Permit r '' ' . PLUMBING PERMIT
y y.
` w . . COMMUNITY D EVELOPMENT Permit #: PLM201000215
IGARD' 13125 SW Hall Blvd., Tigard OR,97223 503.639.4171 Date Issued: 07/02/2010
<T
m „- rNfi Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: ' Stash Tea
Project Description: Relocate (1) breakroom sink, add (2) new bar sinks (food prep), (1) 2” floor drain and (1) water
heater
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Floor Drain /Floor Sink/Hub 07/02/2010 $25.02
PHONE: 503-624-6300 3 ea Sink 07/02/2010 $75.06
1 ea Water Heater 07/02/2010 $37.52
1 12% State Surcharge - 07/02/2010 $16.51
Contractor: Plumbing
CASCADE PLUMBING CO
2630 N HAYDEN ISLAND DR #3
PORTLAND, OR 97217
PHONE: 503 - 289 -7095
FAX: 503 - 283 -9514
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: / 4 Permittee Signature: a'/V 94:P /9-7 /
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.
, � CITY OF TIG��A�R®
SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2010 -00094
: 1 - 1.GAFtiti 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/08/2010
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Stash Tea
Project Description:
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Sewer Connection 07/08/2010 $1,640.00
PORTLAND, OR 97224
PHONE: 503- 624 -6300
Contractor:
PHONE:
FAX:
Type of Use:
Class of Work:
Install Type:
Fixture Units:
Number of Dwelling Units:
Total $1,640.00
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 vvill 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 b the Oregon
Utility NotificatioaC. nter. Those rules are set forth;! in OAR 952- 001 -0010 through OAR 952 - 001 - 0100. You may obtain o' of the s
or dire uestions to OU • calIi 03.246.6699 or 1.800.332.2344.
sued By: k /44 Permittee Signature:. AV
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 #2S113ACO01101 ?» tt`.., ',' l x mi
T Nam Stasb Tea I ' „ , „,,,-; _ t., r, f ) This.SWR# X2010,00094 c L
r i J . �'� ,,'..,.` ° This P1 M# '2010.00215. s °_ . <.`. . ,,'
Site t \ddre�s:. 16;655�SW 72nd "Ave #200 _� e � �1 ,� _ _� . ,
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
Baptisery/Font 4 a1�3. 0 IC,, W. - -:; 0 ,` 0 0 0
Bath - Tub /Shower 4 MINV 0 M" % 0 MOIRA 0 0 0
- Jacuzzi /Whirlpool 4 i s , 7 0 MO r a' 0 ,^ , ,, , ,_',` 0 0 0
Czar Wash - Each Stall 6 f ,, 0 : =i 1 0 ` .,,
0 0 0
- Drive through 16 ,: _ • 0 a 0 Sail 0 0 0
Cuspidor/Water Aspirator 1 i° 0 4Z d^
Dishwasher - Commercial 4 'AWN €_ „z 0 { ii .W 0 « �„ r 0 0 0
- Domestic 2 " ,` K , . 0.I f,� 0 !Rand 0 0 0
Drinking Fountain 1 g .r 0 EM414 0 'MOB 0 0 0
Eye Wash 1 gsintio 0 ar, JA 0 I iT'll " 0 0 0
Floor Drain /Sink - 2 inch 2 iii ; 0 4:A40 0 , .iB1w; 0 0 0
- 3 inch 5 ,' 0 y .{ L' 0 it>i ?g# . °f 0 0 0
-4inch 6 Make* 0 t' roVE. 0 rtrinti : 0 0 0
- Car Wash Drn 6 ..,.'A:~ 0 P i 0 D , 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 Zia 0 , 4 i .,., 3 0 : i ; N 0 0 0
- Commercial (to 5 HP) 32 Sgelctl 0 mkt N X 0 M.R 0 0 0
- Industrial (over 5 1 -IP) 42 -- Nifi...7 0 9111M1 , 0 NIRO 0 0 0
Ice Machine /Refrigerator Drain 1 Eithilia 0 iit _. > 0 `=O 0 0 0
Oil Sep (Gas Station) 6EOM 0 il,AP 0 ' 0 0 0
Rec. Vehicle Dump station 16 r g' r . µ te ": 0 4 'r 0 :< , „I. v? 0 0 0
ems" ' i ¢ d , o S k r
Shower - Gang (per head) _ -,, 1 ,ex s 0 , A . „� 0 b ; K „ 0 0 0
- Stall 2 se's" 0 WOW 0 lirlilf 0 0 0
Sink - Bar /Lavatory 2 .,, =r., - ',. 0 a ,, 0 1 al 0 0 0
- Bradley 5 ilk : ',01 0 Maid 0 REM 0 0 0
-Commercial 3 Lice, 0 ';r 0 miktiii 6 2 6
- Service 3 0 Kale o PEON 0 0 0
Swimming Pool Filter 1 4 , ` 0 v 0 0 0 0 0
JAM; �° r r .. rr 0 0 0
Washer - Clothes 6 ,� .„ _, 0
Ni t o °, xa s s . g reaa .
