Permit CITY OF TIGARD PLUMBING PERMIT
IN la
■, . COMMUNITY DEVELOPMENT Permit#: PLM2013 00320
Date Issued: 09/16/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718.2439 parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7250 SW DURHAM RD, STE#900
Project: Universal Tea Co Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 25-27,2;
Project Description: Reset(1)urinal,(1)lay,(1)kitchen sink&(1)dishwasher
Contractor: DEAN WARREN PLUMBING& REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 ATTN N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE 503-236-4152 PHONE' 503-624-6300
FAX. 503-296-2218
FEES
Quantity Description Date Amount
1 ea Dishwasher 09/16/2013 $25.02
Specifics: 1 ea Sink 09/16/2013 $25.02
1 ea Lavatories 09/16/2013 $25.02
Type of Use: COM 1 ea Urinal 09/16/2013 $25 02
Class of Work: ALT 1 12%State Surcharge- 09/16/2013 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112 09
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
issuan if—work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti Notification Cent• Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
direct questions to OUN• b • 503.232.1987 or 1.800 332 2344.
Issued By: Permittee Signature. A��
a...4...4..1 ∎illito1
Call 503.639.4175 by 7:00 a.m.for the next available in pection date.
This permit card shall be kept in a conspicuous place on the Job site ' completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures FoR OFFICE: USE ONLY
RECEIVED Received ? // 3
City of Tigard Date/By
((% Permit No �aNad /32 o
1pgv 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
A Phone: 503.718.2439 Fax 503.58 196(1 6 2013
Date/By Other Permit No 4j1 /a_00ad 2
T I G A R D Inspection Line 503 639 4175 Date Ready/By Juns ® See Page 2 for J
Internet. www.tigard-or.gov
CITY OFTIGARD Notified/Method Supplemental Information
TYPE ° LNG DIVISION FEE* SCHEDULE
/ e rtstrQetien ❑Demolition For special information use checklist
Description I Qty I Ea. I Total
41Ad ition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500 32
❑Accessory building ❑Multi-family
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: 7,2.G-0 �uQ i,L1 •
Catch basin or area drain l8 76
Drywell,leach line,or trench drain 18 76
City/State/ZIP: Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 9ee I Project name:OA(%/SP/ /5-7",)51, fads 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.: Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
/k e cJ2,/— /- U4 • / • I-a t/- / h$- / - /Jw Dishwasher 1 25 02 2 1=C%L
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
t-- Fixture/sewer cap 25 02
Name:
Ac. ��S Floor drain/floor sink/hub 25 02
Address: t“5--e/ cut. c€.,0 0/d Via4-4
Garbage disposal 25 02
City/State/ZIP: 1-05 d 6/72, / Hose bib 25.02
Phone:(SZ)) G.2.-if, 6 3,Cl Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: ,i,�� a.. �a /I/ / Medical gas(value $ ) Page 2
``��/• Primer 12 51
Contact name: `7t,e_ Roof drain(commercial) 12.51
Address: P,013o� 1t/7G! Sink/basin/lavatory 2 25.02 p t/
S G,
City/State/ZIP: /(76p-/ 0/i >J.c-, Solar units(potable water) 62.54
Phone:(5-3-1 ) 78 G - 5.4 e•( Fax: :(S�) ) 2 C‘-- .?)/‘4 Tub/shower/shower pan 12.51
E-mail: Urinal / 25.02 �S•a/—
' CONTRACTOR Water closet 25 02
Water heater 37 52
Business name: Water piping/DW V 56 29
Address: Other 25 02
City/State/ZIP: Subtotal /r0_en
Phone:( ) Fax:( ) Minimum permit fee. $72.50
CCB Lic.: / c-yg/ Plumbing Lic.no.:)6- 7 )6 /...7d
Plan review (25%of permit fee)
State surcharge(12%of permit fee) 4Z a/
Authorized signature. TOTAL PERMIT FEE /42.6?
Print name: 4...... /< This permit application expires if a permit is not obtained within 180 days
�S Date: /(-
after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
I\BuidingWermits\PLMU-PermitApp doe 10/01/09 440-46I6T(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
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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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 90.00Mr $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
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drive tall 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 Drain/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
WaterCloset-Toilet * plumbing permit can be issued.
Urinal
Other Fixtures.
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