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Permit CITY OF TIGARD PLUMBING PERMIT 1111 I ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00299 T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/14/2015 Parcel: 1S133AD16200 Jurisdiction: Tigard Site address: 12700 SW NORTH DAKOTA ST 180 Project: Straight Up Chiropratic Subdivision: 1995-073 PARTITION PLAT Lot: 3 Project Description: Install(1)new clothes washer,cap(1)sink. Contractor: EAST WEST PLUMBING INC Owner: PACIFIC CREST PARTNERS SCHOLLS L 10610 SE 145TH AVE 7000 SW HAMPTON ST, STE 130 HAPPY VALLEY, OR 97086 TIGARD, OR 97223 PHONE: 503-777-1594 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Clothes Washer 09/14/2015 $25.02 Specifics: 1 ea Fixture/Sewer Cap 09/14/2015 $25.02 22 Minimum Fee Adjustment- 09/14/2015 $22.46 Type of Use: COM Plumbing Class of Work: ALT g 12%State Surcharge- 09/14/2015 $8.70 Plumbing Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within t0 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t• follow the rules .dopted b e Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0e•0 You may •• .in a co*, of the rules or direct que '•• to OUNC b calling 503.232.1987 or 1.800.332.2344. Issued : • , ' Permittee Signature: 4. /)�'1 . Call 503.639.4175 by 7:00 a.m.for the next available inspe,'•n date. This permit card shall be kept in a conspicuous place on the job site unti completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures RECEIVEP P FOR OFFICE USE ONLY City of Tigard Received / Permit No.: Date/By: 9 /e/ /� r`.).40 r 64/0;2.4,/,,--..e.....26,;;;;1/49 9 13125 S50 Hall Blvd.,Tigard,59722 G Plan Review Other Permit No.:�W p/.;vital/U Phone: 503.718.2439 Fax: �$.16At Z •1 Inspection Line: 503.639.4175 Date/By: T I G A R D Date Ready/By: Anis: la See Page 2 for Internet: www.tigard-or.gov t. ) Notified/Method: Su lemenalInformation ❑New construction Demolition For special information use checklist Description I Qty. 1 Ea. 1 Total Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) J -' CGOR O CONSTRUCTIOII ll SFR(1)bath 312.70 ❑ 1-and 2-family dwelling LCommercial/iindustrial SFR(2)bath 437.78 �l\ SFR(3)bath 500.32 51❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATIO Site utilities: Job site address: 2„7Q d /v A ital., 5-- Catch basin or area drain 18.76 - ' y Cv Drywell,leach line,or trench drain 18.76 City/State/ZIP: Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: f Q I Project name: e4/4w,4,P�jh1/Q nTe.-, 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 r Subdivision: �" I Lot no.: Fixture or item: / Tax map/parcel no.: 5 / 5.3/3D f/0C)e Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 GO/fr,,/ ,J Clothes washer t 25.02 015 O2- kI 6f,4Ll,.(/) A)e w CLC7rn5 L COTE Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture/sewer cap ( 25.02 Name: Floor drain/floor siridhub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet 25.02 Water heater 37.52 Business name: pa S- (.4/4 4.- (A wt L M.% Water piping/DW V 56.29 Address: 166 i i i J /V.1-44---- / ,C Other: 25.02 City/State/ZIP: -- (4.117 O._- y 70e45 Subtotal Phone:(4 7l _5-40" .:. pG.. ll Fax:( ) Minimum permit fee: $72.50 7e.• CCB Lic.: �i U�5-r ( Plumbing Lic.no.:aZ s3) go Plan review (25%of permit fee) -r'C State surcharge(12%of permit fee) V-76' Authorized signature: 1/ „"'�����i°°° - 4....e._ /l ` TOTAL PERMIT FEE 8'/.o2 Print name: Date:e`yam�5 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. s 7 1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/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-1st 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 v„ : ,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 t er nspect><ons or ees Qh'• 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*. j 1 bi ial tallat b `. 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 ❑ Any new commercial building with water service 2"and i}„m greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car 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 El Any multipurpose tire 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: -Lav/Bar 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 plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2