Water Extractor 6 I I 0 1 0 d x egt :t o 0 0
` »;
Water Closet - Toilet 6 s r 0 0 0 0
Urinal 6` Rig : 0 ffa7;7" " 0 OCIV 0 0 0
Previous EDU Count ' t 1 ' '''A 0 0
Capped EDU Credit ':, 0
`1'O "I'ALS 0 0 0 _ 0 2 6 _ 2 6
Current Fixture Value 6 divided by 16 = 0.4 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 6 divided by 16 = 0.4 over (under) $ 1,640.00
.Enter EDU Change Here G' 0 4 ', .;"
Notes:
Authorized Name /Signature !Debbie Ada_mslu; n ,,, _ , , „, , ,� e., �,. k ' 't lot :?
i � Date: �.., �7/.8/ . � =gti. �„,. � . ��,� -..� t
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.
1:A Building \Sewer Tally \SewerTallyShcet- 3600.xls 06/25/08
lambing pee°anit Application 1 : -octh
1 k ! ' \p d� 194 e+ Y a� + , l + .. 4 + A na n 4 �� 1 91 ,,,, , , I ,„„,,,,, 1 „.,„
• 1,:014,
Building �Fixtures d I h
�ON I I( i til l)N � + l `a l
� "Stiff +
H �� , h ltn • �y
' u City of Tigard
;:; ty aecetvcd y / .�
� S� / — /
P erm it P7 a.
a• ` ' f 13125 SW Hall Blvd_, Tigard, OR 97 , DareB ! ' d / /� — Qi'7o2� ■
F ® ' Phone 503.639:4171 Fax: 503:598. L. plan It " ' " Other Permit No `(/ do/
llV O Datc/By:'
Inspection Line: 503.639.4175 ,�\- C h, ` Datc Ready/By: Juris: ` ET gee Pope 2:for
f f 11 Lt� J
M "3' . a +xa a- . Internet: www;tigard•or:gov i
a `,�1 ` * 'otificd/Method: I Supplements! Information
YPE OF WORK •.. ... � 1TEE* 3CAEDTJf:E ...
T ..: .
El New construction ❑ DemoVitiar � P" For special information use checklist
Descn.mien • • Ea. Total
I Addition /a1teration/replacetnen t ❑ Other: New 1 - 2- faunal ;d ellin • $ (includes 100 ft. for each utility connection
1 I t a a 1
SFR (3) bath ❑ Accessory building 0 Multi- family 11
Each additional bath/lcitchen 1
❑ Master builder ❑ Other: Fire spririlder ( sq. ft.) Page 2
JOB, S1TE .. D4: MAT ON LocAUON , Site utilities:
Job site address: / o 47 5 -� n d Catch basin or area drain 18.76
Drywc11, leach line, or trench drain 18,76
City /State/Z1P: / /C16/ / i9ed Footing drain Page 2 -
Suite/bldg. /apt. no -: fie./ Project name: SL ii Cle-CA , Manufaetured 50.03
Cross street/directions to job site: Manholes � El
Subdivision: Lot no.: Fixture or item:
18.76 all
Page 2
Page 2
Tax map /parcel no.: t = ` ` ' '
A.
�'- / . � 25.02
pe O zArf ll_= r 1 25.02 iiim
ti * I. a jeli.,1111 Drinking fountain 25.02 NMI
Ejectors/sump 25.02
1
Floor ,, 1
disposal Garbage 1
CitY/StaterZ .1-lose bib 25.02 .
. :.: 0 A>: Y ,. , Er. CO TACT, r>RSON InteroTtorigease traP 25.02
Business. name:
- - Primer 4 12.S1 MIN .
Gantlet name Roof drain (commercial) 12.51 '75',0
Address: . ry „o 25.02 j. fil
City /State /Z1P: Solar units (potable water) _ 62,54 -
Urinal MI 25.02
Water closet 25.02
37.52 PM7. 5 2-
.i 1 A t s M _• _ 56.29
M e '
�. i 0 s 25.02-
J •/Q 0 7 d Subtotal
Phone: 0e ° I 9 Fax: 0'6 3) . 5 / 1V1inimum permit fa: $72.50
CC1� Plumbing Lic. uo.:. C� r Plan review (26% of permit fee) / 6 , 5 / .
State surcharge (12% of permit fee)
Authorized,signature :' 1 ...4_� TOTAL PERMIT FEE
Print naive: S i ( � Date: 7 This permit applicati
afton expires if a perteit,ia not et t rued w n I80 dim
Sa f . er it hae '1>ee n secepted 0.R Complete
w/ `Fee m ethodology set by T ri - County Building Industry Service Board.
2;18vildin glPennitsIPLAX- permitApp.doc 10101 GAO -0616Tocilo21Cow,va)
! //
6O/TO 39 d = aa'DS D Vt 6E8 EOS CO :ET OIO /L
•Piuinb ng,Pe>rmit Apv1icatioar - City of Tigard
Page 2 - Supplemental Information -
Fee Schedule Residential Fire Su . xession S stems:
S . y "1 rxri 71�i , °i7; t ,,. :, y .. Y F.4r r a i }+ ' F v ' ri • ,, t
t,� � v- vv � Is-'''.' Ij a.
