Permit CITY OF TIGARD PLUMBING PERMIT
g COMMUNITY DEVELOPMENT
Permit 4: PLM2013 00201
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2013
Parcel: 1 S 135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY 238
Project: Southside Christian Fellowship Subdivision: METZGER ACRE TRACTS Lot: 9
Project Description: Add (1) breakroom sink, replace (1) lay and (1) toilet
Contractor: MCINNIS INDUSTRIES LLC Owner: COMMERCIAL ENTERPRISES LLC
PO BOX 920 8320 NW HWY 99
BEAVERTON, OR 97075 VANCOUVER, WA 98665
PHONE: 503 - 643 -6343 PHONE
FAX• 503 - 643 -6343
FEES
Quantity Description Date Amount
1 ea Sink 06/27/2013 $25 02
Specifics: 1 ea Lavatories 06/27/2013 $25 02
1 ea Water Closet 06/27/2013 $25 02
Type of Use: COM 1 12% State Surcharge - 06/27/2013 $9 01
Class of Work: ALT Plumbing
Type of Const:
•
Occupancy Grp:
Stories:
Total $84.07
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 foil. . the rules adopted by the Oregon
Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 Yo, may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800 332.2344.
Issued t( Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspectio /ate.
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
City of Tigard ' Receiveed /„ �,/ / Permit No.. L��`3- 6Cf
U 13125 SW Hall Blvd., Tigard,OR 972 2 3 4 2013 Pl Review
Y J
Phone: 503.718.2439 Fax 503 598 1960 DateBy Other Permit No 43LAe915 - al2) !4
Inspection Line: 503.639.4175 CI OF 1IGt�1�1
T Y Y' 7 �"' Date Rea B a7 /p �Q Juns 63 See Page 2 for
J
Internet www tigard or.gov Notified/Method Supplemental Information
TYPE OF B WO R K OINCD NISION CI , � rn� FEE* SCHEDULE .
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total r
Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft for each utility connection)
• . - CATEGORY OF CONSTRUCTION SFR (1) bath 312 70
❑ l- and 2- family dwelling Commercial/industrial SFR (2) bath 437.78
,
SFR (3) bath 500.32 IN
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25 02 Q
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 D
r .JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: // 9 q l., pc, _ L .J Catch basin or area drain 18.76
City/State /ZIP: � y ( Z Z Drywell, leach line, or trench drain 18 76
` 1 y / Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: 2.3 Z 1 Project name: S 0J $ 1 `I! ( ,I I I ws 1 t Manufactured home utilities 50 03
Cross street/directions to job site: Manholes - 18.76
14 y 9 Rain drain connector 18.76
Sanitary sewer (no linear ft.: ) Page 2
Storm sewer (no. linear ft • ) Page 2
Water service (no. linear ft.. ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31 27
' DESCRIPTION OF WORK Backwater valve 12 51
Clothes washer 25.02
4471) 53 Nk /mot/ o %ems /Cj ,! -eL.-, e 11--c Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25 02
❑ PROPERTY OWNER I Fr TENANT Expansion tank 12 51
Name: 5 �,,� - h S ) j c I t7 1 , ; p Fixture /sewer cap 25 02
Address: / / q L f f 5 t,.j 9 e Cr c- /4 -w tk 23 p Floor drain /floor sulk/hub 25.02
9 d Garbage disposal 25.02
City /State /ZIP: � (G 6i ( C) (Z ci ?-- 22-3 Hose bib 25.02
Phone: (5 p")) 7 S 6 7 6. 5 Z Fax: ( ) Ice maker 12.51
❑ APPLICANT )' CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Contact name: 60("c4 0 A./ 9\i_ 1,..50 ' V Primer 12 51
Roof drain (commercial) 12.51
Address: 9 -7 p S-J r(Z I t/ cc w Ott L c, n e. m asi a story a .. 25.02 57) °y
City/State /ZIP: (iJ, c fJ 2 p 7 ZZ 1 -7/ Solar units potable water) 62.54
Phone: (q11 ) Z../ _ r7. 2 3 Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: 9 0 C cl 0nJ _ /VC- 1 50 0/ e KO �'/lila 1 1 , (D /VI Urinal 2502
t CONTRACTOR Water closet ! 25 02 � j • 0 :) ,
. Water heater 37.52
6V
Business name: `G 1 j 5 /;'r GJ vs J.( Water piping/DWV 56 29
Address: I /c ., A DX' 92._ a Other. 25.02
City/State /ZIP: e I-2)4/ OR- - ° f - j 73' Subtotal
Phone: (50 3) g / Q (p y Q 1 Fax: ( ) Minimum permit fee: $72.50 75 • 0e0.
CCB Lic.: / 7 `._ 3 q / Plumbing Lic. no.: 3 7 Li/7 63 Plan review (25% of permit fee) —
State surcharge (12% of permit fee) 9,0/
Authorized signature:)( - TOTAL PERMIT FEE g q. 07
This permit application expires if a permit is not obtained within 180 days
Print name 1(6 rn ` v - .! 50 Date: P PP P P y
after it has been accepted as complete.
°Fee methodology set by Tn- County Building Industry Service Board
I \Building\Permits\PLMU- PermitApp doc 10/01/09 440- 4616T(10 /02/COM/WEB)
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 - 1 100' 50 03 0 to 2,000 $121 90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169 69
Sewer 3,601 to 7,200 $233 20
ewer - 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 &Ram Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50
• Storm & Ram 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
l� 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 * . . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash. Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Dram/sink - 2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non -food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non -food related
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet - Toilet i plumbing permit can be issued.
Urinal
Other Fixtures:
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