Permit (195) CITY OF TIGARD PLUMBING PERMIT
'91COMMUNITY DEVELOPMENT Permit#: PLM2019 00202
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 05/13/2019
TIGARD9
Parcel: 2S 112 DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 150
Project: Financial Investments Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Relocate break room sink for TI.
Contractor: ALWAYS FAITHFUL PLUMBING LLC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 757 ATTN: N PIVEN
WILSONVILLE, OR 97070 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-780-9486 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 05/13/2019 $25.02
Specifics: 1 12%State Surcharge- 05/13/2019 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 05/13/2019 $47.48
Class of Work: ALT Plumbing
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 OUN by calling 503.232.1987 or 1.800.332.2344.
Issued By: \ , yLy Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspect on •ate.
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 R E C E I V E
Building Fixtures
City of Tigard MAY 13 2019 Received j �C .4 P No
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: - /3 /f /t-Jr�L�I/�/ ��1.,2�?
IC Phone: 503.718.2439 Fax: 503.598. ITY OF TIGARD Plan Review ^ /
.1114
Inspection Line: 503.639.4175 ILDING DIVISION Date/By:
Other Permit� ►�/�' GZ'�
1 I G A R D Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
O' "%1 RK-
❑New construction ❑Demolition For special information use checklist
Description Qty. Ea. I Total
rAddition/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 ]Commercial/industrial
SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
:SOB„SITE INFORMATION AND LOCATION` , ," Site utilities:
Job site address: ( Catch basin or area drain 18.76
15 ssso r � aA- / iw Drywell,leach line,or trench drain 18.76
City/State/ZIP: Pa�r4It1ko Q 9,.,��.a� -1
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: f N, jAL I#)anufactured 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
Backwater valve 12.51
DESCRIPTION OF YORK, ,
41A Clothes washer 25.02
1 '2 0t #-T p(3`-"'' l''"K Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
a , ❑" 'RO'IaRTY' v• ER 1 .g.:...:. 0 TENANT::, 7 Expansion tank 12.51
Name: P(.1.(Ac((� 22u1 Fixture/sewer cap 25.02
Address:
' I7 - Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
.i , APPLICANT 0:CONTACT PERSON ` Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 1 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( /,�) f ( ,,,Faa�x::( ) 1//�(( Tub/shower/shower pan 12.51
E-mail: 14(.� y5 4 j' T► �tMi PE.i►'1Y i�(_" t '//' W,c.;��/1 Urinal 25.02
COIRe1,CTR. `�� t u�� Water closet 25.02
*" Water heater 37.52
Business name: A[t y5 P-,,,( j L P( ni6i,U(, Waterpiping/DWV 56.29
Address: PO 60k 1 -35-3.- Other: 25.02
City/State/ZIP: w 1 x,.5013 t(L-L&' p r, ",(4) -7-,
Subtotal
Phone:(Ajit)'$ l lit s)6 Fax:( ) Minimum permit fee: $72.50 �� s�1
r-yt� v Plan review (25%of permit fee)
CCB Lic.: Q`-1-2 iJ Plumbing Lic.no.: F61,11-{
State surcharge(12%of permit fee) ?. 70
Authorized signature: / ' TOTAL PERMIT FEE ?%Ad
Print name:C.ILe Utb Date: 6-1-3.- 1 q This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fn., •thodoh,gyts^t 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:
Site Utilities Q 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
74111i •0n, Pemu. Fe+e
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
Other Inspections orf F#'es Qt'' (ea) Total 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*. pian Review for umbing installations
Quantlty by Fixture Type Plan review is required for any of the following.
fixture Type for Replace/ Please check all that apply.
Work Performed: ti;a,Capped= " Added Relocate
0 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 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic 0 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 Riser Diagram
4" ❑ Isometric or riser is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
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:
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:
15350 SW SEQUOIA PKWY 150, TIGARD,
OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2019-00202
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor