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Permit
CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2010 -00125 TiGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/20/2010 Parcel: 1 S136CD01001 Jurisdiction: Tigard Site address: 11747 SW PACIFIC HWY Subdivision: Lot: 0 Project: Chevron Project Description: Site utilities and interior plumbing for new canopy, fueling facilities and office building to replace existing structures being demolished. Owner: FEES CAIN PETROLEUM INC Quantity Description Date Amount 4512 SW KELLY AVE PORTLAND, OR 97239 3 ea Catch Basin or Area Drain 07/20/2010 $56.28 PHONE: 30 If Footing Drain 07/20/2010 $50.03 168 If Sewer Service 07/20/2010 $100.06 365 If Storm and Rain Drain 07/20/2010 $175.10 Contractor: 105 If Water Service 07/20/2010 $100.06 RICHARD RUTHERFORD PLUMBING 1 ea Backflow Preventer 07/20/2010 $31.27 370 EDGERTON LANE 1 ea Hose Bib 07/20/2010 $25.02 SUNNY VALE, OR 97497 1 ea Interceptor /Grease Trap 07/20/2010 $25.02 PHONE: 541-441-8069 1 ea Roof Drain (Commercial) 07/20/2010 $12.51 FAX: 1 ea Lavatories 07/20/2010 $25.02 1 ea Water Closet 07/20/2010 $25.02 1 ea Water Heater 07/20/2010 $37.52 1 12% State Surcharge - 07/20/2010 $79.55 Type of Use: COM Plumbing Class of Work: NEW Type of Const: Occupancy Grp: Stories: Total $742.46 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: / 62 . ''fi:t r _ eci .. sc.._ Permittee Signature: eN �L / 6 -% ZO/ 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. 08/22/2010 07:21 FAX 5414742528 a 002/003 Plumbing Permit App lication REr Building Fixtures JUN 2 2 2011 1 OR t)hl lc( t SE ONL1 City f Tigard , TV AGAR Date/B : Received r No.: r .. IN • 131 25 SW Hal Bl vd. Ti ard, OR 97223 CITY ' of 1541 lf� L / /� ��Or & Phone: 503,639.4171 Fax: 503.598.1 an Review 96 I Other Permit Nn. ,� �UlLDli� (�iiflSBC't A ,loaao tzEo T 1 G A R 17 Inspection Line; 503.639.4175 Date Ready /By: heie. ES See Page 2 for Internet: www.tigard or,gov Notified/Method: Supplemental information ,. N` In , t T � :1Sfi! RM .. I .n 7. d t 5, l 1J ,' k <y ,. 1 . „r' r P.17, 3 e.1 er.q '- v ;la.'l n:•. iii ,? ., :;' < iii+, d( r ,• r�i A rl 11; ` „ 4 (� . 1 +nVt'• x- .- '. iy ,: �. � 't, .. . S'1'1A1,:, .0igt414 1< CA New construction ❑ Demolition Far special Information use checklist --• Description f Qty. I Ea. I Total ® Addition /alteration/replacement ❑ Other: S New 1- 2- family dwelltniis ((includes 100 ft. for each utility connection) 1 . 6 �g u } y . ; ''� I g ,, 7 L ( 1 . e , { . 1 ,_W Ri. ��tS il 7 � . ( y tr c i f ' r r 1 . 4r$. 5 4 ,.. SFR (1) bath 312.70 ❑ 1- and 2- family dwelling © Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 0 Accessory building ❑ Multi- family - Each additional bath/kitchen 25.02 ❑ Master builder 0 Other; Fire ; sprinkler ( sq. ft.) Page 2 3 } �; i a}' 4,, t ,1;; r �/"�" 7 e , tl�tt 1 aly l, !, " c k, r site utilities- lities- - , wn.. r J r�s �i a, . '� :; .. . °rid, . i Job site address: 7 Catch basin or area drain 16.76 5‘,2.e. / 7 y ! S. W' ��. �L 5-- 14 L Orywell, leach line, or trench drain 18.76 City/State/ZAP: T, ii, ,,,rd ok. °11 Z'L3 g ( ) 1 g SO.0 Footing drain no. linear ft.: Page 2 Suite/bldg. /apt. no.: Project name: Ga.trl. / manufactured utilities 50.03 _ �i 2 V -fit f d h d J Cross street/directions to job site: (v e. - I-I 1r 4.,,,,c(, Z 11 Manholes - 18.76 Rain drain connector 18,76 - Sanitary sewer (no. linear ft.: (It 1 Page 2 100 (o .O Storm sewer (no. linear ft.: NP5) Faso 2 (15. 10. _ water service (no. lin fl.: l0 5,) Pa 2 100 , Q Y Subdivision: Lot no.: 1 t? D { Fixture or Item: 'Tax map/parcel no.: 5 - Co T15 '1W /SI - ('. • 00 Backflow preventer J I 1 31,27 3 1. T - r 0 ,, •.Q yKyt1 77 e r 1-73 it� S, k . '1 dy ...