Permit CITY OF TIGARD PLUMBING PERMIT
` I NI >. COMMUNITY DEVELOPMENT Permit #: PLM2010 -00236
TIGA' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/22/2010
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Parcel: 2S 112DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 110
Subdivision: Lot: 0
Project: Spec Space
Project Description: Cap existing fixtures: (2) lavatories, (1) 2" floor drain, (1) water closet
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Floor Drain /Floor Sink/Hub 07/22/2010 $25.02
PHONE: 503 624 - 6300 2 ea Lavatories 07/22/2010 $50.04
1 ea Water Closet 07/22/2010 $25.02
1 12% State Surcharge - 07/22/2010 $12.01
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 $112.09
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.
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Issued By: / Permittee Signature: OAr �74/ e___/ e. e9- 7 zei
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 Applicati
Building Fixtures II roll Oi'l•l( r; 1 !•4'. ONLY
City Of Tigard JUL. 2 c L i Received n . Permit N° j0� .2, / D A 4
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_ all 13125 SW Hall Blvd., Tigard, OR 97223 plan Ravi •
Phone: 503.639.4171 Pax: so3 ft F TIGARD ,.. - :: Other Permit zo jfc�4/e if010,
1 i `" " R D Internet n t on Line: d -o6r v7S BUILDING DIVISION DateReady/B I • . s�Ps 2 for
..:... ' . ,1. d/Me f Seppt
Notifie hod• • . ^ , .FEE' SCHEDULE
Q New construction 11'*sr• , olition For •ecial ornrutton use ckeekllssg
Descri eu Ea Total
0 Addition/alteration/replacement 0 Other: New 1- 2- family dwellin:a (includes 100 ft. for each utility oomtection)
• .: .. ::''' CATEGORY; ONUCPION. ,..:; .: -
1� �h , , SFR (1) bath � ME 312.70
b 31 70
0 1- and 2- family dwelling . , nrmerciaFindustrial SFR ) 437.78
SFR (3) bath 500.32
0 Accessory building ❑ Multi - family Each additions! bath/kitchen 25.02
0 Muster builder 0 Other: Fire sprinkler (_, sq. ft.) Page 2
• , . ; J OB S1Tlu.Air:0 AND �;OEATION Site utilities:
Job site address: 1 :5 1 j S _s&) s- LkI,eCul Catch basin or area drain 18.76
n Drywall, leach line, or trench drain 18.76
City /State/Z�:
-1q / o� Footing drain (no. linear ft.: ) Page 2
Suite/bld /apt n I Project name: ( Manufactured borne utilities 50.03
Cross street/dire ' ob.sitc: Manholes mil 18.76
Rain drain connector 18.76 -
Sanitary sewer (no. linear ft.: ___) Page 2 1
•
Storm sewer (no. linear ft.: _ _) Page 2
Water service (no, linear ft.: _) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.; Backflow prevcntcr 31.27
Backwater valve 12.51
:, DTSCR 'YTON 17 `WORK
Clothes washer 25.02
_WAWA Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump MI 25.02
Li 'PROPERTY OWNS 'R'; `. - ' : ` = ; El TENANT Expansion tank 12.51
Name Fixture /sewer cap 25.02
Floor drain/floor sink/hub L 25.02 7 6C?
Address: Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
. . Interceptor /grease trap 25.02
. .:• : Q�. APPI: IC? AiN1 ';:! . - ` p::COP�fA4"1'>PERSON ...
p
Business name: r Medical gas (value: 3 • ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory >2._ 25.02 50.O(.1
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( )
Tub /shower /shower pan 12.51
Urinal 25.02 •
E -mail: Water closet 1 25.02 -z5 . 0
C 1fOR Water heater 37.52
13US : a . r,tC.f A .' • , Water piping/DW'V 56.29
Address: a,. b 0 J f t 1 d - Other: 25.02 .
City / State/ZIP• itni o - 7 r / 7 Subtotal ZO.. i A
Plumbing Lie. no.: 5
.' one: (,,03 a l ' 76' t Fax 3) ; J t •'� Minimum permit fee: $72.50
, i � nc, Plan review (25% of permit fee)
GCB Lk.: , 2 j7 j/ 14 _
State surcharge (12% of permit fee) ... 0
• Authorized signature: r TOTAL PERMIT FEE //2 .0 lam'
Print name :C r � t nt ,S Date: This permit application has been p ae ot p within *80 days
? V V ` / ( / �G e .� / 1 aiA/' "Fee methodology set by TA-Comity Building Industry Service Board,
Baudd )k ngWermitaLMU.pmmitApp.doc taau 44o4slsr(]0 /oz/COMIWEB)
E0 /T0 39'08 3QVDSVD VI56E8ZEa9 9Z:0T 0TOZ /0Z /L0
Plumbing Permit ,Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su , , ression S terns:
v('v � . f , ' .yr" k luky A M T c a . i - ,f "4.'4'4 F
.. ..; '�4li� + } � of,.J 1 � .4���� ✓�.pi �a�.+i(�rN,S" RIL...r ' ,. ' ....... -. ,. , ..c S : � r , .. ,.�.. .Yi.,.....vt
_ )�� O to 2000 $115.00
Footingdraiit• l 100' 55.00
Footing drain -each additional 100' 4fi.40 2 001 to 3 600 $160.00
8 3 601 to 7 200 $220.00
Sewer -1st 100' 55. 00 7 201 and : - ter $309,00
Sower - each additional 100' =IIII 46.40
Water Service • 1st 100' 1.1111 55.00 Mill Medical Gas S stems:
100' +w r �rc,,pr+7j'7� yi r Q �{l, v ur . - tjv1,.,,? sly eke"„' ' . ' °•' ++�� {..
