Permit ` CITY OF TIGARD PLUMBING PERMIT
<: a ; COMMUNITY DEVELOPMENT Permit #: PLM2010 -00096
A � 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/02/2010
Parcel: 2S112DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKVVY, STE# 100
Subdivision: PACIFIC CORP CENTER Lot: 0
Project: Coca Cola
Project Description: Cap (1) wc, (1) lay & (1) 2" floor drain. Add (1) sink.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 3 ea Fixture /Sewer Cap 04/02/2010 $75.06
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 $16.51
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 $154.11
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 ques ' to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B : • /J „(J Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that bu= ess day.
This permit card shall be kept in a conspicuous place on the job site u completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
�e'� s �� ` IN- IN LJsl )`NI 1�* `5- �w z
Building Fixtures
414 tt' ..,,` .+�'u�-�AA,4,,+^.1s °'i ' . ir:.i�✓S„„Pr,:I,a.'Yn�Va .r.li�., I+J.klek� . 4A'i,.� 4
Received n
City of Tigard Date/By:
/D Permit No.: , G a _. DO0 �
n 13125 SW Hall Blvd., Tigard, OR 97223
Other Permit N (J
74
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review er ermo.: Q I
` H : Date/By: AJUp�40'G?
:1- I t; A l f ) ' Inspection Line: 503.639 Date Ready /By: luris: ® See Page 2 for
. 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
EK 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 ® 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: 1533 S 3310 61A PK�1 Catch basin or area drain 18.76
" Drywell, leach line, or trench drain 18.76
City /State /ZIP: ii? R I Q a�L.1 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I ci0 Project name: Cpl_ CO (4. 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: Lot no.: Fixture or item:
s l/ a -
Tax map /parcel no.: a 70 � Backflow preventer 31.27
DESCRIPTION OF WORK '
Backwater valve 12.51
n_ Clothes washer 25.02
T.', °env) 1 o. L• l 1 LAv 1 C.O. Dishwasher 25.02
\00 1 SICK Drinking fountain 25.02
Ejectors /sump 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture /sewer cap .3 25.02 75. to
Name: Q Ae ((� (Z� L ll
Floor drain/floor sink/hub 25.02
Address: t S 3 SV6 51..3 5 e. V O 1 A- Garbage disposal 25.02
City /State /ZIP: T i 6 A 04 2 -1..-1 Hose bib 25.02
Phone: (f 53) ( a y - (e5cAor Fax: ( ) Ice maker 12.51
. , APPLICANT -❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: OG a,t3 1i / ,3 A V ry g 1K) Medical gas (value: $ ) Page 2
efj Primer 12.51
Contact name: T pE
Roof drain (commercial) 12.51
Address: Pp . 6 O s .1 L. I - a .( n 1 Sink/basin/lavatory 1 25.02 .L5.56 Z
City /State /ZIP: ( kl-t_tA1JD 1512- GAzy Solar units (potable water) 62.54
Phone: (co 3) '3$05 - 1`t Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: s)01 (At -loo u - Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater I 37.52 L-7,5
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 / 3 7, CD 4
//�� Plan review (25% of permit fee)
CCB Lic.: \ (Et 26e.. �',P� � � Plumbing Lic. no.: � State surcharge (12 %ofpermit fee) /6,6
Authorized signature: TOTAL PERMIT FEE /5-y .11
Print name: A Q AR6 Date: Li- 2- J' This permit application expires if a permit is not obtained within 180 days
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' Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - I n 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
Valuation: 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
Other Ins actions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
l� 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'Plumhing.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
-Tub/Shower as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ 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 • • r Isometric or Riser Diagram
Floor Drain/sink - 2" 1 ❑ Isometric or riser diagram is required for new buildings
3 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 1
- 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
Accumulative Sewer Tally Parcel # 2S112DA00700
Tenant Name: Coca-Cola . . This SWR# N/A .
Site Address: 15333 SW Sequoia Pkwy #100 This PLM# 2010
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
Baptistry/hoot 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 1 2 . . 0 -1 -2
-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 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 /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
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
"I'O'1'A1.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: * * *CRED1'f5* **
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 \Sewei I'allyShect- 3600.x1s 06 /25/08
a4 fed
PLUMBING PERMIT
. $ . r ' q CI Y OF TIG RD
_ '. COMMUNITY DEVELOPMENT Permit #: PLM2010 -00096
T 1 G?.RD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/02/2010
Parcel: 2S112DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKWY, STE# 100
Subdivision: PACIFIC CORP CENTER Lot: 0
Project: Coca Cola
Project Description: Cap (1) wc, (1) lay & (1) 2" floor drain. Add (1) sink. 5/26/10, adding (1) hub drain, (1) RP device
and (1) primer.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 3 ea Fixture/Sewer Cap 04/02/2010 $75.06
1 ea Sink 04/02/2010 $25.02
PHONE: 503-624-6300 1 ea Water Heater 04/02/2010 $37.52
1 12% State Surcharge - 04/02/2010 $16.51
Contractor: Plumbing
DEAN WARREN PLUMBING & REMODELING 1 ea Backflow Preventer 05/27/2010 $31.27
INC 1 ea Floor Drain /Floor Sink/Hub 05/27/2010 $25.02
PO BOX 14701 1 ea Primer 05/27/2010 $12.51
PHONE: 503-236-4152 0 12% State Surcharge - 05/27/2010 $8.26
Plumbing
FAX: 503- 296 -2218
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $231.17
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 que s to 0 C by calli g 503.246.6699 or 1.800.332.2344.
Issued y: // / �� / 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 # 2S1 12DA00700
Tenant Name: Coca -Cola ** *REVISED * ** This SWR# 'N /A
Site Address: 15333 SW Sequoia Pkwy #100 This PLM# 2010 -00096
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
Baptistry /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 1 2 1 2 0 0
- 3 inch 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 1-IP) 32 • 0 0 0 0 0
- Industrial (over 5 I -1P) 42 0 0 0 0 0
!cc 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 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
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
'I'O'I'ALS 0 0 3 _ 10 2 _ 5 -1 -5
Current Fixture Value -5 divided by 16 = -0.3 Current EDU 1 EDU = S 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -5 divided by 16 = -0.3 over (under) S (1,080.00)
Enter EDU Change Here - -0.3
Notes: ** *CREDI'T'S * ** 5/26/10, revised to add (1) 2" hub drain
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 \Sewer I'allySheet- 3600.xls 06/25/08