Permit (228) CITY OF TIGARD PLUMBING PERMIT
114 COMMUNITY DEVELOPMENT Permit#: PLM2016-00622
RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/22/2016
T[G
`` g Parcel: 2 S 112 DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 130
Project: PacTrust Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Interior plumbing for TI:Adding(1)sink and(1)water closet for new restroom.
Contractor: COLUMBIA MECHANICAL INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 2164 ATTN: N PIVEN
WOODLAND,WA 98674 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 360-225-1600 PHONE:
FAX: 360-225-8755
FEES
Quantity Description Date Amount
1 ea Sink 12/22/2016 $25.02
Specifics: 1 ea Water Closet 12/22/2016 $25.02
22 ea Minimum Fee Adjustment- 12/22/2016 $22.46
Type of Use: COM Plumbing
Class of Work: ALT 1 12%State Surcharge- 12/22/2016 $8.70
Type of Const: Plumbing
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 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 1. .2344.
Issued By: 9 ittee Signature:
r_ Csf
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 Application . f i . ,
/I
Building Fixtures �\iFOI( OFF 1c H: 1 SE o'i.'
City of Tigardd 0C Received
CC Date/By: Permit No.: n ��/ ^
lig U 13125 SW Hall Blvd.,Tigard,OR 9723 �o1v / L �6�� �
Phone: 503.718.2439 Fax: 503.598.1960 �( . K�^Plan Review
f` j Other Permit No.:/.{ 7w c, a{�
Inspection Line: 503.639.4175 By' Page Otcl tf(t� Jy�✓
1 1(;A R D i ��� Ready/By: Juris: ® See 2 for
Internet: www.tigard-or.gov �� ,r ���® Notified/Method. Supplemental Information
TYPE OF WORK � tO�, FEE*'SCHEDULE
❑New construction ❑De pion For special information use checklist.
Description Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
\ CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-and 2-family dwelling laCommercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
O Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION `:_. Site utilities:
Job site address: Catch basin or area drain 18.76
5 5~ s l `1�� I ��'� Drywell,leach line,or trench drain 18.76
City/State/ZIP: f c .-t L,‘,...X9 C)Q G[', .Z 2`(
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: (3:9 Project name: "� 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
/AO 0J .c.l 6, 7 /2 t_1 "en o '72, J U,i a t,,ii Dishwasher 25.02
�/ Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY,OWNER I 0 TENANT yY 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
Interceptor/grease 25.02
CI' API'11:7CANT �] CONTACT PERSONtrap
Business name:
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory i 25.02 ,01.
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail:C,(Y\T 0- Urinal 25.02
Cr® V ._ .< �. - ,a'of 1Sset 1 25.02 ,2_5-,(4)„.
1 Water heater 37.52
Business name:C O 1 v(vi Lo A m "e_c2, tcwoa.__ T r`)( t Water piping/DWV 56.29
Address: p, o . �a C a_l & k--` Other: 25.02
City/State/ZIP: Irf 00C,fD (_,A,--"T) V-) /\ CZ s� 7 L Subtotal
Phone: 4t7) Sl f -7 Z,�ef Fax:36 Z Z-- g-7 s5Minimum permit fee: $72.50 �� �
CCB Lic.: 1 S^ Z Plumbing Lie,no.: 3") l(s!�1i�
Plan review (25%of permit fee)
State surcharge(12%of permit fee) � 'Zv
Authorized signature: 7 z- ...?„.... 4 .- TOTAL PERMIT FEE/
Print name: viEes E s i L 1.i icA. Date:1 Z�'1-( ...i This permit application expires if a permit is not obtained 'whin 180 days
1 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(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) TotalSquare Footage: Permit Fee:
Footing drain-ls`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
Qty: 'Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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 PIu bang`Insta18tions
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
0 Any new commercial building with water service 2"and
Baptistry/Font -Tub/Shower greater,except systems designed and stamped by licensed
Bath:
engineer.
Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 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 R44ier Diagram
a„
0 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 1 plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15115 SW SEQUOIA PKWY 130, TIGARD, OR,
97224
Record Type: Record ID:
Commercial - Plumbing PLM2016-00622
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor