Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00173
1G AAUP 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/02/2010
Parcel: 1S126DC04900
Jurisdiction: Tigard
Site address: 9445 SW LOCUST ST
Subdivision: Lot: 0
Project: Bowman M.D.
Project Description: Installing (1) shower stall and capping (1) water closet.
Owner: FEES
LOCUST PROPERTIES LLC Quantity Description Date Amount
5632 SW EDGEMONT PL
PORTLAND, OR 97239 1 ea Tub /Shower /Shower Pan 06/02/2010 $12.51
PHONE: 1 12% State Surcharge - 06/02/2010 $8.70
Plumbing
60 ea Minimum Fee Adjustment - 06/02/2010 $59.99
Plumbing
Contractor: 1 ea Fixture /Sewer Cap 06/02/2010 $25.02
KTP PLUMBING CO
8455 SW HOMEWOOD ST
PORTLAND, OR 97225
PHONE: 503 - 297 -7650
FAX: 503 - 297 -7645
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $106.22
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:/ - Permittee Signature: .
h
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 # 1S126DC04900
"Tenant Name: BOWMAN M.D. This SWR#
Site Address: 9445 SW LOCUST This PLM# PLM2010 - 00173
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/Pont 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
Eyc Wash 1 0 0 0 0 0
•
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4inch 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 1-1P) 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 1 2 1 2
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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'I'O'1'ALS 0 0 1 6 1 2 _ 0 -4
Current Fixture Value -4 divided by 16 = -0.3 Current EDU 1 EDU = S 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -4 divided by 16 = -0.3 over (under) $ (1,080.00)
Enter EDU Change Here -0.3
Notes: ** *CREDIT * **
Authorized Name /Signature: BRANDEN 'I'AGGART Date: 6/2/2010
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.xis 06/25/08
Jun 01 10 08:26a K.T.P. Plumbing Co. 503 -297 -7645 p. 2
Plumbing Permit Application rS C9 1C- Ka 0 y
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Received • ( / �� Permit No.: T . 1 `�, to -
d`i i emu 'r:.. - C. Datc/n /
` " ���°�' City of T �d/ 111
t' Pla Review
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q i +r 13125 SW Hall Blvd., Tigard, OR 97223 Other Permit No.: r 1 )7�l
��0 1 Date
: c x� ^„ Phone: 503.639.4171 Fax: 503.5 By' suds 8 See Page 2 for
't .fl+�
Inspection Line: 503.639 4175 Date Ready/By: uns. ��
T 1'G \ RD Notified/Method: ,yv Supplemental Information
SCHEDULE
TYPE 0 iw b "Nova Internet: www.tigard or.gov CITY OF i TIc ■ q + 1 Iii � 4 ! H i
,..0.• .. special i nformation use checklist
❑ New construction • Demolition Description I Qty. , Ea. y Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft_ for each utility connection)
SFR (1) bath 312.70
CATEGORY OF CONSTRUCTION SFR (2) bath 437.78
❑ I- and 2- family dwelling f?51 CommerciaUndustrial SFR (3) bath 500.32
CI 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:
Catch basin or area drain 18.76
Job site address: y -i ` i �' ;`l ,v 1- 18.76
I.L. Urywetl, leach line, or trench drain
City/State/ZIP: ,, ,' f ri �' i C f �'� Footing drain (no. linear ft.: _.J Page 2
Suite/bldg. /apt. no.: J t Project nante: cll r i . �
Qv t�t.r!/� ftn1 � Manufactured home utilities 50.03
Manholes 18.76
Cross street/directions to job site: ,,, 18.76 • / t Rain drain connector
^ (.- ( _�i • � + / Sanitary sewer (no. linear ft.: ) Page 2 IIN
I
6 • 1 - Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: _ Lot no.: Fixture or item:
_ Backflow prevcnter 31.27
Tax map /parcel no.: Backwater valve 12.51
DESCRIPTION OF WORK Clothes washer 25.02
I �1 'i ^ ^ '- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
TENANT Expansion tank 12.51
❑ PROPERTY OWNER ❑T -
Fixture/sewer cap 25.02 . 01. �(j„
n � �
Name: Floor drain /floor sink/hub 25.02 1• W
Address: _ _ Garbage disposal 225 g, 5.02 1C
- . )
City/State /ZIP: Hose bib
Phone: ( )
Fax: ( ) Ice maker 12.51
-
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ^) Page 2
Business name: Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /StatelZIP: Solar units (potable wafer) 62.54
Phone: ( ) I Fax: : ( ) Tub/shower/shower pan 12.51 l
Urinal 25.02
E- mail: Water closet 25.02
�� l CONTRACTOR I 1 Water heater 37.52
Business name: j li' I l ! 'I-� 1':7 I (I('l I- (.' Water piping/DWV 56.
i�11 J 25.02
Address: sL. \ 1� i^l -)E.L ' ..rr �--
Other. Subtotal
City/State/ZIP: p y '�- C j'� (� C �i - _. Minimum permit fee: $72.50 j�1, �� +
Phone: ( j( ) 6 1 - Cr' SC � 7 " ! ] ax. ( JL� ) C ! - Z ` �� - Plan review (25% of permit fee)
CCB Lic.: LI 1 y //AV,/ Plumbing Lic. no.: y�3 Li f �� State surcharge (12% of permit fee) 4 : 7 ,•') Authorized sigttatttre
- "to 1 TOTAL PERMIT FEE `� t '
fir- _ / j
/ / This permit application expires if a permit is not obtained within 180 days
Print name: /i i 1 -` ( 11 : t! Date: / // p(), - - ((( 0 after it has been accepted as complete.
•Fee methodology set by Tri -County Building Industry Service Board.
0..2::iti‘
Jun 01 10 08:26a K.T.P. Plumbing Co. 503 -297 -7645 P -3
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 - l 100' 50.03 0 to 2.000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain - each additional 100' 3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and greater 5327.54
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 $72.50lfirithe first
$100.00 or00 or fraction 1.52 for to
Other Inspections or Fees Qty. Fee (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
each additional $100.00 or fraction thereof.
(minimum charge - 112 hour) _
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 (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 ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub /Shower as defined in OAR918 780 - 0040.
- Jacuzzi/Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall ❑ Any multipurpose fire sprinkler system.
- Drive Thru ❑ Any complex structure as defined in OAR918 - 780 - 0040.
Cuspidor/Water Aspirator _ -
Dishwasher - Commercial Submit 2 sets of plans with any of the above.
Domestic
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 Dram
Garbage - Domestic
Disposal -Commercial Comments regarding fixture work:
Industriaal
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 plumbing permit can be issued.
Water r Extractor
Water Closet - Toilet 1
Urinal
1�
Other Fixtures: \ 1rJt
thr 0u' y
6 Nib