Permit ./////
d r CITY OF IGAR® PLUMBING PERMIT
q
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00097
Date Issued: 04/02/2010
:TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 460
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: AM Trust North America
Project Description: Cap (1) we & (1) lay. Add (1) sink. 5/11/10, per property owner and plumber also capped shower
stall. Sewer tally revised for additional credits.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 2 ea Fixture /Sewer Cap 04/02/2010 $50.04
PHONE: 503 - 624 -6300 1 ea Sink 04/02/2010 $25.02
1 ea Water Heater 04/02/2010 $37.52
1 12% State Surcharge - 04/02/2010 $13.51
Contractor: Plumbing
DEAN WARREN PLUMBING & REMODELING
INC
PO BOX 14701
PHONE: 503 - 236 -4152
FAX: 503 - 296 -2218
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $126.09
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 -0100. You may obtain a copy of the rules
or direc estions to a NC by calling 503.246.6699 or 1.800.332.2344.
Issu , d By: Permittee Sig •
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Accumulative Sewer Tally Parcel # 2S101AD03200 :
Tenant Name: Am Trust ** *REVISED 5/11/10 * ** This SWR# N/A .
Site Address: 12909.SW# 68th Pkwy #460 This PLNI# 2010 -00097 •
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 . 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
I [:ye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -IP) 16 0 0 0 0 0
- Commercial (to 5 I -1P) 32 • 0 0 0 0 0
- Industrial (over 5 1 -IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 • 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 • 0 0 0 0 0
Shower - Gang (per head) 1 - 0 0 0 0 0
- Stall 2 0 1 2 0 -1 -2
Sink - Bar /Lavatory 2 0 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
\Vatcr la:xtractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'I'OTAI S _ 0 0 3 10 1 3 -2 -7
Current Fixture Value -7 divided by 16 = -0.4 Current EDU 1 EDU = S 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -7 divided by 16 = -0.4 over (under) S (1,440.00)
Enter EDU Change Here -0.4
Notes: ** *CREDITS * ** 5/11 /10, Revised to include capped shower stall.
Authorized Name /Signature: Debbie Adamski Date: 4 /2/2010 & 5 /11 /10
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:A Building \Sewer Tally \Sewcr'l'allySheet - 3600.x15 06 /25/08
q CITY OF TIGARD PLUMBING PERMIT
" � COMMUNITY DEVELOPMENT Permit #: PLM2010 -00097
T E G ARO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/02/2010
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 460
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: AM Trust North America
Project Description: Cap (1) we & (1) lay. Add (1) sink.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 2 ea Fixture /Sewer Cap 04/02/2010 $50.04
PHONE: 503 - 624 -6300 1 ea Sink 04/02/2010 $25.02
1 ea Water Heater 04/02/2010 $37.52
1 12% State Surcharge - 04/02/2010 $13.51
Contractor: Plumbing
DEAN WARREN PLUMBING & REMODELING
INC
PO BOX 14701
PHONE: 503 - 236 -4152
FAX: 503 - 296 -2218
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $126.09
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 -0100. You may obtain a copy of the rules
or direct estions to • C b calling 503.246.6699 or 1.800.332.2344.
r
Issue By: j/ " Permittee Signature. ' ite
Call 503.639.4175 by 7:00 a.m. for an inspection that busi • . .- day.
This permit card shall be kept in a conspicuous place on the job site unti •mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
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Building Fixtures � ti t �� � y , l OR`aOI I I(I ' Iltil OV'I�la u� k �� , "`
Pr D Zia'k�mlllr � td"r .`�,!C7�N�iv6�Y�4 � ,iU�l, "! «rC.�N'G]'n�'t "� �6 r� .:�,� T k� 'w. l�f.. �� o�l���. e ".iG �.�h 1i�'v' �.`�
s Received 4/ �,/ o
Cit o f Ti gard Date/By: Y o /0 Permit No.: L! /Ave -a00 ' .
