Permit CITY OF TIGARD PLUMBING PERMIT
n COMMUNITY DEVELOPMENT Permit #: PLM2010 00290
T 1 G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2010
Parcel: 1S 136AD04000
Jurisdiction: Tigard
Site address: 11527 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Spec Space
Project Description: Interior plumbing: Adding (1) 3" hub drain and (1) primer, and capping (3) sinks and (2) water
closets.
Owner: FEES
PACIFIC TERRACE COMMERCIAL LLC Quantity Description Date Amount
C/O NORRIS & STEVENS, 621 SW MORRISON
SUITE 800 5 ea Fixture /Sewer Cap 09/01/2010 $125.10
PHONE: 503-223-3171 1 ea Floor Drain/Floor Sink/Hub 09/01/2010 $25.02
1 ea Primer 09/01/2010 $12.51
1 12% State Surcharge - 09/01/2010 $19.52
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 $182.15
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.
i
Issued By: �+ PermitteeSignature:
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
Building Fixtures RECEIVED
City of Tigard c� i�p Q 1 2010
13125 SW Hall Blvd., Tigard, OR Sa7ti323
Phone: 503.639.4171 Fax: 503.598.1M,
TIGARp
Inspection Line: 503.639.4175 C1
T}(
Internet www.tigard -orgov ntIl n�N GDIVIS ION
E New construction
Addition/alteratiiaat/replacemcnt
❑ 1- and 2- family dwelling
❑ Accessory building
0 Master builder
Job site address: (( 591 s'io
City /State/ZIP: 1 q /J4 d
Suite/bldg./apt. no.: t • Project name:
Cross street/directions to job site
Subdivision:
Tax amp/parcel no.:
Name:
Address:
r a 3 iv L. c.itd e2 1 -
S �" . Fred 1 hub O�- +''ct.; n Gt�''I
NJ
City /State/ZIP:
Phone: ( )
0 PROPERTY OWNER
Q AVPLILANT:
Phone (go3 6n 4 ) ?64W Fax: +56' 3) 75'1
CCB Lic.: 2
Authorized signature:
E0 /T0 3E d
:TYPE 0 WORK
,'Demolition
D Other:
CATEGORY .OZ? ctiiimucrwre
X Cou mnetcialfmdustrial
❑ Multi -family
Q other.
JOB SITE JNFOI MATION AND .LOCATION
St 1 Thivci
aejlia ihv
ACC-
Let no.:
BTIDN OF WORK
Fax: ( )
- 0 TENANT
.CO1t1TACT PEBSON
Plumbing Lic. no.: 611
3CIVDSd3
.i 0I O
FoR OH (' f'.L\•
•S
Received q
Date/By:
Plan Review
Date/By:
Date Ready/By:
Notified/Method:
SFR (1) bath
SFR (2) bath
SFR (3) bath
Each additional bath/kitchen
Fire sprinkler ( sq. ft.)
Site utilities:
Catch basin or area drain
Drywell, leach line, or trench drain
Footing drain (no. linear ft.: _)
Manufacnned home utilities
Manholes
Rain drain connector
Sanitary sewer (no. linear ft:
Storm sewer (no. linear ft.: _)
Fixture or item:
Baddlow prevcnter
Backwater valve
Clothes washer
Dishwasher
Drinking fountain
Ejors/sump
Expansion tank
Fixture/sewer tap
Garbage disposal
Hose bib
Ice maker
14 677
Floor drain/floor sinklbub
Interceptor/grease trap
Medical gas (value: S
Primer
Roof drain (commercial)
Sink/basin/lavatory
Solar units (potable water)
Tub/shower/shower
Urinal
Water closet
Water heater
Water piping/DWV
Other
pan
Permit No.:
Other Permit No.:
unk}LO -6M0
Jude ® See Page 2 for
1 4 Supplemental Information
FEE* SCE
Forspedal lnrorwaadon use cheekldt
Description 1 Qty. 1 Ea. 1 Total
New 1- 2 -faintly dwel5aes (includes 100 ft. for each utility connection)
437.78
500.32
25.02
Paget
312.70
18.76
Page 2
18.76
Water service (no. linear ti: _1 Page 2
31.27
12.51
25.02
25.02
25.02
25.02
12.51
25.02
25.02
25.02
25.02
12.51
25.02
Page 2
12.51
12.51
25.02
62.54
12.51
25.02
25.02
37.52
56.29
25,02
Subtotal
Mntimum permit fee: $72.$0
Plan review (25% of permit fee)
a5.
10.51
'75. fa0
*o.oy
Ilan. b 3
State surcharge(12%of permit fee) 19 .52.
TOTAL P ERMIT FEE / $a. I r J
loo permit application expires if a penal it not obtained w ithin 180 days
after K has been accepted as complete.
