Permit •
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CITY OF: TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00328
T t G A R D 13•25 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/13/2012
Parcel: 1 S135BD00100
Jurisdiction: Tigard
• Site address: 9600 SW OAK ST
Project: Plaza West Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: Replace fixtures, (4) lavatories, (2) urinals and (5) water closets
Contractor: JAMES ROOD PLUMBING INC Owner: SHORENSTEIN REALTY SERVICES
125 S 1ST AVE #542 5335 MEADOWS ROAD SUITE 300
HILLSBORO, OR 97123 LAKE OSWEGO, OR 97035
PHONE: 503 - 648 -3907 PHONE: 503-619-3200
FAX: 503 - 681 -2196
FEES
Quantity Description Date Amount
4 ea Sink / 40tatr eS 11/13/2012 $100.08
Specifics: 2 ea Urinal 11/13/2012 $50.04
5 ea Water Closet 11/13/2012 $125.10
Type of Use: COM 1 12% State Surcharge - 11/13/2012 $33.03
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
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Total $308.25
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: y pp (� 1'!/ Abaty j I j zi
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. r, tJ
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 Applicati&RECEIVED
Building Fixtures NOV 0 8 2012
City f 'Iti altd R eceived
Permit No.:
■ 13I SW Hall Blvd., Tigard, OR 9 OFT Date/By: era
u 3 " �O /�-DD
; :: Phone: 503.718.2439 Fax: 503.5. ^ DIVISION ��B Other Permit No.13(,I / �la..-eb/9/
T I G A R n Inspection Line: 503.639 • 11 L!I V J V ry Date Rey /By: • rins' El See Pape 2 for
Internet: www.tigard- or.gov Notified/Method:
Su Dte•teatel Information
r- t °.ate =. °• •r ( :rr - - -
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❑ New construction ❑ Demolition For special inforntation use checklist
Description I 'Qty. 1 Ea. I Total
A Addition/alteration /replacement ❑ Other: New 1 2 family dwellings (includes 100 ft. for each utility connection)
ripiIii ( •s:• _ � 'n:+ - -:x.. n' : e.c w_ , ,_ i, :
T ` ' �' -- !'�' t tr'. d � . ,.
n � • i � 4 1 p ItJ R� J g � ,r ' -' .•1 'CI �,E `"v
..! ' n iS' ; . l iA , A ::i4 a ` f..:C fe!" T'P.' �iJ. ;.sr-riff.�1i .a 1.5.1- 4, ( 1 F hi ; ( ) bath 312.70
e ., .. h 7!51..... R . e, )'. ... .�,• SFR (I) '
❑ I - and 2- family dwelling 1 Commercial/mdustrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
_
El Master builder ❑ Other. Fire sprinkler ( sq. ft) I Page 2
• lf{ 'i -- -`Fr ""co11 ,: i rc_:.�?w..'; t _ . : :' .I:::i. : ii1 :Y :t - ti .,,� , rr. : i" :.} v :
t1a1 f f`. i{•t„ rite i. . � i t :r7 • . t �:'_4 51 - _ r ' t S r , ti -� N ( r Site utilities:
s 1
cl',.•,:e?x1:._�._.. ,u.cw { � ,r- .•...1°r. { :Nsu :4rL•_ _._.�i;a _ ::4 _.. .. ! ... - .r � :._ -.... i.u....- .. . -:,
Job site address: (3 L p p s GJ O 0.„1( Catch basin or area drain I 18.76
City/State/ZIP: ' 004 - �� r Drywall, leach line, or trench drain 18.96
s Footing drain (no. linear ft.: _j Page 2
Suite/bldg. /apt no.: I Project name: gott„ i pote t Manufactured home utilities 50.03
Cross street/directions to job site: 2...J .CI* u.,.... Manholes _ 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear R: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
u
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
• i Y ....- .:•yxr ^ " :! ll_M ";ftgIJS,�;Kvl <<�'''r'�,, r;� .. 'lS: �" 7,7217 „n.,- n Backwater valve 12.St
q:1H:, R. ( ' .-- t G .q > , 'r (P n n ] e Str'L. I j ,. (dq k
� 2.. ". .+;r+ '- d. 1 . .n '"`. :F; y...' ' "'
Clothes washer 25.02
P i
p c. t.e. fe tk. i-e5 Dishwasher 25.02 .
Drinking fountain 25.02
Ejectors/sump 25.02
a
i:SL t r it _i` :i" Y_;tti: : ot }o:. r•4 t 5t!Fi�'r -
7 7O t�'rTs�j_±I.,��f anSon tank • 12.51
. ^ .M .,,I Z ''ri i i `f .e .^f j a \ 7!`Y{: i n , j ' lfZir '' . O.9 .l i t �'1 !uI1 �,� r E xP f I
CY.f1 �:V" ... . __ - ...., 30.t irk∎ ,4 .r...,(.. s..... 1, It ..6 ,.,i _.a+9. T.. 11. a. Z. ;e , .r,. T.E1..