Water Service - each additional 100 46.40 , , ti ' , rv , a , f, ?$ 4 . e4 h
Storm &Rain Drain -1st 100' MI 55 $1 "00 to $5000.00 Minimum fee $72,50
Storm & Rain Drain - each additional 100' 46. $S,OQ 1.00 to $10,000.00 $72.50 for the first 35,000.00 and $1.52 for each
r $ additional 5100.00 or fraction thereof, to and
r i /0 �-t , i t ?,, r�x1;,. MW } including 310,000.00.
Commercial Back Plow Prevention Device 46 -40 t o.o0 1.00 to $25,000.00 $148.50 for the first S10,000.0074 $1.54 for
Residential Baeldlow Prevention Device each additional $100.00 or fraction thereof, to
minimum • , ' fee 336.25 r 27.55 and including $25,000.00.
Rain Drain, single family dwelling MI $25,001.00 to $50,000.00 $379.50 for the first 525,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or MI and inciudin $50 000.00.
• =jai re i --cons - • hour 72.50 $50,001.00 and up $742.00 for the first 550,000.00 and $1 .20 for
Subtotal; MME each additional $100.00 or fraction thereof
f
Fixture k: , Tx T t.P Y ' 4,rr Jr ,g .:n - ) , ' +l ti
. . "',.0
F ixture Work: "1 ! ,,, i� ,! ` F1 +'r .,, r +� ' 1 ' . +.�; , _ f s, ., .
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.
te! * 0 Any new commercial building with water service 2" and
aecur - . .. , , + rt fixtures
.. f . could result in increased sewer fees*. greater, except systems designed and stamped by licensed
in �a G y . 1 J ' A gyp ,....,'t i +) , engineer.
r ' , ) ,,, '% .. N, t 4, 4 y. '# ;' x r + 1i J I,. g
. , ":mat, � ?- ! ` 0 rz..10 .1e , ` ,1. ' .., 4 ;1164_,,,!1)...,.„ 1 , . 0 Any new exterior plumbing site utilities.
B ., s /Font MilillINNIM NM. ❑ Medical gas and vacuum systems for health care facilities.
Bath :roman? MIIIIIMIIMMIIMMEM 0 Any multipurpose fire sprinkler system. .
-Jacuzzi/Whitt .1 IIIIIIIIMIIIMMEIM 0 Any complex structure as defined in OAR918 - 780 - 0040,
Car Wash - Each Stall MIIIIIMMENIMIN
- DriveThru MilIll_MIIIIIMIIIM Submit 2 sets of plans with any of the above.
C .idor/Water :,irator MINU MNIIMMiiiMIM � 4 r,ps•x, a ti e s� ;'�r rr �;.�
Dishwasher -
Commercial -Domestic -- , . ' :' . , ::
Isometric or riser diagram is required for new buildings
Arinlsia: Fountain ���
- e Wash ���� that meet the • ualifications above.
Floor Drain/sink - 2 " lIMIIIIIMMIll �
• NMI -- Comments regarding fixture work:
Car Wash Drain illMININIMIIMNMMIMI
Domestic -- 1
D - Commercial 1111111 MIIIIIIIIIMIIM
Industrial M•111111 IN1111111•111..1
Ice MachJRefri; Drains IMO MI.
011 ,.,, ., or Gas Station MEMNIMMINNII �- -
Rec. Vehicle r , . Station Mililliall=1111
Shower -Gang �
*Nate: If the > fxture work under this permit results in an
�
Stall _IIMMI_MIll increase of sewer EDUs, a sewer permit will be issued and
Sink Bar/Lavatory MIINL/ =MEMMINIMI fees assessed for the sewer increase must be paid before the
- Bradley MIIIIIIMMIIIMIMIIIIIII -commercial plumbing permit can be issued.
4 r
,Serviceervice
, , g " . , _Pool Filter 111.111.
��� -
Washer - Clothes
Water Extractor
Water Closet - Toilet MiniiiiiMIIMIIII
Other Fixlures:IIIIIMINIMM
£0 /ZO 3Jdd 3QVDSVD VI96£8Z£09 9Z :0I Ot0Z /0Z /L0
Accumulative Sewer Tally Parcel # 42S112DA00800 j
! Tenant Name: Spec Space, PCC 231 1 This SWR# !N/A {
Site Address: 15115 SW Sequoia Pkwy, Ste. 110 1 This PI.,M# '2010 -00236 C
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 1 2 0 -1 -2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Dm 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 -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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit -- 0
TOTALS 0 0 4 12 0 0 -4 -12
Current Fixture Value -12 divided by 16 = -0.8 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous IDU
Change -12 divided by 16 = -0.8 over (under) $ (3,280.00)
Enter EDU Change HereI -0.8 I
Notes:
Authorized Name /Signature: L. Howse 1 Date: j 7/22/2010
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 Tally \Sewer l'allySheet- 3600.xIs 06/25/08