, �� ` � t k tS ° ° ii f9, . :5 �. a /I �: Crrin;Nl . t . : -., ...r. -.; - e r i .. r � .vi •i',,..
t , r x � s9
aM �
Footing drain • 1 100' 55;00 0 to 2 000 $1
Footing drain• each additional 100' Mill 46,40 Isom 2001 to 3 600 $160:00
3,601 to 7 200' $220,00
Sewer -'1st 100' _ En 55.00 7201 and c eater $309.00
Sewer - each additional 100' NM 46,40
Water Service - 1st 100' 55.
� Mil Medical Gas S .stews.
Water Service • caah 100' 1111.1 46,40 ,,,, ' "1?m.77i �� ` ;, �,i , . 1 fi , h °
Storm & Rain Drain -1st 100' ,
55,00 ,i w ;, . •..
_ $ t 00 to $5;000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' Eli 46.40 1111.1111 $5,001.00 to $10,000.00 $72.50'for the first $5,000.00 and $1.52 for each
rig • �a , , r additional $100.00 or fraction thereof, to and
r ... , , ' r 2t' , . , k 40 r 1 ? 0 including 510,000,00.
Commercial Back Flow Prevention Device 46.40 $10,401.00 to $25;000.00 $148.50 for the first $ 70,000;00 and $1.54 for
Residential Baclofow Prevention Device = each additional $100.00 or fraction thereof, to
minimum , it fee $36.25 and including $25,000.00.
Rain Drain, single family dwelling 111111126111.11111 $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 includin $SO 000,00.
• cull re • uested ins ctlons - . =r 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.
,
{ C , r r,; t�R -ws, '° Cpr i rr Ak pa d ' "11 ; y , t ' �'� 7
fixture Work.
• ,. r; $SL, .•tr. +6: 4. �r. w,�.'c? .n., }. , i 'r... ■ 1. , .c,
Are you capping, adding or replacing fixtures? 0 "yes ", Plan reviewis required for any of the following.
please indicate work performed by fixture- Failure to Please check all that apply.
accuratel , re , ort fixtures could, result in increased sewer fees *. 0 Any new commercial building with water service 2" and
gam . rr T„ . „�,7 greater, except systems designed and stamped by licensed
in il � ;t ; 1 4 J .. :N . ' Vj i 1 ) . '� ii, r , Or r ' +'4 .1 1 r 71 „r 06 /xy :4 .. , e ,)r / , L ' b
# r c _s p 4 , r, <`_, s ly ,�te engineer. V. I ' q; i A n� i i y I y e. 7 x �, , El Any new exterior plumbing site. utilities.
on , ..... .. ; �.. 1 . , l-; �..l. .�
B:=. 'tis r /Font ❑ MediesL and vacuum systems for health care facilities.
Bath 'tub /Shower 1.1111111111=111.11111.11111 ❑ Any multipurpose fire sprinkler system.
lacuszi/Whirt „1 11111MOIMEMIMMIIIMMI ❑ Any complex structure as defined in OA1t918- 780 -00
Car Wash -Bach Stall -E1=1.11
Drivc'fhru 110111111_ Submit 2 sets of plans with any of the above
Cts,idor/Water As, irator IIIIIIMIMIIIIIIIMI
Dishwasher fiommerciaS IIIIIMMIIIIIIIIIMIIMIIIIIIIIM _ , ti t4ry ,.r J r � , +(,�r ,. � �t�_I
4,!, A,h 1 � :2 , v.._ .
- bomcstic • Isometnc orr d is required for new buildings
Ed W Fountain � � that meet the uallfications above. EMIIIIIIIIMIIIIMISIIII E e Wash
Floor Drain/sink - 2" MIIIIIIMIIIIIIIIIMIMIIMIII
• 3" •1■ii Comments regarding facture work:
- 4" Milliallin NMI. carwasliDraln INONI111111111111111111111111
Garbage Domestic 111111=. -
Disposal - Commercial ��_
- Industrial MINI IMINIIIIIIMMII
tee Se a rid& G as Station ��� _
Oil 5e arator G Sion ' --
Res. Vehicle Dam. Station
Shower -Gang IIIIM *Note: If the fixture work under this permit results in an
.Stall MOM 111111111M1111111.11 increase of sewer EDUs, a sewer permit will be issued and
Sink - Bar/LovatnrY - 1111M11111MIMMIMMI fees assessed for the sewer increase must be paid before the
- Bradley plumbing permit be issued.
-commercial
Service IIIMIIMOIIIMIIOMIIMIMMIIII
Sy/Mullin:, er - Pool 1?ilter
Washer Clothes
Water, Extractor - ilinnini.
Water Closet- Toilet IIIIIIM•
other Fixtures: ,
' „Irmo mmumor
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