Permit (31) CITY OF TIGARD PLUMBING PERMIT
;F1 • COMMUNITY DEVELOPMENT Permit#: PLM2016-00023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/09/2016
Parcel: 1 S134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 200
Project: I Love Kick Boxing Subdivision: (KOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: Interior Plumbing:Adding(1)2"floor drain and(1)sink;Relocating(2)sinks and(2)water closets;Installing(1)
primer and(1)water heater.
Contractor: MODERN PLUMBING Owner: ROBINSON, CONSTANCE A
11120 SW INDUSTRIAL WAY BY KILLIAN PACIFIC LLC
TUALATIN, OR 97062 500 EAST BROADWAY, STE 110
VANCOUVER,WA 98660
PHONE: 503-691-6166 PHONE:
FAX: 503-691-6771
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 02/09/2016 $25.02
Specifics: 1 ea Primer 02/09/2016 $12.51
3 ea Sink 02/09/2016 $75.06
Type of Use: COM 2 ea Water Closet 02/09/2016 $50.04
Class of Work: ALT 1 ea Water Heater 02/09/2016 $37.52
Type of Const: 1 12%State Surcharge- 02/09/2016 $24.02
Occupancy Grp: Plumbing
Stories:
Total $224.17
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 'cation Cen , Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir ct questions to OUN ey calling 503.232.1987 or 1.800.332.2344.
Is ued By: /l // Permittee Signatur <-)tire_
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.
JAN-22-2016 10:27 From: To:5035981960 Page:1/2
Plumbing Permit AppltittEIVED ts/3 410900
Building Fixtures FOR OFFICE USE ONLY
City of Tigard JAN 2 Received ---
„..- 13125 SW Hall Blvd.,Tigard,OR 972n 5 2 016 I Dateirly: 01,5 i to /377--- Permit No.:101/1x 10 X);23
: - Phone: 503.718.2439 FaCRA490$01 IGARDPlan Review
Dare/Ry: Othcr Permit No.:5(.4)4blCal)4
inspection Line: g.4
5u3•63v4;.ri"ILDING DIVISION Itc.„ tpsiese mPagetaIforo anon
1 1(..jAHI) Date ReadyMy;
Internet: www.tigard-or. Nolined/Methoil:
' .
TYPE OF WORE , • .1;x:E•'.'stifitnyty
, . .
1:1 Ncw construction 0 Demolition For special information use checIdist.
Description I Qty. I Ea. I Total
El Addition/altcrationitcplaccmcnt 0 Other New 1-2-family dwellings(includes 100 II.for each utility connection)
•
• ' H .Cik,rktc..;oRy OF'cims-x•Rue.ro* , , SFR(1)bath 312.70
0 1-and 2-family dwelling El Commercial/industrial SFR(2)bath
- .... 437.78
SFR(3)bath 500.32
o Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
•,163 gri INFORMATION AM) LOCATION'" . ' , Site utilitie
. s:
Catch basin or area drain 18.76
Joh site address:10115 SW Nimbus Ave.
Drywc11,leach line,or trench drain 18.76
City/State/7.1 P:97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt,no.:104,25r) 1 Project name:1 Love Kick Boxing Manufactured home utilities 50.03
Crass street/directions to job site: Manholes 111.76
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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Hackflow prcvcntcr 31.27
• •
. DIiSCRIFL1ON:OF WORK , . •,.. ' ' . Backwater valve
-- . 12.51
..
.' ' __ Clothes washer 25.02
Tenant Improvement
.. Dishwasher 25.02
._... .
___. Drinking fountain 25.02
Ejectors/sump - 25.02
ID PROPERTY OWNER ' , • D'tENANT Expansion tank 1151
Fixture/sewer cap 25.02
Name:
- • Floor drain/floor sink/huh 1 25,02 25.02
Address:
Garbage disposal 25.02
Ci ty/Sta tc/Z I P: Hose bib -. 25,02
-----
Phone:( ) Fax:( ) Ice maker 12.51
. . . .. .
, . El.A1111citlw1. . t , •0 CONTACT FERSON. Interceptor/grease trap 25.02
S
Business name:Modern Plumbing Co. Medical gas(value. _____) Page 2
. --- Primer 1 12.51 12.51
Contact name:Deborah George
_. Roof drain(commercial) ,-
12.51
...
Address:11120 SW Industrial Way,Bldg.93 -- Sinkihminflavatory go" 3 25.02 75.06
City/State/ZIP:Tualatin,OR 97062 Solar units(potable water) 62_54
Phone:(503)691-6166 Fax;;(503)691-6771 Tubis.hower/showcr pan 12.51
_
E-mail:inin@modernplurnbing.us . Urinal
_.. 25.02
. . . Water closet '' 2 25.02 50.04
CONTRACTOR . • •
•
• • •" Water heater 1 37.52 3752
Business name:Modern Plumbing Co. Water piping/DWV 56.29
Address:11120 SW industrial Way,Bldg.9-3 Other: 25.112
City/Statc/Z1P:Tualatin,OR 97062 _ Subtotal 200.15
Phone:(503)691-6166 Fax:(503)691-6771 ......._ Minimum permit fee: $7250
Plan review (25%of permit fee)
CCB Lic.:87906 Plumbing Lie.no.:34-250PB
Authorized signature: ..._...........__ State surcharge(12%of permit fee) 24.112
TOTAL PERMIT FEE
224.17
Print name:Deborah George Date:
This permit application expires if a permit is not obtained within 180 days//ea/if° ,
after it has been accepted as compkte.
9,ee nieleiviotegy set by Tri-County Building Industry Service Board.
1:1BuiWinkt1Perfain\PINIJ PennitAtip.dor latelina 440-4616 I(MOM 1)1WW/-Ft)
JAN-22-2016 10:27 From: To:5035981960 Pa'ae:2'2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities '. ,-:(#3,. Fee(ta) Total .Square Footage: - Permit Fee: .. .
Footing drain-1.100' 50.03 oto 2,000 $121.90
Footing drain-each additional 100' 37.52 2,IX)1 to 3,6(X) $569.69 .
3,601 to 7,200 $233.20
Sewer-tat 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: Pelt trait Fee: • .
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fcc$7250 _ _ __ _
Storm&.Rain Drain•each additional 100' 37.52 $5,(X11.00 to S10,(X0.(X) $7250 for the first$5,0(0.(X1 and$1.52 for
Other rnsp'ections or Fees .Qty. Fee(ca) Totiil ' each additional$100.00 or fraction thereof,to
and including$10,(NXL(N).
Inspection of existing plumbing or[or $10,00-1-.00-in$2.5,(10.(0 $14g...50 for the first$10,000.01 and$1.54 for
which no fee is specifically indicated 90.(X1/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) _ and including$25,(XX).00.
Inspections outside of normal business 90.00/hr $25,(X)1.00 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 550,000.00 and$1.20 for
(minimum charge 1/2 hour each additional$1011.00 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*.
Qusa• by Fixture Type Plan Review for Plumbing Installations
lore Type for Rep:NCe1 Plan review is required for anyof the following.
Performed: Capped Added Relocate 1
Baptistry/Font Please check all that apply.
Bath Tub/Shower 0 Any new commercial building with water service 2"and
Jacuva/ hirlpnnl greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru - 0 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 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structurc as defined in OAR918.780.0040.
Eye Wash
Floor Drain/sink -2" I Submit 2 sets of plans with any of the above.
-3„
4-. •
Isometric or Riser Diagram
Car Wash Drain
(iarhage -Domestic-non-food -- --"— 0 Isometric or riser diagram is required for new buildings
Disposal -Domestic food related that meet the qualifications above-
-Commercial-food related
-Industrial-food related
lcc Mach./Rcfrig.Thairts
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related 1 2
-Bradley
-Commercial-food related
-Service
Swimming Poul Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet•Toilet 2 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
(::\U.serslmary\Desktop\I'LMF_PermitApp(9)-doe 2