Permit (149) CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit#: PLM2016-00573
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/30/2016
T I t'Ai Dg Parcel: 2S112DC00500
Jurisdiction: Tigard
Site address: 15889 SW 72ND AVE
Project: Spec Space Subdivision: FANNO CREEK ACRE TRACTS Lot: 40
Project Description: Add(1)new lay&(1)new water closet.
Contractor: MIKE PATTERSON PLUMBING Owner: PACIFIC REALTY ASSOCIATES LP
15028 S MITCHELL LN ATTN: N PIVEN
OREGON CITY, OR 97045 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-632-7374 PHONE:
FAX: 503-632-5647
FEES
Quantity Description Date Amount
1 ea Lavatories 11/28/2016 $25.02
Specifics: 1 ea Water Closet 11/28/2016 $25.02
1 12%State Surcharge- 11/28/2016 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 11/28/2016 $22.46
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: Ar Permittee SiAso
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit App i i,o� :.1 , v-i
Building Fixtures ;.:. . � . .
City of Tigard NO 438
Received
ah ■ 13125 SW Hall Blvd.,Tigard, �72�3 �� Date/By: fy all, /t0 Permit No.: ���665 73
Plan Review �/b'! /'/
Phone: 503.718.2439 Fax 503.598 1960 Date/By: Other Permit No.
Inspection Line: 503 639 1 , i 1?-,.;.A 1
7 1 C,A R D h Date Ready/By: June 0 See Page 2 for
Internet www tigard or Y , r s {, 4 a, Notified/Method Supplemental Information
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❑New construction El Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) p
CA`s+ ORY G 8TRUTCTIOIi SFR(1)bath 312.70 t
ID1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 4t.
IDAccessory building 0 Multi-family SFR(3)bath 500.32
Q
Each additional bath/kitchen 25.02
❑Master builder 0 Other: oil"
Fire sprinkler( sq.ft.) Page 2
JOB SITE�'OI4$AfQi A**l4' ATli t i Site utilities:
Job site address: SW 72ND AVE SUITE 1( Catch basin or area drain 18.76 V
Drywell,leach line,or trench drain 18.76 '-c
City/State/ZIP:PORTLAND,OR 97224 i *-
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:40.1494.1...0..iffietyManufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
.' a-.4240-111A.=1 +, ,,_,�� 2 �j,�,�,J Rain drain connector 18.76
tat Of-611/LL
on. !� (5252-e44.0
52 _._. . I ts/ Sanitary sewer(no.linear ft.: ) Page 2
�/ Q�l /J/AGO Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: !!tt I Lot no.: Fixture or item:
Tax map/parcel no.: 9--' I l 3 0645a) Backflow preventer 31.27
.O� Backwater valve 12.51
..._, Clothes washer 25.02
ROUGH IN AND INSTALLI'OILETS,TAVS, Dishwasher 25.02
BOOM SINiz ! 6NE. 014-1f-
Drinking fountain 25.02
Ejectors/sump 25.02
1 OPERT OwN utoi µ Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
>1 PPUIGA1`I „ r ❑ TA PE S Interceptor/grease trap 25.02
Business name:MIKE PATTERSON PLUMBING INCL Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:MIKE MANLEY
Roof drain(commercial) 12.51
Address:PO BOX 850 Sink/basin/lavatory 4 I 25.02 95766,
City/State/ZIP:GLADSTONE,OR 97027 Solar units(potable water) 62.54
Phone:(503)655-4306 Fax: :(503)655-4349 Tub/shower/shower pan 12.51
E-mail:knelson@mikepattersonplumbing.com Urinal 25.02
Water closet ij►1 25.02 6r6'ozr
3P+)I' +CTO1
T. . Water heater 37.52
Business name:MIKE PATTERSON PLUMBING INC
Waterpip i m WV 56.29
Address:PO BOX 850 Other: 25.02
City/State/ZIP:GLADSTONE,OR 97027 Subtotal 125.10
Phone:(503)655-4306 Fax:(503)655-4349 Minimum permit fee: $72.50 '79, •s0
CCB Lic.:81746 Plumbing Lic.no.:3-359PB
Plan review (25%of permit fee)
:, I _ State surcharge(12%of permit fee) ��d 5"01
Authorized signature: '/(LIV4-/li7f� ,...6
TOTAL PERMIT FEE .2°1,4111.1-1-•
Print
410.1 -
Print name:KATIE NELSON Date:11.16.16 This permit application expires if a permit is not obtained w&nin 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) :6�I ! 13/
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
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
Yahiat rn ' fru l Fee:.
Storm&Rain Drain-1st 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
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$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
t t ntity by Fi tur Plan it PII t � lel
Fixture Type for - Iteplacet
orPerftiried pd Adrrect kit$ Plan review is required for any of the following.
Baptistry/Font Please cheek all that apply.
Bath -Tub/Shower 0 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 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 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.
-3"
Car Wash Drainlr` 1Il`. t � #
Garbage Domestio-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
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under thisermit results in an
Washer-Clothes p
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet t fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\katie\Downloads\PLMF_PermitApp.doc 2