Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2010 00187
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2010
Parcel: 2S 102AA01100
Jurisdiction: Tigard
Site address: 12035 SW PACIFIC HWY A
Project: Tigard Auto Stop - Brake Team Subdivision: Lot: 0
Project Description: Capping fixtures due to removal of portion of structure. 1/25/11, reprint to add to project description. Tenant
moving to 12047 SW Pacific Hwy.
Contractor: KERR CONTRACTORS Owner: TIGARD AUTO STOP PARTNERS
PO BOX 1060 2829 RUCKER AVE STE #100
WOODBURN, OR 97071 EVERETT, WA 98201
PHONE: 503 - 796 -2887
HONE: 971 - 216 -0050
FAX:
FEES
Quantity Description Date Amount
2 ea Fixture /Sewer Cap 06/11/2010 $50.04
Specifics: 1 12% State Surcharge - 06/11/2010 $8.70
Plumbing
22 ea Minimum Fee Adjustment - 06/11/2010 $22.46
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 -0090. You may obtain a copy of the rules
or direct qu • OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue By: A !, i Permittee Signat
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
ri EF CITY OF TIGARD PLUMBING PERMIT
` = COMMUNITY DEVELOPMEN Permit #: PLM2010 00187
T [
GAR II 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/11/2010
Parcel: 2S102AA01100
Jurisdiction: Tigard
Site address: 12035 SW PACIFIC HWY A
Subdivision: Lot: 0
Project: Tigard Auto Stop - Brake Team
Project Description: Capping fixtures due to removal of portion of structure.
Owner: FEES
TIGARD AUTO STOP PARTNERS Quantity Description Date Amount
2829 RUCKER AVE STE #100
EVERETT, WA 98201 2 ea Fixture /Sewer Cap 06/11/2010 $50.04
PHONE: 503-796-2887 1 12% State Surcharge - 06/11/2010 $8.70
Plumbing
22 ea Minimum Fee Adjustment - 06/11/2010 $22.46
Contractor: Plumbing
KERR CONTRACTORS
PO BOX 1060
WOODBURN, OR 97071
PHONE: 971 - 216 -0050
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 Noti - - • -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir- questions to OU C by calling 503.246.6699 or 1.800.332.2344.
I sued By: j y Permittee Signature:
p ` 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
s °' O '�Y ''`':8�tt'�vd�T' s , la' *'�h}J4 P t ai, 4Ha %gAt,ye n 1� 4 °a�fl i
Building Fixtures : ; 1 t)144) 1 Ic 1 h1litil c)N10 :)i. , _
fl� 'I ,? „y � - dhrt.''iit''
Received
City of Tigard Date /By: CQ /II //d / Permit No.: Vv 'r
JG _ez) ` g-7
v 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone: 503.639.4171 Fax: 503.598.1960
Date/By: Other Permit No.:
I 1 Ci'n It la' Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
, . Internet: www.tigard- or.gov Notified/Method: -rift,. Supplemental Information
TYPE OF 'WORK • • FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I 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 (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: /a��7 5 A, Ac ,G1 C /41-1 eJ V Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP:
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.:9 I Project nam A4y Aire) o 2)/ 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: 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
n P/ AV ' /:- /
x S • e--e 72) / 6/. Dishwasher 25.02
x Q7 0 ,J C/ L C7V / • Drinking fountain 25.02
Ejectors /sump 25.02
isit PROPERTY OWNER I • ❑ TENANT Expansion tank 12.51
Nanie:.�riR.2b n u- � n (�� � Fixture /sewer cap 25.02
n i T 1 r Floor drain floor sink/hub 25.02
Address: 2 4c 2-' i KuC_ 6f 12__ aoL , 5,TI too
Garbage disposal 25.02
City /State /ZIP: £t' eLtrr L erg 201 Hose bib 25.02
Phone: (/)5) 7 q/e - a gg 7 Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ . CONTACT PERSON ' Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
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 25.02
Water closet 25.02
CONTRACTOR 0
. ' • Water heater 37.52
Business name: E�Q \ (2 b' � oL" -tDfQS Water piping/DWV' 56.29
Address: , Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: 7 v,5 �' Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: ���), Ge... - TOTAL PERMIT FEE
Print name: trilk• t!vikey Date: 4///a.el 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.
1:\ 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 - 1' 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 Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P 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
-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 Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
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 A
Urinal . •
Other Fixtures:
•
1: \Buil ding \Permits\PLMF - PermitApp.doc 2
Accumulative Sewer Tally Parcel # 2S102AA01100
Tenant Name: Spec Space, This SWR# N/A
Site Address: 12035 SW Pacific Hwy #A This PLM# 2010 - 00187
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
I3aptiscry /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
Eyre 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
( ;arbagc Disposal
- Domestic (to 3/4 1 -IP) 16 0 0 0 0 0
- Commercial (to 5 1 -IP) 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 2 4 • 0 -2 -4
- 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 2 12 0 -2 -12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
' IOTA LS 0 _ 0 4 16 0 0 -4 -16
Current Fixture Value -16 divided by 16 = -1.0 Current EDU 1 EDU = S 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -16 divided by 16 = -1.0 over (under) $ (3,600.00)
Enter EDU Change Here -1
Notes: ** *CREDITS * **
Authorized Name /Signature:'Dcbbie Adamski ' ' Date: 6/11/2010
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'1' ally \Sewer 1'allyShect- 3600.xIs 06/25/08