Permit (9) CITY OF TIGARD PLUMBING PERMIT
2: � COMMUNITY DEVELOPMENT
Permit#: PLM2017-00150
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/27/2017
T t gah Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 180
Project: SMC Corporation Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Add(1)break room sink
Contractor: DEAN WARREN PLUMBING&REMODELING INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-236-4152
PHONE: 503-624-6300
FAX: 503-296-2218
FEES
Quantity Description Date Amount
1 ea Sink 04/27/2017 $25.02
Specifics: 1 12%State Surcharge- 04/27/2017 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 04/27/2017 $47.48
Plumbing
Class of Work: ALT
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 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 question - • NC by calling 503.232.1987 or 1.800.332.2344. /1
�; C�.
Issued By / CJI Permittee Signature: �(
Call 503.639.4175 by 7:00 a.m.for the next available inspeQtron 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
Building Fixtures EIS J Received ,/
City of Tigard V' Date/By: 7 �/ /7 Permit No.: /4.4:90/ DO l S73
1 III u 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review !��j�/�
C Phone: 503.718.2439 Fax: 503.96 2017 Other Permit No.:6,..„),2,,,90
Date/By:
TIC,A R D Inspection Line: 503.639.4175 + p `,�g Date Ready/By: tuns: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGA D Notified/Method: Supplemental Information
TYPE FolulliwkIG DMSIQN FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description Qty. Ea. Total
.&ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 Z
- SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: J
Fire sprinkler( sq.ft.) Page 2 1
JOB SITE INFORMATION AND LOCATION <" Site utilities:
Job site address: / S�7 s w s' u ,, p4v ,,/, Catch basin or area drain 18.76 O
��,y Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1 aro c i.7 y y y 0
'7 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: , 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: ( Lot no.: Fixture or item:
Tax map/parcel no.: . 5// "D4 00 Backflow preventer 31.27
'tBackwater valve 12.51
D l , IN OF WORK
�qJ /` / 4 Clothes washer 25.02
/ c`a 1 S t'it/7 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ OPEIETy co***--4" ' ❑ TENANT Expansion tank 12.51
Name: .7)Li c'/A/5,,-- Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: / 5-?('v t w j 5",,. .. 6, h w2�' Garbage disposal 25.02
City/State/ZIP: 7 r•1.4 A G-71, cr 7 2,./ Hose bib 25.02
Phone:( 521) G ).-1.(...6 3a0 Fax:( ) Ice maker 12.51
0 APPLICANT 'a a .:1',! ,,,, 1.4 CONTACT PERSON Interceptor/grease trap 25.02
Business name: 0a V. p / Medical gas(value:$ ) Page 2
� �"., J / i c"s'"zreti
Primer 12.51
Contact name: S6,41„
Roof drain(commercial) 12.51
Address: /0 O A„ /X70( Sink/basin/lavatory / 25.02 2 f ,Z_
City/State/ZIP: 77�..i O'ft A. rr 7 2.. 3 Solar units(potable water) 62.54
Phone:(-3 ) ... v_ 9 y- c J Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
atm.., 07y41„ao cam„,
a er c oset
9.
25.02
.. r.r ...: Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( )
Minimum permit fee: $72.50 72 Jam'
CCB Lic.: 75-‘,/ 9l, /lam/if Plumbing Lic.no.: )G 7 3 6 dg Plan review (25%of pennit fee) .....--------
// �l State surcharge(12%of permit fee) g,70
//,
Authorized signature: y! Y_ TOTAL PERMIT FEE g`,�Q
This permit application expires if a permit is not obtained within 180 days
Print name: ,4 !t, ,, Date: y-2 7-1 "7
after it has been accepted as complete.
*Feesmethooldolloogy set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) �!///�X 7. 0O
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-151 100' 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
Other Inspeetions,or Fees Qty. Fee(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*. Plan Revjew for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Relt)atel Please check all that apply.
Work Performed: Capped Added Retoeate
Baptistry/Font
0 Any new commercial building with water service 2"and
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
- rive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 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"
isometric or Riser Diagram;' .r
4„
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 plumbing permit can be issued.
Urinal
Other Fixtures:
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Plumbin&Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems: •
Site Utilities. •... • A Ql• ' Fee( ) Total Squire Footage • 1 Permit'Fee: ,
Footing drain-1"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' 6234 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:,•' Permit 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
.'9')'• 7'Fee(en)` Total. each additional$100.00 or traction thereof,to
O.t1ze>c Ynspecdioi>ts or Fees: and including$10.000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $14850 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 90.00/1u' $25,001.00 to$50,000.00 $379.50 for the that$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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*. -
. Quantity by Fixture:lype . :' Plan Review:for Plumbing Installations
Fizlirre hype for' i
' Replaecl Plan review is required for any of the following.
Work Performedi ' '':' ,tapped Added,. Relocate
Please check all that apply-
Baptistry/Font
0 Any new commercial building with water service 2"and
Bath -Tub/Shower
- greater,except Systems designed and stamped by licensed
-Jacuzzi/Whirlpool
Car Wash -Each Stall engineer.
Drive,hhru 0 Ncw 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-(X)40.
Eye Wash
Floor Drain/sink 2 Submit 2 sets of plans with any of the above.
-3„
•4" , ,,,':,:Tsometric,or Riserrata..
Diag . -
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related __ that meet the qualifications above.
-Commercial-food related
•industrial-food related
ice Machikefrig.Drains
Oil Separator(Cris Station) Comments regarding fixture work:
Ree.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 this permit results in an
Washer•Clothesincrease of sewer EDUs,a sewer permit will be issued and
Water Extractoror
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: (SQ (Uw C ui4 (
http://www.tigard-or.gnv/dacument_center/Building/PLMF_ ermitApp.dr