Permit 7.1 t
a '1 CITY OF TI AD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2008 -00127
T.IG DATE ISSUED: 9/2/2008
T 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S102CB -03200
SITE ADDRESS: 09975 SW FREWING ST 1020 ZONING: C -G
SUBDIVISION: MASSIH OFFICE BLDG LOT: 021 JURISDICTION: TIG
PROJECT: VISION WORLD
Project Description: 1.9 EDU increase.
TENANT NAME: VISION WORLD
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1.9
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTP IMPERV SURFACE:
Owner:
MASSIH LLC FEES
PO BOX 108 Description Date Amount
BEVERTON, OR 97075
[SWUSA] Sewer Connection Fee 9/5/2008 • $5,890.00
Phone: Total $5,890.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date
issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If
the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located,
the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow
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 copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue by: ` � , ', Permittee Signat - �, �,,I�! r4 � . 0
1
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.
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Building Fixtures �d 9 , ' .FOR>OFFICE USE`ONLY * : % t
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�• , City of Tigard A ?j Permit No. •
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Date/By: • 0 4 T : • 2 . _ JI ��3 i
+ q 13125 SW Hall Blvd., Tigard, OR 97 C' ..
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d ,4 Phone: 503.639.4171 Fax: 503. .' i� Milli ; Other Permit No.: C am - I 6 , 7
Inspection Line: 503.639.4175 ^
Td I CA' , R D' p Off+ A^ Date Ready /By: uric: la See Page 2 for
,;s7.,, Internet: www.tigard- or.gov � 0 (J , e y x,J� Notified/Method: ),0 Supplemental Information
TYPE OF WORK . ( 4 FEE* SCHEDULE
❑ New construction ❑ DemolitiO' 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 (I) bath 249.20
❑ 1- and 2- family dwelling 2 SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder 1 Other:
_ _ Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION Al.0 LOCATIO Site utilities
�iI'A .W
Job site address: • Of Catch basin or area drain 16.60
City /State /ZIP: ./Z ,}e - e2 P e Drywell, leach line, or trench drain 16.60
�� /� Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: rr3yv a�
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: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION` OF. WORK Backflow preventer Page 2
Z. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
:' . ❑ PROPERTY OWNER . I :. ,0 - TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( )
Garbage disposal 16.60
Hose bib 16.60
0 . APPLICANT .. . .. ❑ CONTACT PERSON •
Ice maker 16.60
Business name: cEFU Ls ?,0.Kv44Sa/u Interceptor /grease trap 16.60
Contact name: 7 el7e2rtSd, Medical gas (value: $ ) Page 2
Address: AjCUd , 95'f4' .)--, 1 -r F _ 0 . 6 Primer 16.60
City /State /ZIP: v pqA-.(d•nv6 ty ,pr j ' e fT
Roof drain (commercial) 16.60
Sink /basin/lavatory
1 16.60 "f/ l 4 . IA Phone: (no) 0 1 /7_ QT( 57 Fax:: (3e ) of(3 -®7i 7 Tub /shower /shower pan + 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.6033,E t)
Business name: 1 f p thcz c4 / Tile Water heater 16.60
Address: P. U (30x, 6 . / . ' y� Other:
Subtotal
City /State /ZIP: g4 Zt t w /1 1 X�l ?
C Minimum permit fee: $72.50 1 ` r v
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 Q (p
CCB Lic.: /O l Q/� 7 /h/G Plumbing Lic. no.: f,Q S/.l Plan review (25% of permit fee)
Authorized signature: ../.-/- -7/ /� State surcharge (12% of permit fee)
! r TOTAL PERMIT FEE ,
t�J '5
Print name: 7 e)ezriS'.4--- Date: Y -,01-o ? 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\PLMF- 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:
Qty. Fee (ea)
Total
Site.Utilties , . S quar e Footagei� Permit •Fee:
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2 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 & Rain 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
Fl%ture 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including 0.00.
specially requested inspections - per hour 72.50
Subtotal: $50.001.00 and up $742.00 for the e first irst $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for�Plumbing Install
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
QuaotitYby (Fixture) WorkPeriormed greater, except systems designed and stamped by licensed
• Fixture Type: - , Replace:- - engineer. •
• . • Previous Capped . • Added • Existini - ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic •
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" 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 ft Q
- Bradley *Note: If the fixture work under this permit results in an
- 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 a
Urinal
Other Fixtures:
i:\Building\Permits\PLM- PermitApp.doc 12/27/06
, Accumulative Sewer Tally . Parcel # } 2S102CB -03200
Tenant Name:, VISION WORLD I This SWR# ISWR2008 -00127
Site Address: 9975 SW Frewing St, Ste 1020 I This Pl,M# IPLM2008- 00348. ! 631 Fixture • Value Previous Previous Credits Capped Fixture Fixture eSCS
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
- 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 1-IP) 16 0 0 0 0 0
- Commercial (to 5 1 -1P) 32 0 0 0 0 0
- Industrial (over 5 1 -IP) 42 0 0 0 0 0
I ce 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 9 18 9 18
- 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 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 4.1 65.6
'1'OTAI,S 0 0 _ 0 0 11 30 11 -35.6
Current Fixture Value -35.6 divided by 16 = -2.2 Current EDU 1 EDU = S 3,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -35.6 divided by 16 = -2.2 over (under) S (6,820.00)
Enter EDU Change Here I -2.2
Notes: ** *CREDITS ** *Applicant did not set any fixtures in shell. Should have only been charged 1 EDU at shell for initial sewer connection.
So 3.0 demo credits plus 1.1 [DU fee paid applied to this permit for a total of 4.1 credits.
Authorized Name /Signature:BRANDEN TAGGART /Debbie Adamski I Date: 18/25/2008 - 9/3/08
Building Division
ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
-ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\ Building \Sewer Tally \Sewerl'allyShcet- 3100.xls 06 /19/08
City of Tigard, Oregon e 13125 SW Hall Blvd. O Tigard, OR 97223 �� �' .}''� r
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September 8, 2008 " '-
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'Dr. I'anlelia M asstll i 1: 7�^q'�'r K," €r ` :v
I'O Box 108
Beaverton OR 97075
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Re: Vision World, 9975 S \\ Frcwi.ng St, Tigard, OR
Dear Dr. i \1assih,
As part of your office project, 3 residential houses on sewer were demolished. With the demolition
of the 3 residences, you were awarded credits for .3 Equivalent Dwelling Units (EDU's). On the shell
plumbing permit you here also charged for. 1.1 E )1_ 's. Since you did not `set' any fixtures in the
shell we arc combining the 3 demolition credits along with the 1.1 paid I- DU fee for a total of 4.1
EDU credits. The sewer System Development Charges (SDC's) for this tenant improvement totaled
30 fixture values or 1.9 EDU's. We applied these credits to the SDC fees for this permit: 4.1 EDI:
credits — 1.9 F.."DU charges = 2.2 MU credits.
Attached are copies of the plumbing and sewer permits issued for your current tenant improvement.
Also attached is an original sewer tally worksheet that shows you have 2.2 'EDU credits remaining.
You must present this original document to redeem these credits on future system developrnent
charges.
If you have any questions regarding this matter please do not hesitate to contact me.
cly,
, 1 ‘ , .12 ... p . t eri.4 . 1A.4.. ki i.
Debbie A dam ski
Building Permit Technician
debbieatigard or.gov
503 - 718 - 2450
Phone: 503.639.4171 e Fax: 503.684.7297 e www.tigard - or.gov 0 TTY Relay: 503.684.2772