'lee methodology set by T i -Cotmd Budding Industry Service Board.
tIS6E8ZE09 9E:60 0T0Z/T0/60
Panmb Pe rmit Application - City of Tigard
P age 2 - Supplemental Information
Fee Schedule:
Res
„ - T ><d teal Fire - � � }ass A , ,y,;N; ,u
en Su ression steins:
rooting drain - l' 100' MI 55.00 Nino ow 001 c 3 600 slbo. o
Footing ' each additional 100' 46.4° drain 3 601 to 7 00 5220.00
Sewer -1st 100' 55.00 Mil 7 01 and _, -= 5309.00
Sewer - each additional 100' ' 46.40
Water Service - 1st 100' NMI 55.00 Medical Gas stems:
Water Service - each addidonal 100' 46.40 .. '", r ,r j ',t •
-0 T ' `�,��'' ,) . "..F ). -' D» • r n.'.tt.,
Storm dt Ram Drain -1st 100' 55.00
51.00 to S5,000.00 . Minimum fee $72.50
Rom & Rain Drain - each additional 100' 1.11 46.40 NM 55,001.00 to $10,000.00 . S72.50"for the first $5,000.00 and 51.52 for each
k additional $100.00 or fraction thereof. to and
� 4.t 1 7 t -42. s ,' .. i -,''1, , ° 7 includm_ $10000.00.
Commercial Back Flow Prevention Device IMMI 46.40 510,001.00 to 525,000.00 $148.50 for the first S10.000.00 and S1.54 for
Residential BackBow Prevention Device 11111111 -- each additional $100.00 or fraction theteot to
minimum . - ,•' fee $3625 and inclo ' $25411 000.00.
Rain Drawl, single family dwelling IIIII 65.25 $25,001.00 to 550,000.00 5379.50 for the first $25,000.00 and 51.45 for
each additional $100.00 or fraction thereof; to
lospedton of existing plumbing or and includin • $50,000.00.
i �; ens . horn 72.50 $50,001.00 and up $ 742.00 for the fast 550,000.00 sad 51.20 for
Subtotal: _1111111 , each additional S100.00 or fraction the eof ,,
.h u Work
ng, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
Y capping,
please indicate work performed by fixture. Failure to Please check all that apply
accurst r , ' rt fixtures could result in increased sewer fees. ❑ Any new commercial building with water service 2" and
.s k fl-, I -tt 9r 7 : if Neater, except systems designed and stamped by licensed
engineer.
. � , .. _ , � „ _ ; �,� 3 :_ ❑ Any new exterior plumbing site utilities.
..... ; / om ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tob/Shower ❑ Any multipurpose fire sprinkler system.
-.1 - ,; , , .. ITIMPA1111171•11•12ALICAM4 ❑ Any complex structure as defined in OAR918- 780.0040.
Car Wash -Each Stall i''llit∎ 1i!'arr i'''' -
-Drive Thtu v- Submit/ sets of plans with any ofthe above.
«,,.. idor/WVater - isator
Dishwasher - Commercial
111 -
� V, r , s •�V n '
-Domestic
r„ , . . Formula ❑ Isometric or riser diagram is required for new buildings
-
Eye wash - - that meet the ' ualifications above.
Fl oor DrainF .2.. ,
- 1 Comments regarding fixture work:
-a
Car Wash Drain
Garbage - Domestic - - `""------
Disposal -Commercial -
- rndaudal
lee MachiRefrig Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang *Note: If the fixture work under this permit results in an
-Stall increase of sewer EDUs, a sewer permit will be issued and
Sink -Bar/Lavatory fees assessed for the sewer increase must be paid before the
-Bradley plumbing permit can be issued.
- Commercial
- Service
Pool Rita
Washer. Clothes � I
Water Extractor
Water Closet - Toner LP:'
Urinal -
Olher rixttu - -
E0 /Z0 39dd - • -_. 3000SGO bt56E8ZEaS 96 :60 0t0Z/I0/60
Accumulative Sewer Tally Parcel # 1 S136AD04000
Tenant Name: SPEC SPACE This SWR# NONE
Site Address: 11527 SW PACIFIC I-IWY This PLM# PLM2010 - 00290
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
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 1 5 1 5
- 4 inch 6 0 0 0 0 0
- Car Wash Din 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 I -IP) 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 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 3 6 0 -3 -6
- 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
TO'T'ALS 0 _ 0 5 18 1 5 -4 -13
Current Fixture Value -13 divided by 16 = -0.8 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -13 divided by 16 = -0.8 over (under) $ (3,280.00)
Enter EDU Change Here -0.8
Notes: ** *CREDITS * **
Authorized Name /Signature: BRANDEN TAGGART X2449 Date: 9/1/2010
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 TallyShcet- 3600.xls 06/25/08