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
i- . 0 ,ti Phone: 503.639.4171 Fax: 503.598.1960 Date/By: - Other Permit No.: pay _p „
I I � , I
Inspection Line: 503.639.4175 Date Read B • Ju ris: ® S ee Page 2 for
CiLD.; Ready /By: g
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
' ' TYPE OF WORK - -FEE* SCHEDULE • . ,
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
Addition/alteration /replacement ❑ 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 J ..Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
. JOB BITE INFORMATION AND LOCATION . Site utilities:
Job site address: / 2 % G 9 ■ G a-,44---ii Catch basin or area drain 18.76
^� Drywell, leach line, or trench drain 18.76
City /State /ZIP: o) Jr� U'� , 71 (t' Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.:L f 60 I Project name: fr - '1 to.. .57 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: 25/D(/9-7)0 Lot no.: Fixture or item:
Tax map /parcel no.: 3 pea ° Backflow preventer 31.27
• DESCRIPTION OF WORK. Backwater valve 12.51
bkho Qe...4 Clothes washer 25.02
!9 °rrla /- '•LC- i - 1.a✓ ..„.,,...„.„s ...e. O ca�� Dishwasher 25.02
- tit-5i;.) ( I - S, `a•4 dry. Drinking fountain 25.02
Ejectors /sump 25.02
9 PROPERTY OWNER . ❑ TENANT Expansion tank 12.51
Name: i ii4e ru ST Fixture /sewer cap .9,_-- 25.02 �Q •oy
Floor drain/floor sink/hub 25.02
Address: j 3 5b 5 Lk.- C e „,./Alrr7 k^ . Garbage disposal 25.02
City /State /ZIP: 1. j ,,J U/j - 4 ) . 2 . . 2 ( . 1 Hose bib 25.02
Phone: (Se ) C v-6 L9c Fax: ( ) Ice maker 12.51
4, APPLICANT . ❑ CONTACT PERSON - Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name: /) (,..„) -r A (4.4ri /...,,,A. /
Primer 12.51
Contact name: 3 e
Roof drain (commercial) 12.51
Address: , G, 73o/ fit/ ?G( Sink/basin/lavatory / 25.02 j ,-.
City /State /ZIP: 1-4--I-, 0 /( '5 72 1' 3 Solar units (potable water) 62.54
( )) 7 4 e C ( 5 7 Tub /shower /shower pan 12.51
Phone: z 7 O - Fax: Y S) 2 ( -- 1 zi �
E -mail: n � 1,(Ak,,� IL , f ti Urinal I 25.02
d cam,, «'1'I
Water closet 25.02
CONTRACTOR ,
Water heater / 37.52 - 5 -). ¢2
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal (�
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 8 i4 .5 O
CCB Lic.: / q Plumbing Lic. no.: Plan review (25% of permit fee) - f
/ 5' g 2 15 °7 36! "/
State surcharge (12% of permit fee) / % • s/
Authorized signature• c.: l TOTAL PERMIT FEE /a6 .
Print name: �� A a�l Date: �( L ! CJ This permit application expires if a permit is not obtained within 180 days
c after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 46I6T(10 /02/COM/WEB)
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 - 1m 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 Inspections or F ees
Qty. Fee( Total each additional $100.00 or fraction thereof, to
p 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 ", Plan Review. for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
'Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Tub /Sr 1=1 New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower /Whirlpool Tub /S owerlpool as defined in OAR9I8- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash ,Isometric t r Riser Diagram:
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory f
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service 1 increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet l
Urinal
Other Fixtures:
I:\ Buil ding\Permits\PLMF- PermitApp.doc 2
Accumulative Sewer Tally Parcel # 2S101AD03200
Tenant Name: Am Trust This SWR# N/A
Site Address: 12909 SW #68th Pkwy #460 This PLM# 2010 - 00097
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -IP) 16 0 0 0 0 0
- Commercial (to 5 I -IP) 32 0 0 0 0 0
- Industrial (over 5 1-IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /l.,avatory 2 0 1 2 0 - -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'TOTALS 0 0 2 8 1 3 -1 -5
Current Fixture Value -5 divided by 16 = -0.3 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -5 divided by 16 = -0.3 over (under) $ (1,080.00)
Enter EDU Change Here -0.3
Notes: ** *CREDITS * **
Authorized Name /Signature: Debbie Adamski Date: 4/2/2010
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\ Building\ Sewer Tally \Sewerl'allySheet- 3600.xls 06/25/08