Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00361
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/13/2012
Parcel: 2S102AA04800
Jurisdiction: Tigard
Site address: 8962 SW COMMERCIAL ST
Project: Tri -Met Transit Center Subdivision:V1ORIN'S ADDITION - VACATED 142/182 Lot: 26
Project Description: Replace 80' of sanitary sewer line.
Contractor: ROOT EXCAVATION Owner: TRI- COUNTY METROPOLITAN
10824 E OAK ST TRANSPORTATION DISTRICT OF
MILWAUKIE, OR 97222 OREGON
4012 SE 17TH AVE
PORTLAND, OR 97202
PHONE: 503 - 656 -6610 PHONE:
FAX: 503 - 656 -6625
FEES
Quantity Description Date Amount
80 If Sewer Service 12/13/2012 $62.54
Specifics: 1 12% State Surcharge - 12/13/2012 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment - 12/13/2012 $9.96
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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: / jAr
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.
Dec 12 2012 17:34 UPSSTORE 313 LRSERJET FAX 503 - 794 -5929 p.2
Plumbing Permit ApplieatiR
Building Fixtures I 0 )IZ (II H r I .l ; OA %
City of Tigard DEC 12 2012 /0 ,,8, ,,;i, permieNe./01,4 B,a -0636!
13125 SW Hall Blvd., Tigard, OR 94315/ OF TI^AR Plan
ly' Review' Other Permit No.:
® Phone: 503.718.2439 Fax: 503.5 I t�lrgt7LJ
I nt ww.t garb gov75 BUILDING DtUfSr' i I j d,Mt�. ' - Se RI See Wit; nformation •
§50: y':�xaama iw cr!m^ a. _ l<`•E kifriss"kS3' 65 .�u} 'Mira:, 6r' y {III s {! } ��','r i.9 :leA✓�nu '. c,(� m!/.� N -, . • :1,
'3: tI ' • IM ! FJea t ,' Fr4 t�i}L 1 1 SD :{ ,c. 10l3,>ea l.PY lT 4fl lit".. �f`6': 'g.
❑ New construction ❑ Demolition For special information use checklist:
Description I Qty. I Ea. I Total
® Addition/alteration/replacemem ❑ Other New 1- 2- family dwell lags (includes 100 it for each utility connection)
!bri ' 1 ; - ' .. 11.. : ' d i at Pl' .:ACr8�ii; se r' er 7. , ' y . SFR (1) bath 312.70
❑ 1 - and 2- family dwelling ® Commercialrndustrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Mulct- family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: . , . Fire sprinkler ( sq. ft.) Page 2
..' o W'°,`f 0 . .3•'-.. i • >xe tivd rP f ,a �.k r i t a r Site alludes:
Job site address: 8962 SW Commercial Avenue Catch basin or area drain 18.76
DryweQ leach line, or trench drain 18.76
City/State/ZIP: Tigard Oregon Footing drain (no. linear ft.: _) Page 2
Suite/bldg./apt. no.: I Project name: Manuflsctured home utilities 50.03
Cross street /directions to job site: Manholes 18.76 J
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: aft) 1 Page 2 62.54
Storm sewer (no. linear ft.: __,) Page 2
Water service (no. linear 8: _) 1 Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
P, •-,i,,,,,14.:1 .:� e ,�',� .n,� .. _ �,t ,, , i ; It,r'4..! Backwater valve 12.51
v.A.# +' . . . s l r } ,it s ' ?gila.k' :sk +' 41 '. r '' Clothes washer 25.02
Replace property's Sanitary Sewer Line on propertt Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
t : , ,, + x ra r �r u m,�; l w v cKew 1 t t... r' • > E xpa a s lon tank I 12.51
` ; , i ! r .. a�Aa:. 'cli: c SC Z a stwtt4 . , } . t ;, ' � + o, {.ftl� �
Name: Trimet Trand Center F cap 25.02
Floor drain/floor sink/hub 25.02
Address: 8962 SW Commerdal Avenue Garbage disposal 25.02
City /State/ZIP: Tigard Oregon Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
.: x " ' )� +L� F '-a ' , t . rml wis Cep Sre I 25.02
1 'Ai -A. s i It Inter tOr/ aSe tr ap
�, rs ` ��t�!sSm:1,�x�i t'I`,+ ! r � ��+
Business name: Root Excavation
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Bridget Wilson Roof drain (commercial) 12.51
Address: 10824 SE Oak Street 322 Sink/basin/lavatory 25.02 _
City/State/ZIP: Milwaukie Oregon 97222 Solar units (potable water) 62.54
Phone: (503) 656 -6610 Fax: : (503) 656-6625 Tub /shower//shower parr 12.51
Urinal 25.02
E -mail bridget®raglandslnc.com
{, : , tq trx A F• h or a Water closet 2502
ri ..,..,E..: y, , 4- x? • -,� i ' ` _,........ a r . r• .. r . . - water heater 37.52
Business name: Root Excavation Water piping/DWV 56.29
Address: 10824 SE Oak Street 322 Other: 25.02
City/State/ZIP: Milwaokie Oregon 97222 Subtotal 62.54
ne: (503) 656 -6610 Fax: (503) 656 -6625 Minimum permit fee: $72.50 72.50
Plan review (25% of permit fee)
J
t CCB Lic.: 1 ' : Plumbin: Lic. no.: 3433pb
.r__ State surcharge (12% of permit fee) 8.70
Authorized signature `- t ,•e M TOTAL PERMIT FEE 81.20 '/
Print name: Bridges ate: 12- 2 -2012 Thb per appli attoe expire` d a paint! u soot obtained within 180 days
Sa Wig m* after Is has been accepted as com ie s&
*Fee methodology sat by Tri - County Balding Industry Service Board.
