Permit (145) CITY OF TIGARD PLUMBING PERMIT
11 COMMUNITY DEVELOPMENT Permit#: PLM2018 00301
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/21/2018
TLC,Aiai 9 Parcel: 2S103DD01100
Jurisdiction: Tigard
Site address: 13939 SW PACIFIC HWY
Project: Providence Retail Clinic Subdivision: None Lot: None
Project Description: Extending sewer line in building 5'for new clinic space.
Contractor: CASCADE PLUMBING CO Owner: WALGREEN CO#5780
15765 SW 74TH AVE PO BOX 901
TIGARD, OR 97224 DEERFIELD, IL 60015
PHONE: 503-289-7095 PHONE:
FAX:
FEES
Quantity Description Date Amount
5 If Sanitary Sewer 06/21/2018 $62.54
Specifics: 1 12%State Surcharge- 06/21/2018 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 06/21/2018 $9.96
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 questions to O,UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � ,r __ Permittee Signature: 04 /ce.."Cel-77U"V
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 -► 1012 Ohlal'L CSL ONLY
o� qu Received
City of Tigard o l Q``' Date/By: /2e f� Permit N /1,a204 -0030`
ii 13125 SW Hall Blvd.,Tigard,OR 97223 A. t ttevie�w/ /
_ Phone: 503.718.2439 Fax: 503.598.1960 \`�N t'� Other Perni f /y'�Q/,S!/
1 1 c n to tt Inspection Line: 503.639.4175 ... . -.ReadyiBy: urb: see Pale 2 for /!
Internet: www.tigard-or.gov 0. � ' otified/Method �'�+ �� -1► Supplemental tnformation
ding 44 '''','"'l 9p;'''''''''l` 6, s ( 1 ='''"U, Y,'
;„Iliiw i'OF WORK i Vi.,a,` ef"f ,ft4K, +E ����iV��l���9 Ji��„� 41'.
❑New construction ❑Demolition For special information use checklist:
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
��� i � .- x N y i Oy d l i a i °r l'�
,, ;�n ��i ' + ATEGQR CO4iTit�' +i SFR(I)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
rI„ ithigift 11tTFO. "T')t,ON Mi!)LOCATION Site utilities:
Job site address:13939 SW Pacific Hwy Catch basin or area drain 18.76
City/State/ZIP:Tigard Or 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I 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.:5) I 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
DESIPTION OF WO Backwater valve 12.51
Clothes washer 25.02
Extending sewer line in building 5 feet into future clinic space
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,",,EI P49-11ERTX OWNER 1:3 TENANT 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
it: APPLICANT 0 CONTACT PERSON Interceptorigrease trap 25.02
Medical gas(value:S ) Page 2
Business name:Quality West Plumbing DBA Cascade Plumbing
' Primer 12.51
Contact name:Bekka Greer
Roof drain(commercial) 12.51
Address: 15765 SW 74'Ave Sinkibasin/lavatory 25.02
City/State/ZIP:Tigard Or 97224 Solar units(potable water) 62.54
Phone:(503)289 7095 Fax::( ) Tub/shower/shower pan 12.51
E-mail:Cascadeplum@yahoo.com Urinal 25.02
' Water closet 25.02
CONTRACTOR .
Water heater 37.52
Business name: Cascade Plumbing Water piping/DWV 56.29
Address: 15765 SW 74th Ave Other: 25.02
City/State/ZIP:Tigard Or 97224 Subtotal
Minimum permit fee: 572.50 7c2..-Ci...(503)289 7095 Fax: 7c2..-Ci...
Plan review (25%of permit fee)
CCB Lie.:204392 Plumbing Lic.no.: PB1528 -T771/
��
y
/ State surcharge(12%of permit fee) . /L'
Authorized signature: f / i TOTAL PERMIT FEE f/r, �e)
Print name:Bekka Greer Date:6/18/2018 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete. I�{/ye---
*Fee methodology set by Tri-County Building Industry Service Board.""
I-IOuilding remits PLMU-PermilApp.doc 10'01'04 440-4616T(10 02t oxt Wits)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
'sue Utilities 1 , Qty. Fee{q) Tgtal square Footage: Permit Fee: _.""
Footing drain-I"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 S stes•
Water Service-each additional 100' 37.52 1 I `'
t 1)lbi m E t I`ee: ;iiiili! hl G '919:
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
�brruvkpeefeWT.AtM ' each additional$100.00 or fraction thereof,to
Other.G1SP t SiOr: cps 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*.
' Quantity by Fixture Type Plan Review-for->Piumbing,Installations ,
Vlxture Type for Replace/ Plan review is required for any of the following.
Work performed: Capped Added Relocate Please check all that apply.
Baptistry/Font pP y'
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacura..i/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ 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,.
Isometric or Riser Diagram
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-tool related
-Industrial-food related
Ice MachiRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/lav -Non-food related
-Bradley
-Commercial-fixxl related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\Cascade Main\Downloads\PI,MF_PermitApp(I 1).doc 2