Permit il f.� R C ITY OF TI A D
l PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PERMIT #: PLM2007 -00219
TIGA 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/24/2007
"^= PARCEL: 25101 DA - 00100
SITE ADDRESS: 13010 SW 68TH PKWY ZONING: C -
SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 007 JURISDICTION: TIG
PROJECT: US BANK
Project Description: Capping service line for previous cafeteria /breakroom. Line was service for (4) 2" floor sinks & (2)
service sinks.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC NORTHWEST PROPERTIES
9665 SW ALLEN BLVD Description Date Amount
BEAVERTON, OR 97005 [PLUMB] Permit Fee 5/24/2007 $72.50
[TAX] 8 °A, State Surcha 5/24/2007 $5.80
Phone : 503- 626 -3500 Total $78.30
Contractor:
NOLAN PLUMBING
PO BOX 671
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 267 -4646
FAX 503- 678 -6959
Reg #: LIC 78388
PLM 3 -269PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification_Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rule • direct qu. ti• o OUNC by calling 503.246.6699 or 1.800.332.2344.
0
// j / � ' 1' .� / Permittee Signature: Issued ' � 9 � L_ 41 ,
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.
Plumbing Permit Application
i *, ' FOR.OFFICE USEPON , t' ,- i' t r y � i
r"" 14 Received " �
City of Tigard Received -- N b�f O -�� Permit No.: ' Lrl Win
a 13125 SW Hall Blvd., Tigard, OR 97223
t ; Plan Review
i1,. 't C Phone: 503.639.4171 Fax: 503.598.1960
Date/By: Other Permit No.:
n .:� ° Inspection Line: 503.639.4175 Date Ready/By: Ju ® See Page 2 for
V T IG "A RDt Y Y g
r,,, *; ;� Internet: www.tigard - or.gov Notified/Method: 1 / c, Supplemental Information
TYPE OF •WORK : FEE* SCHEDULE° ' .
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
G Addition/alteration /replacement ❑ Other: New 1- 24amily dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ I- and 2- family dwelling MI Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft:) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 0 0 _ , Catch basin or area drain 16.60
City /State /ZIP: Drywell, leach line, or trench drain 16.60
Footing drain (no. linear
Suite/bldg. /apt. no.: I Project name: ft.: ) Page 2
• Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary . sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.: ) Page 2
Tax map/parcel no.:
g /6/ -DA - 40 /610 Fixture or item
Absorption valve 16.60
(�
\\ n/� Gai DESCRIPTION OF: • W O Backflow.preventer Page 2
PP r o a !� t ro Q_ u l- u S Backwater valve 16.60
r(C, -C 2 ) 4 / 62 ih 1\ ,F} 2 ti A- Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
- ROPERTY: ,OWNER ' 0 TENANT.
Ej ectors /sump 16.60
Name: C t ft C. ` NO2�- t 47 r P E /L1] F , Expansion tank 16.60
�-
Address: 1 '60 0 -v P u ■ Fixture /sewer cap. 1 16.60
City /State /ZIP: 1 (2 R- 2' V/ 77 2- 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60.
Hose bib 16.60
APPLICANT' ❑ CONTACT PERSON
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: . Primer 16.60 ,.
City /State /ZIP: Roof drain. (commercial) 16.60
Phone: ( ) I Fax::( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CO CTOR . Water closet 16.60
Business name: d 4 ��,Cy� - Water heater 16.60
Address: (� Other:
�� / ���� /�
City /State /ZIP: `/� �� 1/ Q� 2P7, j Subtotal
l Minimum permit fee: $72.50 '/ r� -
Phone: 3,�1� �J = !!/ Fax: ( ) ,7 '�j Residential backflow minimum permit fee: $36.25 70t -
CCB Lic.: / ..0 0 i 2/V1 Plumbing Lic. no.: - _ 77A Plan review (25% of permit fee)
State surcharge (8% of permit fee), j" IfU •
Authorized signature: /W/ 7 t
g TOTAL PERMIT FEE 7.5
Print name: �� , 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\PLM- PermitApp.doc 12/27/06 440- 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 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Ram Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
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
-Tub/Shower 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.
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" Y ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory *Note: If the fixture work under this ermit results in an
- Bradley p
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Permits\PLM - PermitApp.doc 12/27/06
4
Accumulative Sewer Tally Parcel # 2S101 DA -00100
Tenant•Name: 'US Bank This SWR# N/A
Site Address: 13010 SW 68th Pkwy This PLM# 2007 -00219
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off # s count 4 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 4 8 0 -4 -8
- 3 inch 5 0 0 0 0 0
- 4inch 6 0 0 0 0 0
-Car Wash Dm 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 2 6 0 -2 -6
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 0 0 _ 0
Urinal 6 0 0 0 0 _ 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 6 14 0 0 -6 -14
Current Fixture Value -14 divided by 16 = -0.9 Current EDU 1 EDU = $ 2,700
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -14 divided by 16 = -0.9 over (under) $ (2,430.00)
Enter EDU Change Here -0.9
Notes: ***CREDITS***
Authorized Name /Signature: Debbie Adamski Date: 5/24/2007
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 \Forms \SewerTallySheet.xls 02/02/07
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00219
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: &2'1/2007
Phone: (503) 639 -4171 4,0
����
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/25/2007 TIME: 7:17AM PAGE: '14
SITE ADDRESS: 13010 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 007 TYPE OF USE:
PROJECT NAME: US BANK
DESCRIPTION: Capping service line for previous cafeterialbrealrQorn. Line +was service for (4) 2" floor sink & (2)
service sinks.
OWNER: PACIFIC NORTHWEST PROPERTIES, PHONE #: 503 - 62&3500
CONTRACTOR: NOLAN PLUMBING PHONE #: 503.2€ 7 - 1646
Inspection Request Scheduled For: Date: 512502.007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 049105 -01 603 -267 -4646 N
Corrections /Comments/ Instructions:
rkIer F Lid,/ V P-(iw.rr
I . fr
XPASS PARTIAL APPROVAL n CANCEL NO ACCESS
n FAIL n CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: 1)d Date: I2 X07 Phone #: (503) 718-