Permit (139) CITY OF TIGARD PLUMBING PERMIT
' Permit#: PLM2017-00053
a COMMUNITY DEVELOPMENT
Blvd.,
13125 SW Hall Tigard OR 97223 503.718.2439 Date Issued: 02/27/2017
T f[;;k It.L_7g Parcel: 2S101AA00100
Jurisdiction: Tigard
Site address: 12300 SW 68TH AVE
Project: Landmark Ford Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Replacing/Relocating:(1)2"floor sink,(1)break room sink,(5)toilets,(1)urinal,(1)sump pump&(1)drinking
fountain.
Contractor: BEAVERTON PLUMBING INC Owner: CORLISS,JAMES L&CORA K
13980 SW TV HWY PO BOX 23970
BEAVERTON, OR 97005 TIGARD, OR 97281
PHONE: 503-643-7619 PHONE:
FAX: 503-643-7620
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 02/27/2017 $25.02
Specifics: 1 ea Ejectors/Sump 02/27/2017 $25.02
1 ea Floor Drain/Floor Sink/Hub 02/27/2017 $25.02
Type of Use: COM 1 ea Sink 02/27/2017 $25.02
Class of Work: ALT 1 ea Urinal 02/27/2017 $25.02
Type of Const: 5 ea Water Closet 02/27/2017 $125.10
Occupancy Grp: 1 12%State Surcharge- 02/27/2017 $30.02
Stories: Plumbing
Total $280.22
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 Notifica'nn renter. 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 estions to 0 C by calling 503.232.1987 or 1.800.332.2344.
Issue By: f\ Permittee Signat .
-,L12-11A---4-k7
Call 503.639.4175 by 7:00 a.m.for the next available ins• ction 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.
Fro :Beaverton Plumbing
5036437620 02/17/2017 13:56 #296 P.001/002
Plumbing Permit APPlictirc
Building Fixtures •- FOR OFFICE USE ONLY
Received �1 Permit Vo 1 .J o!7 KJt%
City of Tigard `2 1 7 0y 1 r Date/13y. A /7 �(
u 13125 SW halt •Blvd.,Ti�ard,OR 5-3
Plan Review
Other Permit N•,1 + 'i. ' •4� i•
Phone 503.718.2439 Fax. 503.598.19e6�0 .,
Date/By:
Inspection Line: 503.639 4175 O I I A f! Date Ready/By: �r�/� (Zs/49terns H See Page 2 for
TIGARD t/O ! Supplemental Information
Internet: www.ngard-or �(�t,� DIVISION
Notltied.'Metltod
TYPE d,A 1 i � ' .�,.�1� q.s /
FEE* SCHEDULE
{ A%pif . For special information use checklist
❑New construction 0Demolition t f;a. Total
Description Q Y _ �SFR(1)bath 312.70 �
®Additio»/alteration/replacement 0
Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION �
SFR(2)bath 437.78
❑ 1-and 2-family dwelling ®Commercial/industrial - 500.32
SFR(3)bath M
CN
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler(_____sq.ft.) ( Page 2
fik* JOB SITE INFORMATION AND LOCATION Site utilities: -----OQ
µ Catch basin or area drain 18.76 C/}
Job site addressi9 /A340 0 tog Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD,OREGON 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:LANDMARK FORD 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 II.. ) f Page 2
Subdivision: Lot no.: Fixture or item:
Backflow preventer 31 27
Tax map/parcel no.: 026/41 e,o/eo 12.51
Backwater valve
DESCRIPTION OF WORK Clothes washer 25 02
INSTALL TOILETS,URINAL,FLOOR SINK,BR SINK,SUMP PUMP Dishwasher 25.02 _
RESET DRINKING FOUNTAIN
Drinking fountain 1 25.02 ,,,26:4'97
Ejectors/sump I 25.02 .09'
0 PROPERTY OWNER 1 0 Expansion tank - 12.51
TENANT
Fixture/sewer cap 25.02
Name: - 25.02 0�'
Floor drain/floor sink/hub 1 as
Address: Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
51 12.
Phone:( ) Fax:( ) ice maker 0 APPLICANT DD CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value $ ) Page 2
Business name:BEAVERTON PLUMBING Primer 12.51
Contact name:JACKIE STEWART Roof drain(commercial) 12.51
s p7"
Address:13980 SW TUALATIN VALLEY HWY' Sink/basin/lavatory 1 ,T, 25.02. �-
City/State/ZIP:BEAVERTON,OREGON 97005 Solar units(potable water) 62.54
Fax::(503) Tub/shower/shower pan 12.51 643-7620
Phone:(503)643-7616 X106 -
Urinal 1 25.02 ,,,,15r4'9"
E-mail:jackie@beavertonplumbing.com Water closet 5 25.02 /d' {D
CONTRACTOR Water heater 37.52
Business name:BEAVERTON PLUMBING Water piping/DWV 56.29
I
Address:13980 SW TUALATIN VALLEY HWY Other: 25.02
r
•
City/State/ZIP:BEAVERTON,OREGON 97005 Subtotal OAU
Minimum permit fee: $72.50
Phone:(503)643-7619 X106 i Fax:(503-)643-7620
Plan review (25%of permit fee) -----
CCB Lie.:12889 Plumbing Lic.no.:34-4PB
State surcharge(12%of permit fee) or 30.0A-.