Dec 12 2012 17:35 UPSSTORE 313 LASERJET FAX 503 - 794 -5929 P. 3
Plumbing_Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su i S stems:
- '.;Y `Te t ...K.I . r . • 4 , 7 . is f , rr V� am' } s � 4 • a , :49- ' �•, Y ,r . ; , s +
it ,,, , „,:;.„... „:;;..
. ^f.,L„� ' a ,..tan. •i. •�_ ; Ai' ,t1 ra '.1�`r`1 ., V=. ;a,,. 4.L: a au.ia....i:r., �„3�:s.�:•a• «.,.,.. .�.r.. �: ti Y. • . 1 i.74.1.
Footing drain - 1° 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,00 l 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 1W 62.54 Medical Gas S stems:
Water Service - each additional 100' 37.52 „is ! rT5`r v i h a '( ` 4r kilii
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
,. , , � w .a7- • ; a -.w p ar;a it ' , c; ii each additional $100.00 or fraction thereof, to
k o#..2 .c .� jt›,, . .t.; b ` : . ' _ •. •' ti M1 ': -, v 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 faction thereof, to
(minimum charge -1/2 how) and including $25,000.00.
Inspections outside of normal business 90.00/fir $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 fir revisions 90.00/hr $50,001.00 and up $742.00 -for the first $50,000.00 and $120 for
(minimum charge -112 hour) each additional $100.00 or faction 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 * .
. - ' : .' 6'F :4 a i " , .ir ' i.r . ' it t ;.atr -. l^Cka:. ii. . ' t ) : r : , Y •
1.• '.;a'.;ac`f':,,?� �!" G t• :�c�- € > : !•(JL , • }i;t ; ii' ; 1(t 7. � 'Lily', � �. • P � � . � • Y� ".ItY.,'�.. . �, .t � � r i.}� t.:l ate, z i d � , � U ' I � � a � Imo. itf;'"
Kp(� .:S "'r`1" i+3 �..es,'�j - � ,r e ' • _ � .� �,�.'4',"�J..,+..dl'+Si ti,.i?G,'�.i�. i':�i.,S.�_. �. :.5_e...K•:e:'t
; f
A , t d �, � 6 , �• t: j ti 'x 4 Pi e , Plan review is required for any of the following.
;, F rPr ` = . ;1 riki ;i A 'P = = Please check all that apply.
Baptistry/Font ❑ Any new commercial building with water service 2" and
Bath - Tub/Shower _ greater, except systems designed and stamped by licensed
-Jacuzzi/Whirlpool
Car Wash -Each Stall engineer.
-Drive Tlw ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR91 8-780 -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 OAR91 8- 780-0040.
Eye Wash ,
Floor Drain/sink - 2" Submit 2 sets of pl with any of the above.
v.11,,,,,-,.-. r *'•,. : r i ...S. u .s,. , ia , 1. 4 wn f t. f . ..t •f t .T t'ur e'e" I
Car Wash Drain Isometric or riser diagram is required for new buildings
Garbage - Domestic non - food
Disposal _Domrstio- -food related that meet the qualifications above.
-Commercial -food related
- Industrial -food rdated
Ice Mach.JRefrig. Drains ,
• Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay - Non -food related
- Bradley .
- Commercial-food related
- Service
Swimming Pool Filter *Note: If the fixture work tinder this permit results in an
Washer - Clothes Increase of sewer EDUs, a sewer permit will be issued and
Water Extractor
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal - plumbing permit can be issued.
Other Fixtures: