Permit CITY OF TIGARD PLUMBING PERMIT 1111
s COMMUNITY DEVELOPMENT Permit f3: PLM2015 00239
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/27/2015
Parcel: 1S 134AA01800
Jurisdiction: Tigard
Site address: 10130 SW NIMBUS AVE D5
Project: Cotton Construction Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: 2
Project Description: Interior plumbing for spaces D5 and D6:Replacing(2)lavatories and(2)water closets.
Contractor: RAYBORN'S PLUMBING INC Owner: HANSON, RONALD D
PO BOX 69 ROBINSON, CONSTANCE A
19990 SW CIPOLE RD ROBINSON, CHESTER TRUST ET AL
TUALATIN, OR 97062 203604 EAST FINLEY RD
KENNEWICK,WA 99331
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
2 ea Lavatories 07/27/2015 $50.04
Specifics: 2 ea Water Closet 07/27/2015 $50.04
1 12%State Surcharge- 07/27/2015 $12.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 11811275.5.243.4.1.
Issued By: r Permittee Signature: #1-‘2!9
Call 503.• •.• 75 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumb_ Permit Application
FOR OFFICE USE ONLY
�fll]CIIrig F lgture$ Received Permit No.:�/ , �,�
City of Tigard Date/By: (9--)
Iii - RECEIVE II.Ian Review OthcrPermitNo.:
13125 550 Hall Blvd.,Tigard,OR 598.1 Date/By:
Phone: 503.639.4171 Fax: 503.598.19 0 El See Page 2 for
Date Ready/By: �l Supplemental Information
Inspection Line: 503.639.4175.or.g v ' Notified/Method:
TIGARD Internet: www.tigard-or.gov FEE* SCHEDULE
i r
TYPE OF WORK r = ii For s,ecial in ormation use checklist
mu Ea. Total
❑New construction
❑ `' •y�j�' Descri.tion
❑Other: New 1-2-family dwellings(includes 100 each utility connection
Addition/alteration/replacement SFR(i)bath 312.70 -
CATEGORY OF CONSTRUCTION SFR(2)bath 437.78 -
CommerciaVindustrial SFR(3)bath 500.32 -
❑ 1-and 2-family dwelling g
❑ Accessory 25.02
building ❑Multi-family Each additional bath/kitchen
❑Other: Fire sprinkler( sq.ft.) Page 2 -
_
❑ Master builder
JOB SITE INFORMATION AND LOCATION 18.76 111111111 Catch basin or area drain _
uG 18.76 -
` Drywell,leach line,or trench drain _
Job site address: /� / S L✓ / Page 2 -
- ' Footing drain(no.linear ft.:_)
50.03 -
Project name: • If A .1 A i C/I •• Manufactured home utilities _
Suite/bldg./apt.no.: 18.76 -
Manholes
Cross street/directions to job site: 18.76 -
Rain drain connector _
Sanitary sewer(no.linear ft.:_) Page Page 2 -
Storm sewer(no.linear ft.: ) _
Page 2
Water service(no.linear ft.:_)
Page 2
Lot no.: Fixture or item: 31.27
Subdivision: Backflow preventer
12.51
Tax map/parcel no.: 22.51
DESCRIPTION OF WORK Clothes washer
25.02
Dishwasher _
._ Drinking
Fountain 25.02 MUM
_ -
Ejectors/sump 25.02
❑ TENANT Expansion tank _
❑ PROPERTY OWNER Fixture/sewer cap
25.02
Floor drain/floor sink/hub _
25.02
Garbage disposal _
25.02
Address:
Hose bib 25"02
irit
12.51
25.51
Phone:( ) Interceptor/grease trap _
APPLICANT ❑ CONTACT PERSON page 2
12.51
Medical (value:
� gas� 12.51
Contact name: Roof drain(commercial) l�
25.02■
Sink/basin/lavatory _
Address: ..,.1 • _ .' EMI 40 Solar units(potable water) 62.54
O�� 12.51
_ Tub/shower/shower pan
Q(- �. 25.02
Phone:� ) 6'�� 3� Fax::(yp3 ) L � 25.02 1, JO L NM Water closet
IIIIII 37.52
CONTRACTOR 56.29
Water piping/DWV
25.02
- " Other:
Address: 4C{,• � G ar.. Subtotal r
` ' ��6 Minimum permit fee: $72.50 00.t,
Fax:(gO?) 6�/- Plan review (25%of permit fee)
Phone:( ) �/. - • 6 !��
Plumbing Li c.no.: L_ State surcharge(12%of permit fee) (a �r
• /�/ TOTAL PERMIT FEE i I .uA
Authorized signature: / / /i//��� This permit application expires if a permit is not obtained witlMrtriu nays
Date: .....-2...- after it has been accepted as complete.Service Board.
.1. ar *Fee methodology set by Tri-County Budding Industry
t
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
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-1st 100' 62.54
51.00 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 ect
Ins ions or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Inspections 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
Quanti ty 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
❑ Any new commercial building with water service 2"and
Baptistry/Font 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 Stall as defined in OAR918-780-0040.
[.71 Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher. -Commercial CI Any multipurpose fire sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash P ' Y
Floor Drain/sink: -2"
Isometric or Riser Diagram
-4" ❑ 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: -Lay/Bar non-food related Z
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filer _ 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 p
Water Closet-Toilet Z plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10130 SW NIMBUS AVE D5, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
October 5, 2015 at 9:37:39 AM
PLM2015-00239
Don Sylvester
Violation Summary:
Inspector Contractor