Permit $ CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00113
I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/15/2010
Parcel: 2S 112AD01000
Jurisdiction: Tigard
Site address: 7007 SW CARDINAL LN 105
Subdivision: Lot: 0
Project: Fax Back
Project Description:
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 2 ea Urinal 04/15/2010 $50.04
PHONE: 503-624-6300 2 ea Water Closet 04/15/2010 $50.04
1 12% State Surcharge - 04/15/2010 $12.01
Plumbing
Contractor:
ADDISON PLUMBING
27425 S BEAVERCREEK RD
MULINO, OR 97042
PHONE: 503 - 740 -8116
FAX: 503- 632 -1168
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 nrk ig . uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. .'cation Center. ' ose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir- t questions to OUNC • alli g 503.246.6699 or 1.800.332.2344.
Issu -d By: / � ` , � I Permittee Signature:
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 # 2S112AD01000
Tenant Name: Fax Back This SWR# 2010- 00113
Site Address: 7007 SW Cardinal Ln #105 This PLM# 2010 -00056
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count f1 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 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 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 /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
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 0 2 12 2 12
Urinal 6 0 0 2 12 2 12
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 4 24 4 24
Current Fixture Value 24 divided by 16 = 1.5 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 24 divided by 16 = 1.5 over (under) $ 5,400.00
Enter EDU Change Here 1.5
Notes:
Authorized Name /Signature: Debbie Adamski Date: 4/15/2010
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 \SewerTallySheet- 3600.xls 06/25/08
Plumbing Permit Application
Building Fixtures - ! 4. .)"FA5 7 ?R:' � T NMV f gm• i ,
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City of Tigard `e' Date/By: / Ao Permit No.: I di� /Q 0M/43
a 13125 SW Hall Blvd., Tigard, OR 97223 y
p `to Plan Review Other Permit N
' - I" a :. Phone: 503.639.4171 Fax: 503.598.1I�R 1 DateBy:' /D `J
Inspection Line: 503.639.4175 Date Ready /By: Juris ® See Page 2 for
• ;FIG R Wt Internet: www.ti and -or. ov -�/ FTIGARD
g g C l r O Notified/Method: Supplemental Information
TYPE OF WOgl9ILDING DIVISION FEE* SCHEDULE •
❑ New construction ❑ Demolition For special information use checklist
Descri*tion •t . Ea. Total
ddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF .CONSTRUC ON SFR (1) bath 312.70
❑ 1- and 2- family dwelling 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 SITE INFORMATION AND LOCATION Site utilities:
Job site address: ,9Q 27 S'' /_ i i , 'd_ , -L , / US
Catch basin or area drain 18.76
!�� Drywell, leach line, or trench drain 18.76
City/State/ZIP: `.-Zr,re.: a y d D 943,2 0..../4-\ e ? y Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: A v Manufactured home utilities 50.03
Ay
Cross street/directions to job site: Manholes 18.76 1
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
DESCRIPTION OF WORK Backwater valve 12.51
• Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: PA...-Fixture/sewer 17? 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
❑ APPLICANT . . 1CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: , t
t° h 4 L r p��l /I Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E-mail: Urinal ,a 25.02 I .
CONTRACTOR Water closet a 25.02 6 ,0 4 1
• Water heater 37.52
Business name: d,.f 3 d. \ r I,,, ft, 71'nr lc Water piping/DWV 56.29
Address: T i, 3 - s �,.v_ r ('� k ( Other: 25.02
City /State /ZIP: M I,;, O( q 7.00 Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 .
-1-P-1 `1 PD Plan review (25% of permit fee) e"
CCB Lic.: / y- Plumbing Lic. no.: / S 1 7S#--
State surcharge (12% of permit fee) /�.0/
Authorized signature: 7 TOTAL PERMIT FEE O
Print name: q l Date: li s -Aa This permit application expires if a permit is not obtained within 180 days
r I G• (/ / 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:
- Site Utilities • Qtr, Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 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 ec
Ins tions or Fees Qty. . Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspections 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
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
Jacuzzi /Whirlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.''•
111 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 or 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
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service 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
Urinal
Other Fixtures:
1:\ Building \Permits \PLMF - PermitApp.doc 2