-
. Y A / TOTAL PERMIT FEE ago.AP-
Authorized signature/�-.� c �/L�` --_ /�'.<._� ��'-:���)"'..
�, -�,- r; This permit application expires if a permit is not obtained within 180 days
I Print name:\,ea C/y i f(f/7.e .,,_5.--/,/2(�)('rr IA Date:,:,?_1l f� 7 /n after ii has been accepted as complete.
f *Fee methodology set by Tri-County Building industry Service Board
I'siiwIdingRerinits'.PLMU-Per tApp.doc 10/01109 440-46161(I 0102/CO0tWES)
'Iunnbin----g------22---2b
Permit pnlicatjon - Ci of Tigard
x.,,/
Page 2 Supplementaa Information
pc,i_t_fa...4-Lits-naz,,e)/7
0�o s3
Fee Schedule: Residential Fire She u pression Systems:
Site �]tliitess city. ` Foe(ea) Tell __-
SQ1k ere I cGh3t`i''*G, Permit Fee:
Footing chain-1"100' -- - $
50.03 0 to 2,00 .T-- 90 - _.-
131_196
Footing drain-each additional 100' 37.52 2(1C!lo 3.(ifl0 S169.69
��"
Sewer-1st 100' 62.M 3,r i1 a 7,7f�'1 $233.20 j
Sewer-each additional 100' 7;U I and g � $327,54 __i
37.52
Water Service-lit 100' 62.54
Water service-each additional 100' Medical Gateias:
37.52 -_-1
Storm&Rain Drain-ht 100' 62.54 �'0l117at7l41]: Permit Fee:
Stam err Rain Drain•cert!'additional 100' 37.52 51.00 to 53,000.00 Minimum fee S72.50
55,001.00 to 510,000.00 $72.50 for the fist$5,000.00 and 51.52 for
other Inepectiors or Fees • Fr'".(ns) Toes) each.aaltiacal$100.00 or fraction thca+f,to
Inspection of existing plumbing or and including$10,000.00.
Much no fee a specifically indica' for 90.00/hr
$10,001.00 to$25,000.00 $145.50 for the fust$10,000.00 and$1.54 for
( charge-l/Z hour) aech additional$100.00 or fraction thereof,to
Inspections outside of normal beginner 90.00/hr and including 525,000.00.
hours(minimum charge-2 hours) ^$25.001.00 to$50.000.00 $379.50 for the fast$25,000.00 and$1.45 for
Reinspection Pecs 90AOAu each additional$100.00 or Emotion thereat;to
Additional plan review for revisions andincluding$50,000.00.
90.00/hr 550,001.00 and up $742.00 for the Pint 350,000.00 and$1.20 for
(miaimom charge-1 i2 hour)
each addition]$100.00 a 6actian 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 Plumhh g j istnllatlons�
1 Qum,b5>tirr 1yy,e , Plan review is required for any of the following.
Fhhaure Type for
I A4 ed : eta ` Please check all that apply.
Work Performed
Baptistry/Font
❑ My new commercial building with water service 2"and
-Mb/Shower
greater,except ayateans designed and stamped by licensed
Batt Jewai/Whirlpool engineer.
Car Wash: .Bach Stall
O New exterior plumbing site utilities for any complex structure
-Olive ihru as defined in OAR9t8-7800040.
Cuspidor/Water Aspirator
O Medical gas and vacuum systems for health care facilities.
Dishwasher -Commercial
O Any multipurpose fire sprinkler System-
Dishwasher:
❑ Any complex structure as defined in OAR9 I 8-780-0040.
Thinking Founula i
' Bio Wash Submit a sets of plans with any of the above.
Floor Draia/s -2"
1 _
-4''
_ _ . Isometric or Riser
Car warn Dalin
Isometric or riser diagram is required for now buildings
Garbage -Domestic non-food that meet the . .. i e cations above.
Disposal: -Domestic food related
-Compal food rotated
-Industrial food related
lee Mach./R g.Drains Comments r• ! • r ti g fixture work:
Oil sopa ntnr(Gas Station)
Rec.vehicle Dump Station J / .
Shower -Gang __ `a/, ,
-Stall ‘fLO L 1/�_a te- .�
Sink: -LwvBer non-food related
-Bradley �_
-Com/Snv/titul food related e _
_Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
WasherCiotea increase of sewer EDLJs,a sewer permit will be issued and
Waw Exhaetb fees assessed for the sewer increase must be paid before the
Winer Closet-Toilet ' .j plumbing permit can be Issued.
Urinal
Other Fixtures:Ac.or4/0 41.14P
I:trrildinee'rmits1PLMF Pi.mdtApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12300 SW 68TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00053
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor