Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2010 -00297
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/09/2010
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Subdivision: FARMERS INSURANCE Lot: 0
Project: Triangle Pointe
Project Description: Remodel 2 bathroom groups and tenant space. No additional EDU's, cap credits still available.
Owner: FEES
TRIANGLE POINTE LLC Quantity Description Date Amount
901 NE GLISAN ST #100
PORTLAND, OR 97232 1 ea Drinking Fountain 09/09/2010 $25.02
1 ea Floor Drain/Floor Sink/Hub 09/09/2010 $25.02
PHONE: 1 ea Garbage Disposal 09/09/2010 $25.02
1 ea Ice Maker 09/09/2010 $12.51
Contractor: 1 ea Primer 09/09/2010 $12.51
RAY'S PLUMBING 1 ea Sink 09/09/2010 $25.02
P.O. BOX 685 11 ea Lavatories 09/09/2010 $275.22
BRUSH PRAIRIE, WA 98606 5 ea Urinal 09/09/2010 $125.10
PHONE: 360 - 892 -8700 1 ea Water Piping /DWV 09/09/2010 $56.29
FAX: 360-892-9644 16 ea Water Closet 09/09/2010 $400.32
7 ea Water Heater 09/09/2010 $262.64
1 12% State Surcharge - 09/09/2010 $149.36
Plumbing
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $1,394.03
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 No • on enter- hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You ma btain a copy of the rules
or • ct questions to OUNG'' - -(ling 503.246.6699 or 1.800.332.2344.
Issued By: /40 Permittee Signature:
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 FOR OFFICE USE ONLY
City of Tigard Received 6 s, /� / Permit N o.: Nei/t) Q`0- OD 7
INII a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
7 a�
C Plan Review Y e l ,,
Pho ne: 503.639.4171 Fax: 503.598.1960 D a t e / By: Other Permit No.: IG�G / �r/
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK _ FEE* SCHEDULE
❑ New construction ❑ Demolition For special information rose checklist
Description 1 Qty. 1 Ea. 1 Total
. ® Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
•
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling [�'Commercia1Iindustrial 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: 3 333 S d= I Y Catch basin or area drain 18.76
City /State/ZIP: Drywell, leach line, or trench drain 18.76
T16 O IZ C ' i 1•D- Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: 'rSZdANktCE k.i...irect Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
- 2.11 °- 1 - 5' 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: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
iZewtoote 1 j 'ice tz),. t+c
ra,. J cru_ps 6 „' 1114 4sof5P" - Dishwasher 25.02
Drinking fountain 1 25.02 g5,)
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank • 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub l 25.02 ;•:;•
Address: Garbage disposal ( 25.02
City/State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker ( 12.51 11.5 I
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name: Primer 1 12.51 0,51
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 1 1-5i s 1>s1 l" 25.02 3�, Z..-
fa' t4+l
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E- mail: Urinat - - - - -- - - -- 25:02 _ I3.5 - IO -
CONTRACTOR Water closet 16 25.02 1-04). 32.
Water heater 4 37.52 262, by
Business name: Z,,(3,,s I:kyletele✓v Water piping/DWV 1 56.29 56,2c
Address: PO go,,, 6c S Other: 25.02
•
City/State /ZIP: 2, z µ PRIj412tc wW c'1 $.604 Subtotal 4n si 41
t
Phone: (;360 ) tea.- q--#,,, Fax: (3( ) +a - 56
Minimum permit fee: $72.50 J �
Plan review (25% of permit fee)
CCB Lic.: 3 Plumbing Lic. no.: 3 - 'Lis p13 State surcharge (12% of permit fee)
Authorized signature: l TOTAL PERMIT FEE 4.Gs Z
/ -�' I This permit application expires if a permit is not obtained within 180 days
j N1
Print name: PeZ �V A M:-^/ Date: gi after it has been accepted as complete
*Fee methodology set by Tri-County Building Industry Service Board. O J ((�I• 2
1: \ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(l0 /02/COM/WEB) ' / 3/
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 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Fee (ea) Total each additional $100.00 or fraction thereof, to
l 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 (Future) 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 ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub /Shower as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash - Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ 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 - DumpStation - - -- -- - --
Shower -Gang
-Stall
Sink - Bar/Lavatory t
- 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 tb
Urinal
Other Fixtures:
http: / /www.tigard- or.gov /city_hal I /departments /cd/docs/PLMF -Perm itApedoc
Accumulative Sewer Tally Parcel # 2S101 DA00104
Tenant Name: Triangle Pointe This SWR# N/A
Site Address: 13333 SW 68th Pkwy This PLM# 2010 - 00297
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
- J acuzzi /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 1 1 1 1
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 1 -IP) 16 0 0 0 0 0
- Commercial (to 5 1 -IP) 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 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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 23.3 372.8
TOTALS 0 0 0 0 2 3 2 -369.8
Current Fixture Value -369.8 divided by 16 = -23.1 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -369.8 divided by 16 = -23.1 over (under) $ (94,710.00)
Enter EDU Change Here - 23.1
Notes: Original credits from PLM2009 00059, fixture walk - thru done on 3/20/09.
Authorized Name /Signature: Debbie Adamski Date: 9/9/2010
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 '1 'ally \SewcrfallyShcet- 3600.xls 06/25/08
Accumulative Sewer Tally Parcel # 2S101 DA00104
Tenant Name: Triangle Pointe LLC This SWR# N/A
Site Address: 13333 SW 68th Parkway This PLM# 2009 - 00059
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
F ye 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 I -IP) 16 0 0 0 0 0
- Commercial (to 5 1 -IP) 32 0 0 0 0 0
- Industrial (over 5 I -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 0 0 0 0
- 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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 72 1152 1152
Capped EDU Credit 23.3 372.8
TOTALS 0 1152 0 _ 0 0 0 0 779.2
Current Fixture Value 779.2 divided by 16 = 48.7 Current EDU 1 EDU = $ 3,100
Previous Fixture Value 1152 divided by 16 = 72.0 Previous EDU
Change -372.8 divided by 16 = -23.3 over (under) $ (72,230.00)
Enter EDU Change Here -23.3
Notes: This worksheet is to adjust existing EDU count. Fixture count walk through performed by Brian Blalock on 3/20/09. Per fixture count
actual EDU rate should be 48.7.
Authorized Name /Signature: Debbie Adamski Date: 3/20/2009
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 7' ally \Sewci 1'allyShcet- 3100.xls 06/19/08