-47.14 Bkwater valve 12.51 :2; } ,k"m . • I , , ..N t ' " A. --; 3 , < J , 0 : 13 �U . , . kta' , tip -.. � l r. ' ac Clothes washer 25.02 N r J -411-#110 e s -net ) c4, S rckvb OAS Lt e- st.orwt. 404 . Dishwasher 25.02 sa 'wT, 5 'Gu1 er- 'rvr it$4r ac'l tore o t new CAA-44-0 Drinking fountain - 25.02 ftalivl. e - 0, L I Kato O tee., lu416t,n; Ejectors /sump 25 -02 r , .. ,' 1, t 1 ,11,7 ,Q g, f: S 4:43 , y ' ' F ' i;r ? , 3'' Expansion tank 12.51 - • r t m at Fixture /sewer can 25.02 Name. C.p.1v1... P41L1't?leet rN irt-G, - , Floor drain/floor sink/hub 25.02 Address: 4.51z s W Ke{ tM Garbage disposal - 25.02 City /State /7.1P: Po r t ta.rt,A 1 0 2 972.31 Hose bib 25.02 25.OZ Phone (503) 546 ^ 335 Fax: ( ) ice maker 12.51 Tt,; S> r r r .. # .' lntcrt eptor /grease trap f 25.02 - 2.5 . Oz w ... :i t. „ "" Medical gas (value: $ ) Page 2 Business name: p p ( Primer { 12.51 1'2.51 Contact name: D e, K yhm Roof drain (commercial) i 12.51 25.02 Address: 1 335 S 1,J 4062 tiet Av S 1 - 201 Sin /bas _ J 25.02 City /Statc/Z1P: Po r - ttaas.. 1 . R 9 1 Z 2.5 - M Solar units (potable water) 62.54 T ub /shower /shower pan 12.51 Phone: (503) 3Z9 539 �1 sax:: (�a03) 37-1 - '8+66) 25.02 E -mail p • . ► tatLit.t k c.0 wi..c4 s'� net urinal 25,02 5 02 - 1 y � ,, W closet 1 02 Z !, a 1 '. t i " t:fAM ¢rc 3}x 1 ! I ; w" +nF Y 1 c , ..�. -- „� .. 1 i, „x 1 ? .. , �y , �.....� k: _ �. 1,5,'r ° qe�. ..6't..`r' _ ,•��i.. Water heater 37.52 1.2. Business name: 0- 1 c.. . ;. -_ . Waterpiping/DWV 56.29 Address: 3 4 454, ,„,, / ,. . - Other: - _ 25,02 _ t s . t „ j4 , Subtotal 6 4,2 .91 City /State /ZAP: 5, < Minimum permit fee: $72.50 Phone: (5 ) ! , i y 0‘ , F ax: 9 ( ) Plan review (25% of permit fee) CCB Lic.: �y/ y y syl. h l f Plumbing Lie. no.: PB 2 40 State surcharge (12% of permit fee) /9 .551 Authorized signature: ` 7///11 - TOTAL PERMIT FEE :744 ,�1 �. This permit application expires if a permit is not obtained within ISO days Print name: - ` .0 a .1. �. j Date: (._ Z r - Z v/ p after it has been accepted as complete. fee methodology Set by Tri- County Building Industry Service Board. tu,„ ildin g \PLMU- Permi App dee 10101/09 440- 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 - Is` 100' I 50.03 $'0,03 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' 1 62.54 62.54 7,201 and greater $327.54 Sewer - each additional 100' 1 37.52 37.52 Water Service - 1st 100' 1 62.54 62.54 Medical Gas Systems: Water Service - each additional 100' 1 37.52 37.52 Valuation: Permit Fee: Storm &Rain Drain - 1st 100' 1 62.54 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 2 37.52 75.04 $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 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 El New exterior plumbing site utilities for any complex structure as defined in OAR918- 780 -0040. - Jacuzzi /Whirlpool Car Wash - Each Stall I: Medical gas and vacuum systems for health care facilities. Drive Stall ❑ 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. -4" 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 Urinal Other Fixtures: P: \008 - 002 217 Chevron\Docs \tigard- plumbing - permitapp.doc 2 Accumulative Sewer Tally Parcel # 1S136CD01001 Tenant Name: Chevron ** *CREDITS * ** This SWR# N/A Site Address: 11747 SW Pacific I -Iwy This PLM# 2010 - 00125 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 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 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 1 6 1 6 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 1 2 1 2 - 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 1 6 1 6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 2 32 '1'OI'ALS _ 0 0 0 0 3 14 3 -18 Current Fixture Value -18 divided by 16 = -1.1 Current EDU 1 EDU = $ 3,600 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -18 divided by 16 = -1.1 over (under) $ (3,960.00) Enter EDU Change Here -1.1 Note ** *CREDITS * * *'f Authorized Name /Signature: Debbie Adamski Date: 4/30/2010 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. 1: \ Building \Sewer 1' ally \Sewerl'allySheet- 3600.x1s 06 /25/08