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Permit
CITY OF TIGARD PLUMBING PERMIT . ° . COMMUNITY DEVELOPMENT . Permit #: PLM2009 -00195 T I G A RD .13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/23/2009, Parcel: 2S112DD00701 - • Jurisdiction: Site address: 15800 SW UPPER BOONES FERRY RD 120 Subdivision: Lot: Project: Jonathan Plant DVM ' . Project Description:. Replace (2) lays and (1) sink. Add (7) sinks and (1) clothes washer. Owner: FEES , PACIFIC REALTY ASSOCIATES Quantity Description Date Amount ATTN: N PIVEN, 15350 SW SEQUOIA PKWY r #300 1 ea Clothes Washer 07/20/2009 $16.60 PHONE: 8 ea Sink 07/20/2009 $132.80 2 ea Lavatories 07/20/2009 $33 20 1 12% State Surcharge - 07/20/2009 $21.91 Contractor: Plumbing ADDISON PLUMBING 27425 S BEAVERCREEK RD • . MULINO, OR 97042 PHONE: 503 - 740 -8116 • FAX: 503 - 632 -1168 Type of Use: COM Class of Work: ALT Type of Const: . Occupancy Grp: , Stories: Total $204.51 • Required Items and Reports (Conditions) 1 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 'Noti - • . - - - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may.obtain a copy of the rules or d• - questions to.OU b calling 503.246.6699 or 1.800.332.2344. ;/ _'a sued By: ` Permittee Si / l/ . - Call 503.639.4175 by 7:00 a.m. for an Inspection that b • ess day. : ' , . ' - 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. 5 ' .Plum ' fling Permit Application City of Tigard RECEIVED Received g DateBy 7 e9k9 ©r Permit No.• bog... 00 /Q a 1 SW Hall Blvd ,Tigard, OR 97223 ( � fl . Phonehone . 503 639 4171 Fax 503 59d 1 ,1460 2 O 2009 Date/B 4,9,14F-1:30&? Plan Review C Other Permit No , TIGARD Inspection Line 503 639 4175 Date Ready/By 1 s ^p ® See Page 2 for Internet www.tigard -or gov CITY OF TIGARD Notified/Method I W S upplemental Information �vvv"""" ,S -- - - n`i• t Y e .'' ,.: - R. }. ,, i il' ;':5 ~l' • r . l g =9j -, ', ` i S... ' l ,,JP 7 . • ft,.v.:•. ,•'c _ ° °ki :.. t t. .'a,rc;l:::."t � -,,,, 1 2.;-,-,,,,, , 1 1 ,-. : :_ TVPE 9 1NGD I VISIONy, ,.�;"- ," ,: d• :. .,-,.FEE,- SCHEDULE,,,;, ," ,.� • ., - _ .- ._ _ -�. . . •r. ."t,- �'�r)��.k _ =a_. +, , t.- r .ter ,,,•9,- , n )_t'� .. ❑ 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) ;3" ` j- =1,' ,r:. � :CATEGORYiF O CONSTRUCTION';.. -•' % . c• ' • - ,{; SFR (1) bath 249.20 ❑ 1- and 2- family dwelling OCommercial /industrial SFR (2) bath 350 00 Accessory building SFR (3) bath 399 00 ❑ ry g ❑ Multi - family ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other. Fire sprinkler ( sq ft ) Page 2 _ � « ^ s Tt, �,;� : r� .- - - - w tea:- + =�� -•_ -'-� g ',. i:: i _- JJOB` SITE' INFORMA77ONr_ANb•, 'LOGATIO,,' - ' =: : :":,':.c Site utilities Job site address (5 yd.& S -'- 41 Qc rbco'& e6 r. e-A - Catch basin or area drain 16 60 City/State/ZIP. `r(94"d t c»2 Drywell, leach line, or trench drain 16 60 Suite Idg /apt. no 4 12.o I Project name• Footing drain (no linear ft . ) Page 2 / Manufactured home utilities 110 00 Cross street/directions to job site Manholes 16 60 Rain drain connector 16 60 Sanitary sewer (no linear ft Page 2 Storm sewer (no linear ft ) Page 2 Subdivision: I Lot no: Water service (no linear ft ) Page 2 Fixture or item Tax map /parcel no: 16 60 ;, �Y�' -C"K,, :.. '�::;= ° �'' » -: k 4i u , Absorption valve `:> -,-,--.0•'',=-4,:f4:,,, .'1 :1kP •; 4V.il,._DESCRiPT70NnOF<<VVORK `� max." `r' _ �;r_s: . c , . ., -. - ., .,r. .. ,, ... .,.-...,)%:. `-':. -. - :&.-i Backflow preventer Page 2 Backwater valve 16 60 Clothes washer i 16 60 Dishwasher 16 60 ix�� " ' PROPERTYi:OVN r � �'"s`�' - "+r• n ;ji ;, Drinking fountain 16 60 t;, • -' '. c D . VER;s ';9 . r : -- t .D,TENA�NTn: ''" .-..,«:;: �: - _; ._. • n, -• .. .. , -.. -- « .. '• -.e; Ejectors /sump 16.60 Name 74 1 ,.s+ 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 ,- _ ®.;AP P : _ • -` .'` • - lµ y ^ ® ;CONTACT PERSON fi ...;. 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: ( ) F ( ) 1nybasi f avato g s, -.V- zt , 10 16 60 Tub /shower /shower pan 16 60 E -mail • t „ Urinal 16 60 �',,'-=';',;::''' ( ? t... am :' - . r y ; '' -' ° > ' `CONTRA } ;a •f,:' �: i " i� -a, -; .“ 'z ` ri.:, < . „m „"y .. , _ � .. =w. r Water closet 16 60 Business name: t 4, e lv,...,‘.,;" L. L-C._ Water heater 16 60 Address: Other City/State/ZIP. � c3‘2.- (316.-k7-. Subtotal Minimum permit fee $72 50 ig b0� . 60 Phone: (Se 3) CSZ"llos ? Fax: (S' ) 1 -1 /to`� Residential backflow minimum permit fee $36.25 / CCB Lie.: 1 5 St Plumbing Lic. no.: 3—,t4f•4t96 Plan review (25% of permit fee) _. • State surcharge (12% of permit fee) AI ,y/ Authorized signature i� A/ TOTAL PERMIT FEE „Peg S Print name: 3 o , r , e , Date: - 7 - - 09 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board i \Building\PermitsWLM- PermitApp doc 12/27/06 440- 4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: r1• "� Site 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 $16000 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 - I st 100' 55 00 Medical Gas Systems: Water Service - each additional 100' 46 4 a t ; 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 :Y additional $100 00 or fraction thereof, to and ?h11Xt111'C'' It ."'.-« ? ^Qty ti_Fse tea), . rzT;otal;; 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 each additional $100 00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72 50 $50,001 00 and up $742 00 for the first $50,000 00 and $1 20 for Subtotal: each additional $100.00 or fraction thereof Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", "vt ,"t��. Plan;RevitEw <for. PI_'umbn +Installatons, ��,t:�F 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. ;``; ;dry { ;`Y - ° +' Quantity by (Fixtu`ie)`WorktPe�forine'dr : ❑ Any new commercial building with water service 2" and ''FurtureTy;pe' %' "r " """ r, ; ` ",'• ' ' 't,' F? Re facer greater, except systems designed and stamped by licensed «k;r; h� �3s <ie i s ;^s ' =,5 :�P.r`eviodsf GappeJ;� ',Added;r.i `- _EiistinR; engineer. Baptistry/Font Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure Tub /S i/Whirlpool as defined in OAR918- 780 -0040 Car Wash Each Sall ❑ Medical gas and vacuum systems for health care facilities. Drive Thru ❑ 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 1•� `��;�`' =,r �;r.�i .. �,., .., ,• _ . Isometric ;; ~,; - �..�_,.; -•, ;�,,; Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications 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 Z under un *Note: If the fixture work d this permit results in an -Bradley p Commercial - • I 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 \Bu idmg\Permns\PLM- PermiApp doc 12/27/06