Permit - -44
*'"�*' PLUMBING PERMIT
. CITY OF TIGARD
q
; a COMMUNITY DEVELOPMENT Permit#: PLM2010 -00252
«axe '"jam' Date Issued: 08/03/2010
MONAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
a , Parcel: 2S101DA01200
Jurisdiction: Tigard
Site address: 7165 SW FIR LP 100
Subdivision: Lot: 0
Project: Alternative Services
Project Description: Cap (2) toilets, replace (1) breakroom sink and add (1) breakroom sink.
Owner: FEES
AMERICAN PROPERTY MANAGEMENT Quantity Description Date Amount
2154 NE BROADWAY, STE 200
PORTLAND, OR 97232 2 ea Sink 08/03/2010 $50.04
2 ea Water Closet 08/03/2010 $50.04
PHONE: 503 - 284 -2147 1 12% State Surcharge - 08/03/2010 $12.01
Plumbing
Contractor: 1 Plan Review 08/03/2010 $25.02
BEAVERTON PLUMBING INC
13980 SW TV HWY
BEAVERTON, OR 97005
PHONE: 503 - 643 -7619
FAX: 503- 643 -7620
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $137.11
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
issuanc suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti otification Center. hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
direct questions to OUNC • alli g . • .246.6699 or 1.800.332.2344.
Issued By: // Permittee Signature: • `, i
Apr r
Call 503.639.4175 by 7:00 a.m. for an inspection that busines - 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
Building Fixtures i oiz OI I IKE USE ONLY :, •
III City of Tigard Date/By: 10 k . l Permit No.: ' / }f f / ./V1 ,2� �
• 13125 SW Hall Blvd., Tigard, OR 97223 y [ rJ fN
0 Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.:
Date/By:
Inspection Line: 503.639.4175
T I GA R D Date Ready/By: kris: !a See Page 2 for
. - - Internet: www.tigard - or.gov Notified/Method: Supplemental Information
I YPE. OF WORK FEE* SCHEDULE - '
12 New construction ❑ Demolition 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)
CATEG 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: 7165 SW FIR LOOP Catch basin or area drain 18.76
City/State /ZIP: PORTLAND, OR Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: 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: 1 c, -0/100 I Lot no.: Fixture or item:
Tax map /parcel no.: (e / 1�1� Backflow preventer 31.27
DESCRIPTION OF WORK - Backwater valve 12.51
Clothes washer 25.02
CAP 2 FLOOR MOUNT TANK TYPE WATER CLOSETS. Dishwasher 25.02
PULL & RESET BREAK ROOM SINK Drinking fountain 25.02
ADD BREAK ROOM SINK Ejectors/sump 25.02
❑ PROPERTY' OWNER: ' ( . - ®' TENANT. Expansion tank 12.51
Name: ALTERNATIVE SERVICES OF OREGON Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 7165 SW FIR LOOP
Garbage disposal 25.02
City/State /ZIP: PORTLAND, OR Hose bib 25.02
Phone: ( ) 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 2 25.02 50.04
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax:: ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR - Water closet 2 25.02 50.04
Water heater 37.52
Business name: Beaverton Plumbing, Inc. Water piping/DWV 56.29
Address: 13980 SW TUALATIN VALLEY HWY Other: 25.02
City/State /ZIP: BEAVERTON, OR 97005 Subtotal 100.08
Phone: (503) 643 -7619 Fax: (503) 643 -7620
Minimum permit fee: $72.50
CCB Lic.: 12889 P Wag ic. no.: 34-4PB Plan review (25% of permit fee) 25.02
State surcharge (12% of permit fee) 12.01
C2ee e.A___ Authorized signature: - TOTAL PERMIT FEE 137.11
Print name: COLLEEN KNIGHTON Date: 8/2/10 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\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 Valuation' Permit Fee:
Storm &Rain Drain - 1st 100' 62.54 $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
Q ty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Other Inspections or Fees 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
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash -Each Stall ❑ 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:
http : / /www.tigard - or.gov /city_hal I/ departments /cd/docs/PLMF- PermitAppQdoc
Accumulative Sewer Tally Parcel # 2S101 DA01200
"Tenant Name: Alternative Services ** *CREDITS ** This SWR# N/A .,
Site Address: 7165 SW Fir Loop This PLM# 2010 - 00252
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
Baptistry/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
(:ar 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
Iiyc Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
-3inch 5 0 0 0 0 0
-4inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 IIP) 16 • 0 0 0 0 0
- Commercial (to 5 I-IP) 32 0 0 0 0 0
- industrial (over 5 1 -1P) 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 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 2 12 0 -2 -12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
•I'O'l'AI.S 0 0 2 12 1 2 -1 -10
Current Fixture Value -10 divided by 16 = -0.6 Current EDU 1 EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -10 divided by 16 = -0.6 over (under) S (2,460.00)
Enter EDU Change Here -0.6
Notes: ***CREDITS***
Authorized Name /Signature: Debbie.Adamski'. Date: , 8/3/2010
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 Tally \Sewer I'allySheet- 3600.xls 06/25/08