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
'!�` p r�.�i; r� 5 = ..i ; : %�1y ;;,;. r: }ii�Xi;(TZ.� si. Is t ^' 41fF_; _ = ?�ij * ! r:,
w eh { ft 1i s / 1 r , : r &:2 ( .• �l� {�. Interceptor /grease trap 25.02
�!, � _-' -s e.. ,n_3,....,,.r..,...� ��..... ,. �.. . f .>.: ..1�...._... s. ,..,., ...u'l.t..... are
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) • 12.51
Address:
Sink/basin/lavatory L{ 25.02 /vv 07
City / State/ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax :: ( ) Tub /shower /shower pan 12.51
E-mail: Urinal '''a$... 25.02 50 oil
Fa �: .. �"�i -�- u :¢c ••• .�, ?•; _ _zv;� �.r -.,., 'x"„ - y � '� r'.A" ( i , •yt j :•�e�. r� t;; 5 y - , q Water closet 25,02 ¶. V
-
ii .r.. l i �tq :.' Li l;' u j el. 7 1 ; q e 'S5, 7 � +. . w EFt.`. .a.4(�
'Y •. ^� *°;° � ^°. � .. � � Water heater 37.52
Business name: , • . ( ��Ir.►'aj 4 . 4-Ac Water piping/DWV 5629
Address: /1 5 5- 1 tt St abr Sy Other: 25.02
City/ State/ZIP: 4N; 1isEo11 , 0 ()Le- 971 -3 subtotal 7)5 -T7.
Phone: (S0') b kig f re?
Fax: (S 42?/.-- at ti Minimum permit fee: $72.50
CCB Lic.: 7 -� 0 1 tfa4 �J Plumbing Lic. no.: p 551 Plan review (25% of permit fee)
l
I, State surcharge (12°x6 of permit fee) - 31, 0 - 5
Authorized signature:
/et..- -7 1 1 / TOTAL PERMIT FEE 301 _,
Print name: vt f 2 C4 I Dam: I i igi This permit application expires if a permit is not obtained within 18o days
after It has been accepted as complete.
'Fee methodology set by Tn-County Building Industry Service Board.
I:V aui ldirePermits\PLMU- PefmitApp.doC 10/01109 440 -seise 10/OJCoM/wE6)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su . i S stems:
.C f . ) i� J :rl :� .:u 4 �' :��V„. \ r l u :�an J 1 {:: n }l�l L �� ! f� .. S �� d1�1 .11.1�•C{ .I:ti: -•':! Fr . r+r �i Qj} W
u5,lo
.�- 1:2 Fl�.fa �'.. �..ki :t' �y ..�.'i�Vl�'IJ2.^S.SL. a..,� a. �t'a.:l� :l.: - ., l` �1. .: s �1::::�:�!L.:•I,i- ..u1P�' Footing drain - 1 100' 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 $23320
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 S stems:
Water Service • each additional 100' 3752 ,a n^ { r,","
F'.fVr�li:ni /:r.'3.cl.
Storm & Rain Drain - 1st 100' 62.54
$1.00 to $5,000.00 Minimum foe $72,50
Storm & Rain Drain - each additional 100' 37.52 MI $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
nt'8 'CJi:+n.l l' �,l`; 1 ;d^ •::a!:L -=, • ;1�'i1 lr'1, Jlj ?' 1'fl 1i r''^ •.l" ^'. ". N•Y�'6/ /d'1'`'f
each additional $100.00 or fraction thereof, to
� lit • : {' r.1 rf �1 J)li .1 .t •:.1 ; ;tfi"��4J. ;�.: G(!;. }%.:
and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $14850 fbr the first $10,000.00 and 51.54 for
which no fee is specifically indicated 90.00/hr ■ each additional $100.00 or fraction thereof, to
minimum char_ " - 1/2 hour end 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 char: " - 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 fast $50,000.00 and $1.20 for
minimum char =
- 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 re u ort fixtures could result in increased fees*.
c �r.7 rr smn ism , ?3t S'";: I �.::.,. .r : .,:s . ?.';
If ' �{ - _... l;! , 6 " a i� . ,:•I r., - ��uu r : ui . { "I,IIINtih.d. »:iTl.�lp��
k iii ro y mill la ..I i.3'. �.l„� ;� :� t . t - � l.�ut t.r '�1 1 -• - _��� l „ f k
� � - .r, -
a .o u ! ! , it c a l - P review is required for of the following.
ti :sue '5 Ai ra c a t lr �11:110,4:7 1, #t `: ���' r w St i n 1 , e9 any .
g
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2" and
Jacuzri/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"
•.. -, "v .�' R��0 :: "oyy : ",!':, ! �• :•:.i', >:G
Car Wash Drain g +�` Y , « F � : . :. 4 . y i . 1, M; _ T .a.. (i�aa t ka� :u :!1�Jr T i1,1
Garbage Domestic- non food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic-food related that meet the qualifications above.
- Cornmercial -food related
- Industrial -food related
Ice MachiRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixtur work:
Rcc, Vehicle Dump Station 1Q. C1 1%5 j� „ y 714.4-1
Shower -Gang 7
-Stall W
Sink/Lav -Non -food related
- Bradley
- Commercial- food.n leted
- 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 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\jim\AppData \Local \Temp\PLMF- PermitApp.doc 2