Permit U CITY OF TIGARD PLUMBING PERMIT
' 1 • - COMMUNITY DEVELOPMENT Permit #: PLM201300214
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2013
Parcel: 1 S134AA01800
Jurisdiction: Tigard
Site address: 10150 SW NIMBUS AVE E2
Project: Priaulx Forest Products Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 2
Project Description: Adding (1) new breakroom sink
Contractor: BEAVERTON PLUMBING INC Owner: HANSON, RONALD D
13980 SW TV HWY ROBINSON, CONSTANCE A
BEAVERTON, OR 97005 ROBINSON, CHESTER TRUST ET AL
203604 EAST FINLEY RD
KENNEWICK, WA 99331
PHONE: 503 - 643 -7619 PHONE:
FAX: 503 -643 -7620
FEES
Quantity Description Date Amount
1 ea Sink 07/01/2013 $25.02
Specifics: 1 12% State Surcharge - 07/01/2013 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 07/01/2013 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
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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 direc uestions to • NC • callin• 503.232.1987 or 1.800.332.2344.
Issu d By: Permittee Sig = II/ i , r
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.
From: 06/27/2013 13:30 #135 P.001/003
Plumbing Permit Application L L IFP
Site Utilities JUN 2 7 2013 FOR OFFICE USe ONLY
City Tigard Received # 4..e.,:941 (�
11 .' .
Ci of Ti and �� By: ( a 7 / 3 ,� . I Permit No.• 3 -Q o ,P./ /
13125 SW Hall Blvd., Tigard, OR 97223 OG' �0
C : Phone: 503.718.2439 Fax: 503.598.1 , t ���' °� Pl Rev ew f Other Permit No.:
c 51,0 � � PlateBy: o . 2o /3- ooi
T I GA RU Inspection Line: 503.639.4175 ` °` "-1 :‘' 1 0Sv�. �l Date Ready /By: Janis: 0 See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental information
TYPE Oh WORK. • . FEES SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. f Ea. I Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
, CATEGORY OF CONSTRUCTION , • , , SFR (l) bath 312,70
❑ 1 - and 2- family dwelling ®Commercial /industrial SFR (2) bath 437.78
1:1 Accessory building 1:1 Multi-family
SFR (3) bath 500.32
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: 10150 Nimbus Ave 0 E2 Catch basin or area drain 18.76
City/State/ZIP: Tigard, Oregon 97223 Pi� )( Y Drywell, leach line, or trench drain 18.76
l H L t Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: i -1 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
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.: / 6 / 5 6/ TC,c) Backflow preventer 31.27
DESCRIPTION' OF ..WORK Backwater valve 12.51
- Clothes washer 25.02
Adding 1 new break room sink Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER' " L 0 TENANT ,. Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /State /ZIP: Hose bib
25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ; 0 CONTACT PERSON Interceptor /grease trap 25.02
Business name: Beaverton Plumbing, INC Medical gas (value: $ � ) Page 2
Contact name: Roxanne Grier
Primer 12.51
Roof drain (commercial) 12.51
Address: 13980 SW Tualatin Valley Hwy Sink/basin/lavatory 1 25.02 25.02
City /State/ZIP: Beaverton, Oregon 97005 Solar units (potable water) 62.54
Phone: (503) 643 -7619 Fax: : (503) 643 -7620 Tub /shower /shower pan 12.51
E -mail: roxanne@beavetonplombing.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Beaverton Plumbing, INC Water piping/DWV 56.29
Address: 13980 SW Tualatin Valley Hwy Other: 25.02
City/State/ZIP: Beaverton, Oregon 97005 Subtotal 25.02
Phone: (503) 643 -7619 Fax: (503)643 -7620 Minimum permit fee: $72.50 72.50
CCB Lie.: 1288 Plumbin g Lic. no.: 3 1/ _ 1
7 /6 Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
Authorized signatu e � TOTAL PERMIT FEE 81.20
x � --6k. f A (..-)Th.--/
Print Nam // ! 1 Date: 0627/13 This permit application expires if a permit is not obtained within 180 days • a� n �l� (CL�` after it has been accepted as complete
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"Fee methodology set by Tri- County Building Industry Service Board.
11Building\Pe mits\PLMU- PennitApp,doe 10/01/09 440- 4616T(10/02 /COM/WEB)
From: 06/27/2013 13:30 #135 P.002/003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site'Utilities Qt Fee (ea) , :Total ( Square Footage: s /'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
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 - I st 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 * .
Quautig- by Fixture Type Plan Reviewfor Plumbing Installations
Fixture Type for Replica/
Work Performed: s Capped . Added Relocace Plan review is required for any of the following.
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.
4„ Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic- non -food s
g 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) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related 1
- Bradley
- Commercial- food related
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
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_ hall /departments/cd/docs/PL M U- PermitAp2 doc