om ""
��
mercial/industrial _ _, 500.32
SFR (3) bath
(l Accessory building ❑ Multi- family " Each additions) hathJkitchrn - 2 - 02
0 Master builder ED Other: sprinkler Other: Fir ( sq. tt.) Page 2 t W
JOB SITE INFORMATION AND LOCATION Site utilities: --
- °" ^"'�- """".°" "} " - ""^- " Catch basin or area drain 1&.76
Job site uddres f a - Dtywel), leach tine, or trench drain N I8.76
City/State/ZIP: - "".^.,... Footing drain (no. linear ft.: _ ) Page 2
Suite:/bldg, /apt. no.: Proiect name: , >! l uj i fl e. L.' Manufactured home utilities _ 50,03 I
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 It.: ) Page 2 t
- Water service (no. linear R.: ) Page 2 I -- `
Subdivision: I Lot nn.; u Fixture or it em:
"" -"'�" tiacktlow preventer ^ 31,27 f 7
Tax map /parcel no.: 12.51
Backwater valve
DESCRIPTION OF WORK 25.02 t
" Clothes washer t
a 4 - 1 ' ().4.L,_ e p, ,-i ! C 6,, ,1 _ --„..- 7 ..,-----i Dishwasher 25.02 - l
4" G A..41 C vi. 614).
: i rn.� 7 C Drinking fournain 25'02
Ejectors/sump 25.02
„ ~" - Expansion tank
0 PROPERTY "OWNER 0 TENANT ion t.� -• --
Fixture /sewer cap -, 1 25.02
Nam: - Floor drain/floor sink/huh r 25.02
r _
Address: (;arBnpe disposal 25.02
City /5tatc /ZlP: Hose bib 25.02 M n
Phone: ( ) Fax; ( 1 , ".„w.,�-- •..",, ' Ice maker �,,.. _.,,,..•,., ---,.. A , I 1:,51 m
.-- _� ��CT PERSON ... . �� tofg r_. r . i
�� y [� APPLICANT CON TA Interceptor/grease trap ___W_".."- 25.02 ,
nom: gas (value: $.,�. -_„ 1 I Pab'L 2 ,-
' Business no: CASCADE PLUMBING COMPANY
! _ � �"" __
-^� Primer 12.51"
Contact name: CRYSTAL JONES " - _ . " Roof drain (commcrc;al) 12.51
Address: 2630 N. HAYDEN ISLAND DRIVE #3 - - Sitrk/basin/lavatory _ 25.02 -`
City /Statc/Z1P: PORTLAND, OR 97217 _ __,._" Solar units (potable water) - 62.54
I _�. - _,,..._ -- -•
Phone: (503) 289 "7095 lax: ; (503) 283.95I4 t Tub /shower /shower pan 12,51 _ -
_
-- 4 Urinal 25A2 I
F;•mail: C'ASC'ADEpI.I!Vi(aIYAHOO.COM " .�- . -..__.
- Water closet 25.02 .,..
CONTRACTOR W ater heater -�..." - 37.52
j Business name: CASCADE PLUMBING COMPANY - Water pipi ng/uWV - 56.24
I Address; 2630 N. HAYDEN ISLAND DRIVE 03 Other: -------- 25.02
City/State/ZIP: PORTLAND, OR 97217 _
1 snarotalj 1 " `�
Ph
----- Fax: (.'+03) 283 -9514 1. Minimum permit fee: $72.50 ..,.
nno ( 5031289 -7095 _ "-
Plan review (25 °.0 of permit tee)
CC•I3 Lie.: !20893 - - Plumbing Lic, no.: 34 -412PB j --- State sun :Mtge (I «°'° of permit tee) ~
Authorized signature: � - .�.
---
Authorized FEE j, C•,4
This permit application expires It a permit Is not obtained within 180 days
I Print name CRYSTALS 3 t. Date: �T after it bas been accepted as complete,
1 ICt_ Fi
s X P irr f "Fee methodology set by In- County Building ladusa'y Service Boma. ju di„ 9 �
! t8 a i1dfl1ttlPcrmits `Jr1.11L'•PcrmitApp.doe 10101109 'I.I0-4616T(10 /02/t-OMMTD)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Ystems
esl ential Fire Suppression 5S10I1
...:......
r
.: - ........... ..............<............ , . .may....... sa .� ,, . : -
1
........... . .. , .....fit _- ..;...., : :',� .
Footing, drain - i`100' 50.03 0 lo 2,00(f $121.90
Vooting drain - each additional 100' 37,52 2 to 3 _ -•_• 5169.69
—_ 3.601 to 7,200 $233.20....._. _
Sew.y' - 1m 100' 62.54
7,201 l ttntl rester 5117.54
Sewer - each additional 100' 37,52
Water Service - Isi 100' �... 62.54 Medical Gas S stems:
Water Service - each additional 100' 37.52 , .c:. ; :: Ai : :, _e " :'.0. .
".Y: )'.•: 1 1; 5 , ";���:
:e "
Storm & Rain Din • 1t 100' 6254 .S•
P ;
on ras. ;; ,':<:::.':;:r.:'. :
_ $1.00 to $5,000.00 Minimum fee $72.5(1__ -•
Stoma & Rain Drain • each additional 100' 37.5 ? - $5,001.(x) to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
::. :;..;. ;:,:.::.;•: a• each additional 51(10,00 or friction thereof, to
` : -..,., I . .. and intJudin $IO,U(IO,UU,
"'� � : <�S , et ".tl�$ii�R' :��5� � ? = t :'t� :. "• +'<' :i: : : '�: !i :' r:
inspection of existing plumbing or for S10.001 00 to $254)00,00 $148.50 Mr the f i r s t $ $ 1 0 , 4 0 0 . 0 0 and S I, 54 for
which no the is specifically indicated 90.00•/hr each additioua) SI00.00 or fraction thereof, to
(minimum char .c -- 1/2 hour) I and including_ 9:25,00U.O0.
Inspetxions outside of normal business 90,0 01hr 525,001.00 to $50,00000 I $379.50 toe the lrst $25,000.00 and S1.45 for
hours (minimum charge –2 hours) i each additional $100.00 or function thereof, 10
Reinspection Fees 9(1,OO.4ir ..,.,.....,.....,-,_..-a and including 550,000,00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $74200 for the first $50,000.00 and $1.20 for
t
(minimum charge !/2 hour) each additional 5100.00 m• fraction thereof l
Subtotal;
■
CCmmcrcial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes",
please indicate work performed by fixture. Failure to
accurately re• 1 rt fixtures could result in increased sewer fees * .
... ... , y `
.: of the, following,
::: ...... ................... :,...t;a..: : : :'ndtletl c�iocnCe.; ::
Y
''& Platt review is required Fur any o'
Vfork'' Pcrfotrmcdt . : ...............:.;. : : :' :• Peat. a . �
Ba xistry/Font - Please check all that apply,
Bath -Tub/Shower D Any new tcmunarcial building with water service 2" and
- Jacuzzi/Whirl.. 1 greater, except systems designed and stamped by livens `ul
Car wash -Each Sou
New ef
-Drive Thtu � ❑ New exterior plumbing site utilities ,r any complex structure
[,'us idt>r /water As fiat/1r as defined in OAR918- 780.0040,
Dishwasher -Commercial MIMIIIIIIIIII 0 Medical gas and vacuum systems for health cart facilities -
- Domestic 111111111111111111111111 0 Any multipurpose fire sprinkler system.
1111111_� 0 Any complex structure as defined in OAR918- 780.0040.
t,
Floor Drain/sink . 2" Submit 2 sets of plans with any of the above.
.3" gy m., - .;.;n;: ,, , ∎ v,
,.,:: ` I S o t� eor: ' S Dl ra*1k ,,.,..:.
Car Wash [)rain a i kO :RV,.
Garbage Doates ic mat - loud �. isometric or riser diagram is required for new buildings , <„
Disposal -Domestic related __ that meet the qualifications above,
-C -vial -ft e related
•Industri dotrial -Itwd related
' == Comments regarding fixture work:
Rec. Vehicle Dum. Station
Sink/Lav - Non -food related
-Bradley _
Commercial- fond related _ _ ___.__
_--
-Service
$wimtnin• Pool Filter M ,
W.i her Clothes *rote: If the fixture work under this permit results in an
Water Extractor increase of sewer .EDUs, a sewer permit will be issued and
Water Closet • Toilet .1111 fees assessed for the sewer increase must be paid before the
Urinal = _.-.. - plumbing permit can be issued.
()thee Fixtures_
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CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00112
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
Parcel: 2S110DC00500
Jurisdiction: Tigard
Site address: 11455 SW SUMMERFIELD DR
Project: Schwindt Medical /Dental Office Subdivision: WILLOW- BROOK -FARM Lot: 17
Project Description: Interior plumbing for new dental office. Medical gas done under separate permit.
Contractor: CASCADE PLUMBING CO Owner: CDBK PROPERTIES LLC
2416 N HAYDEN ISLAND DR 11565 SW DURHAM RD BLDG F 100
PORTLAND, OR 97217 TIGARD, OR 97224
PHONE: 503 - 289 -7095 PHONE:
FAX: 503- 283 -9514
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/27/2012 $31.27
Specifics: 1 ea Clothes Washer 06/27/2012 $25.02
1 ea Dishwasher 06/27/2012 $25.02
Type of Use: COM 4 ea Floor Drain/Floor Sink/Hub 06/27/2012 $100.08
Class of Work: NEW 2 ea Hose Bib 06/27/2012 $50.04
Type of Const: 1 ea Primer 06/27/2012 $12.51
Occupancy Grp: 2 ea Rain Drain - Single Family 06/27/2012 $25.02
Stories: Dwelling
12 ea Sink 06/27/2012 $300.24
3 ea Water Closet 06/27/2012 $75.06
1 ea Water Heater 06/27/2012 $37.52
1 12% State Surcharge - 06/27/2012 $81.81
Plumbing
Total $763.59
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 q stion OU 503.232.1987 or 1.800.332.2344.
Issued By: `�C�t1C etit Permittee Signature ,
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 RECE. ... �u eao�a -6G Olo 0
Building Fixtures FOR of FICE tic, E. ONLY
Ree ved of .� - 1331 W H Tigard ., Tigard, OR 97223 MAY - 9 ?O1: Plan Re, r 1 ,, - Permit No.: L �° ge � a //�
Phone: 503.639.4171 Fax: 503.59s.1960 CITYOFT IGAR � -r other Permit No.:etnQ, a,
T 1 G ,t h D Inspection Line: 503.639 �,,, R�d j J hail 1a See Pagel for
Internet www.tigara-0r.gov BUILDING DIvISI i •fieNMet6od: cofi /( /A� _ I suppeemeatai Inrorma
p( rh
New construction ❑ Demolition :.... : " For spedal informaaion use m /list
Description I Qty. I Es. I Total
I ❑ Addition/alteration/replacement ration/teplacemeM ❑ Other:
New 1 -2- family dwellings (includes 100 R for e ach utility connection)
. t ^,i fl'Ry O�E:)1 0*•_liX :•u ' ,;' SFR (t) bath 312.70
❑ I- and 2- family dwelling pi Cotnmercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
❑ Master builder Each additional bath/Idtchen 25.02
F r ❑ Other. Fire sprinkler c___ sq. ft.) Paget
1 14S Ew'QBT[ON;itl4fD: i GA 1(31(: : >t , ' " - s Site utilities:
Job site address: (,� , .co M " e P , - r Catch basin or area drain i " 18.76
�' e l� ) 0
Drywt:ll, leach line, or trench them i 1 8.76
City/StatePLIP: T- 614
(� �� + Footing drain (no. linear R: _) j Page; Suite/bldgJapt. no.: I Project name: V i ,, SCJiw Ad T 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 R: Page 2
Subdivision: I Lot no.: Fixture or item:
"fax map/parcel no.: a ,/ /Oa f r5)C) Bacicflow preventer ( 31.27 31.91
.e.•` :;.e t " '--° , 4 ce Backwater valve 12.51
' . :. ._� �._,!� °i D. . her _J 25.02 G rot/ Ad (eA a r C % CC Dishwasher 25.02 a-5 -0
Drinking fountain 25.02
(Htb (4S U IJbf . `a rt ? .4F7 PEQM 11-) Ejectors/sump 25.02 .
.C1,,PRR "" k -; 'i ,- Exp ansion tank 1151
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub ' 4 25.02 j po. OS(
Garbage disposal 25.02
City/StateILlP: Hose bib a 25.02 G5Q, 04
Phone: ( ) Fax: ( ) Ice maker 12.5
• `_ ' A)PIPLIC*Ni " + ::,. :;; : - ';,:ateM'+ c p1 RsoN' -' "R ` . Interceptor /grease trap 25.02 � r�
Business name: CASCADE PLUMBING COMPANY _ � ► ��" °
• Primer ' 12.51 13.5 I
Contact name: CRYSTAL JONES
Roof drain (commercial) 12.51 p li. Cy a
Address: 2630 N. HAYDEN ISLAND DRIVE H3 Sink/basin/lavatory Too/ 25.02 .300.
City/State/ZIP: PORTLAND, OR 97217 Solar units (potable water) 62.54
Phone: (503) 289-7095 I Fax: : (503) 283 -9514 Tub /shower /shower pan - 12.51
E - mail: CASCADEPLUM t@YAHOO.COM Urinal 25.02 1
..
"''" ` ,.. „» .:, ; Vi n.'__ `t7, :: ` Water closet 3 25.02 - 750 110
.. _.... ; .: ice :_-. :ir`1f �: .:u^' w der h eete[ 1 37.52 'FL .>
Business name: CASCADE PLUMBING COMPANY
Water piping/DWV 56.29
• Address: 2630 N. HAYDEN ISLAND DRIVE #3 Other; 25.02 _ iS
City/State/ZIP: PORTLAND, OR 97217 Subtotal - , '/- �g�'
Phone: (503) 289-7095 Fax: (503) 283 -9514 Minimum permit fee: $72.50 -V--
Plan review (25% of permit fee)
CCB I.ic.: 120893 Plumbing Lic. no.: 34-412PB
--60- a g�
State surChargge (12% of permit fee) 7
Authorized signature: na ► 1 �� L,t,fn.,�f' TOTAL PERMIT FEE I 5 �4
1
Print me: CRYSTAL JONES N/` C� I Dom: I This permit appueatioa aspires if a permit is ot otmined within 180 days ,,t 1_ 3
. a Poer it has ben a as n cemple _ (tY
P 'Fee methodology set by TriCounty Building Industry Service Board.
1: 1Building TermitsTLMU- PermtApp.doc 10/01/09 440- 46I6T(10.02/COM/WEB)
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
. Site Utilities : - .: r... • : ^ Qty= _, : FCC (ea) • _ T ot a l. S gaare Footage: Permit Feel
Footing drain -1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' - 3732 2,001 to 3,600 , $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and grater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52 - •
Storm &Rain gain -1st loo' 6234 Valuation:: ' Permit Fee:: .
$1.00 to $5,000.00 Minimum See $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
Total. each additional $100.00 or fraction thereof, to
Othe�.Inspections or fees > : Qty.. ,: F ee.( , ) and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $1 0,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereot', 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 $120 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 * .
QnantitV by Fixture Tice Plan.Review for PlUinbing Installations
Fixture Type for Replace Plan review is required for any of the following.
Work Performed: Capped Added Relocate Please check all that apply.
Baptistry/Foot
Bath - Tub/Shower ❑ Any new commercial building with water service 2" and
Jaarm/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial fn:•• Medical gas and vacuum systems for health care facilities.
-Domestic I ❑ Any multipurpose fire sprinkler system
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit a sets of plans with any of the above:
3" 3
- ' • :.:..:3. .. • Isometric-Or-:Riser Diagram ::
Car wash Drain
Garbage - Domestic - non - food R Isometric or riser diagram is required for new buildings
Disposal - Domestic related that meet the qualifications above.
-Comtthercia' —food related
- Industrial -food related `
JRefrig. l 7
oil Separator (Gas �) • Comments r • ding fixture , : Ak0
Rec. Vehicle Dump Station �� 1
Shower Of aS I� s .T.i D a h)7
Sink/Lav - Non-food related I V
- Bradley -1.1&101/111;011r .
' / j . p�
�c ial -food related D NI f '
service 1
Swimming Clothes Fi *Note: If the fixture work un er this permit results in an
Water Extracts increase of sewer EDIls, a sewer permit will be issued and
Water Closet - Toilet Z fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: •
C :\ Users \Randy\AppData\Local\Microsoft\ Windows \Temporary Internet )files\ContentOutlookW1XX3V97 PLMF- PermitApp.doc .