Permit v CITY OF TIGARD PLUMBING PERMIT
t3 COMMUNITY DEVELOPMENT Permit #: PLM2012 00184
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/02/2012
Parcel: 1 S134BC00200
Jurisdiction: Tigard
Site address: 12160 SW SCHOLLS FERRY RD 100
Project: Berry Farm Yogurt Subdivision: • WINDSOR PLACE Lot: 32
Project Description: Add (2) 2" floor drains, (1) 3- compartment sink, (1) mop sink & (1) hand sink.
Contractor: NORTH'S PLUMBING II LLC Owner: GREENWAY CENTER LLC
3960 SW 173RD AVE ANA KALAKAUA CENTER
BEAVERTON, OR 97007 2155 KALAKAUA AVE #602
HONOLULU, HI 96815
PHONE: 503 - 649 -5544 PHONE:
FAX: 503 - 649 -8605
FEES
Quantity Description Date Amount
2 ea Floor Drain /Floor Sink/Hub 07/02/2012 $50.04
Specifics: 3 ea Sink 07/02/2012 $75.06
1 12% State Surcharge - 07/02/2012 $15.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
•
Total $140.11
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 Notifica ' n r; nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the ru -s
or direc estions to O C (ling 503.232.1987 or 1.800.332.2344.
Iss ed By: Permittee Signature: / a
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
Building Fixtures RECEIVED FOR OFFICE ESE ONLY
City of Tigard Received iryQ� permit ■4 0 . /g042-004
• 13125 SW Hall Blvd., Tigard, OR 97223 JUL 0 2 Plan Review e [ 2 Plan Review A �c`� -0 6
Inspection 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: A0,24042
ection Line: 503.639.4175 Re
T I G A R D p CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYP OF W0 JILDI (QDIViSIOI`I FEE* SCHEDULE
❑ 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 (I) bath 312.70
❑ 1- and 2- family dwelling ?gCommercia1/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family Each additional bath kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 2. I 6O SW S c.. h 01 Is Ferri, �`� ova Catch basin or area drain 18.76
City/State /ZIP: a d O g q 7 2Z Drywell, leach line, or trench drain 18.76
`7 Footing drain (no. linear ft.: ) Page 2
Suite/bldgJapt. no.: U I Project name:S u buin y 5 u 6 - L4s L Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
C
` mo w S C - )1011.S FeT l y R el /5,A/ 121 s A w. Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _J Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: ( ran Wa Cc n±C r I Lot no.: Fixture or item:
Tax map /parcel no.: I S 1 314- gc. 00200 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
4�
Clothes washer 25.02
A �d 3 - _ I n') 0 s ;,► K , Q t+d Dishwasher 25.02
anti W aS n. $ :n k Drinking fountain 25.02
�J Ejectors/sump 25.02
❑ PROPERTY OWNER. � / I , TENANT Expansion tank 12.51
Name: S erf -- rti rt.t J b g 4 r t Fixture /sewer cap 25.02
t3 5
Address: 1 '�� SW sr,�`oJ�/S w�cf R d /OC Floordraln/floorsinklhub 25.02 �0
ry/ Garbage disposal 25.02
City/State/ZIP: �� VI Q r d / 0 'Z 9 n 22 3 Hose bib 25.02 -
Phone: ( 503) 5 N- r ) 6 f 9 9 Fax: ( ) r Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name: e a rr rare., u r+
Primer 12.51
Contact name: �- rc C Sams) n n C.11 Roof drain (commercial) 12.51
Address: ' L,d40 w 14-1-e) i t d hQ At Sink/basin/lavatory 1 3, 25.02 75.
City/State/ZIP: 6 a vr .-t o n , t] k 1 90 C) J) Solar units (potable water) 62.54
Phone: (o 3 - 5 y- T / -5199 Fax:. ( ) Tub /shower /shower pan 12.51
E -mail: 5c ms
q n De l J _ 6 � -Fron-1-- h i e r� o t Urinal 25.02
CONTRACTOR Water closet 25.02
-- Water heater 37.52
Business name: At I , S # LL C Water piping/DWV 56.29
Address: 39 5 (,v / 73D V E Other: 25.02
City/State/ZIP: E A V ' uaN O • 97140 Subtotal 45
_ Minimum permit fee: $72.50
Phone:53) 649_ C Fax. /_ _ i 1(�'
CCB Lic.: • Sfej/ty Plumbing Lic. no ", 40*-1 P '� Plan review (25 % of permit fee)
State surcharge (12% of permit fee) / S 01
Authorized signs J t i/ea.
? /7 � TOTAL PERMIT FEE / Print name: - T� pi 7eHC^ Date: 7/ A T is Pe rt application expires if a permit is not obtained within 180 days
V G after it has been accepted as complete.
'Tee methodology set by Tri- County Building Industry Service Board.
t:\Building\Pe mits\PLMt1- PermitApp.doe 10/01 /09 440a616r(10ro2/conNWEB)
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 - l 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 any of the following. Performed: Capped Added Relocate 9 Y g•
Baptistry/Font Please check all that apply.
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 required uired 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) - regarding fixture work:
• Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
-Commercial-food related
- Service /
Swimming Pool Filter *Note: If the fixture work under this ermit 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:
http:// www. tigard- or. gov/ city_ ha1l/departments /cd/docs/PLMF- PermitApedoc
City of Tigard • COMMUNITY DEVELOPMENT DEPARTME � �
Y f g , 32012
IN M . 4 Request Permit Action
T l c A li D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • w r,1; ' ;.�o ` . . e) , `
2 1 . `'a.x - — . 4 .
TO: CITY OF TIGARD 1 1 C 9 2012
Building Division Services Superviso � � '
13125 SW Hall Blvd., Tigard, OR 97223 ® AA-- ■;:i r • '' . ; , 1 , 3 a, �•, "'�
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov' ;'
FROM: ❑ Owner ❑ Applicant 1st Contractor ❑ City Staff
(check one)
REFUND OR Name: A
INVOICE TO: (Business or Individual) 1 r-{--Lis V ib/ ,,
Mailing Address: 1 6 CJ s • 1 7' G A-.. e_
City /State /Zip: L/ ivtUAJ 0/1-- 7oo 6
Phone No.: s v3 649 ss ( Lf
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
CANCEL /VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: pLI"4 2_0 (2- 0 C) ( <6 9 -41 Site Address or Parcel #: ( 2 1 () 0 S. i/' 5 141 FQ ( NG j
Project Name:
Subdivision Name: Lot #:
EXPLANATION: 1 pL.,(1 p (. &i 0 c
D CLt" A (0ti/3 S, (. G= c....,
C, i C��O • DC-, >Z. ,s ( -L. 6 u.
Signature: Date: 6 - (-3- rZ
Print Name: : T e - ` - (' 0.s//
Refund Policy
Ad �6 ?a x 9 - G`��.
1. The Director or Building Official may authorize the refund of: / 9'g- P67:3" Q � " �y (G%
a) any fee which was erroneously paid or collected. , g, E f t z ,9.( i /
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2 -4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date B Rte to Bld. Admin: Date J d23 ® B :ill,u7J
Refund Processed: Date /N/ 4— B t Invoice Processed: Date By
Permit Canceled: Date ?AV, Z By 4/9 Parcel Tag Added: Date By
Receipt # Date Method Cii-E Amount $
I: \Building \Forms \RegPermitAction.doc Rev 05/25/2012