Permit (34) CITY OF TIGARD PLUMBING PERMIT
111 . . COMMUNITY DEVELOPMENT Permit#: PLM2018-00267
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/06/2018
TIGARD 9 Parcel: 1S126DC03300
Jurisdiction: Tigard
Site address: 9900 SW GREENBURG RD 240
Project: Advantage Dental Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: Interior plumbing:Relocating(1)water heater.
Contractor: DJS PLUMBING Owner: ATHERTON REALTY PARTNERSHIP
178 ARNOLD ST 2100 S WOLF
MYRTLE CREEK, OR 97457 DES PLAINES, IL 60018
PHONE: 541-863-5040 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 06/06/2018 $37.52
Specifics: 1 12%State Surcharge- 06/06/2018 $8.70
Plumbing
Type of Use: COM 35 ea Minimum Fee Adjustment- 06/06/2018 $34.98
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 ma obt-'n a copy of the rules
or direct questions to OUNC by calling 503.232.198>or 1.800. ' ..2344. /
Issued B r
Y� / 'e ee Signature:
/I►
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
Building Fixtures OFFICE USE ONLY
City of Tigard Received 4, �/er j411 g ��� Date/By: Permit No.:r �l�j
13125 SW Hall Blvd.,Tigard,OR 9722 lD
_ Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639.4175 r. T ate/Ry:
T l G A R D y�q Ready/By: Jwis: See Page 2 Tor
Internet: www.tigard-or.gov -,,ct �v i°t $tiled/method: Supplemental Information
'TYPE'OF WORK �(1.11." FW �i ' FEE* SCHEDULE
❑N onstruction 0 Demolition For special information use checklist.
Description Qty. Ea. Total
Addition/alteration/replacement 0Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
1 i TEGOR3( OF CONSTRUC i' ' " SFR(1)bath 312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION A.4.--3.., Site utilities:
Job site address: 0 q OD5 i 6-r.e.en Ori kl$ .4�l t�
Catch basin or area drain 18.76
l Drywell,leach line,or trench drain 18.76
City/State/ZIP: .. . C 4,) (1 q 7 1 d3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: tib(i"e,f Project name: /0 V'h t'fk, I).t14 Manufactured home utilities 50.03
Cross street/directions to job site: / Manholes 18.76
(t, CC`i- / 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.: Backflow preventer 31.27
'a t PTtON OF V4? {.
Backwater valve 12.51
'12',4-' ` `° Clothes washer 25.02
.J7 i G' C4,''.e C,r.',;--/-e/-/ t, -c��7�h Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
i
❑',PROPERTY OWNER Oft TENANT -'; Expansion tank 12.51
Name: f j 6, i( (ti fly e A 4 Fixture/sewer cap 25.02
66 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
r EriPPLICANT : FACT PERSON Interceptor/grease trap 25.02
Business name: n7 Medical gas(value:$ ) Page 2
(� t G' f�! Primer 12.51
Contact name: ,/J( � C � Roof drain(commercial) 12.51
Address: j -7 f I(/' -1 cit S.f Sink/basin/lavatory 25.02
City/State/ZIP: /41 x, r 7/(-C Cc-9-e i C//' Solar units(potable water) 62.54
Phone:(31-11) 7 L{ 7 4' / Cl Fax::( ) Tub/shower/shower pan 12.51
E-mail: de, rl G' ,., ,( ( 0 h,,,/-, q (i*c cr ,T/` Urinal
x x 4 Water closet 25.02
, � .la .. '� .: �, 3 �-
_ / Water heater j 37.52 �l S
Business name: J I /L . . Water piping/DWV 56.29
Address: / 7 f /1i o(!a'/J 5- Other: 25.02
City/State/ZIP: mil ?//-(/v (' -e--e(t Or- 9 7 (/ 5 7 Subtotal -3.7 S�
Minimum permit fee: $72.50
Phone:(6-�f) 7 (i_ 7 5 /0 Fax:( ) 7,j. �
�(/ y �.f� Plan review (25%of permit fee)
CCB Lic.: n u : / ( U Plumbing Lic.no.: / 6 /c.23 State surcharge(12%of permit fee)
Authorized signature: V lb.47 TOTAL PERMIT FEE' 71,
Print name: ` / [/ This permit application expires if a permit is not obtained within 180 days
�V G,- Date: (1 t -/� 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)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
b att
titles _ ' (Square Foliage: Pet' ut.Fee:
Footing drain-161100' 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 . 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
each additional$100.00 or fraction thereof,to
OtherIns ectons
P or Fees tea) � : 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
fixtures could result in increased sewer fees*. � - �� n :�+�ar ' �mbing �x�.,�
Quantity' y Fixture ype ;. Plan review is required for any of the following.
Fixture Type for Please check all that apply.
Capped Added Rel' to.
1'Vo�k Per�4rmedc x- ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ 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"
-3" sometr c or 6 ain fsR
4„ ❑ 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: CA) c (r h e4
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:
9900 SW GREENBURG RD 240, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00267
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor