Permit CITY OF TIGARD PLUMBING PERMIT
o ' COMMUNITY DEVELOPMENT Permit #: PLM2010 -00366
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/09/2010
Parcel: 2S113AA00300
Jurisdiction: Tigard
Site address: 16320 SW 72ND AVE B3
Project: SERVICE PARTNERS Subdivision: OREGON BUSINESS PARK 1 Lot: 0
Project Description: Demo: (2) wc, (2) lav, (1) urinal. Add: (1) laundry tub. Replace: (2) wc, (2) lay.
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97293 PORTLAND, OR 97224
PHONE: 503 - 236 -4152
PHONE: 503 - 624 -6300
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
5 ea Fixture /Sewer Cap 11/09/2010 $125.10
Specifics: 1 ea Laundry Tray 11/09/2010 $25.02
2 ea Lavatories 11/09/2010 $50.04
Type of Use: COM 2 ea Water Closet 11/09/2010 $50.04
Class of Work: ALT 1 12% State Surcharge - 11/09/2010 $30.02
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $280.22
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 = ^ • ' suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Center. Those •- -s are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0190. You may obtain a copy of the rules
or . irect questions to OUNC by ng . .1987 or 1.800.332.2344.
I sued By: / Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for the next available insp. • n date.
This permit card shall be kept in a conspicuous place on the job site u ompletion of the project.
Approved plans are required on the job site at the time of , • ch inspection.
Plumbing Permit Application '
Building Fixtures RECEIVED FOR OFFICE USE ONLY
Received �/ ? :
�/, /,
City of Tigard 9 201 Date/By: : // 9 /D ,l / Permit No.: L!/km / t.0 4
q 13125 SW Hall Blvd., Tigard, OR 97223 NOV 7 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175
Internet: www.ti ard or. ov CITY OF OF TIGARD Date Ready /By: Juris: SI See Page 2 for
WORK . FEE* SCHEDULE ' .
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
Tt 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 ® 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: / 6 3 L i% S ti.. 7 l ' ----4--
Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: ;2O- t id,, (;) 1_ 1 ) 2- ••/
Footing dram (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 5 ,,,,,, c 1% ,jjfa -"..- Manufactured home utilities 50.03
Cross street/directions to job site: 0 q aj %d, 3 Manholes 18.76
Ram 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: l Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
• Backwater valve 12.51
' I)ESCRIPTIQN OF WORK'.•
Clothes washer 25.02
17 , P., C• 2 . : - Z 4 .44. , i - (114 Dishwasher 25.02
fi,7d - / ._ 7 Drinking fountain 25.02
>2 a/744 .,z ) _ wC - 1 . J :/ Ejectors /sump 25.02
. ❑ PROPERTY OWNER , • I. • ❑ TENANT . Expansion tank 12.51
Fixture /sewer cap S 25.02
Name: �; . t�Sl
Floor drain /floor sink/hub 25.02
Address: i .5 5 - 0 5 w (j 2 %JC, • _ a .72,:)/ w..l Garbage disposal 25.02
City /State /ZIP: ' - _ c:'.2- 5 ) 2 2 - L/ Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
• ,p APPLICANT .' ❑ CONTACT PERSON' :.: Interceptor /grease trap 25.02
Business name: ,/,.,5, S Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: �,�
Roof drain (commercial) 12.51
Address: /'. C. ('c)y, %u 7c t Sink/basin/lavatory 4 25.02
City /State /ZIP: p . 01. 9 7b 'i 7 Solar units (potable water) 62.54
Phone: (p ) - 2a p- g c,/ gC Fax: : ( -;?.,3) X/6"- L 2 / V. Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
TO Water closet - 25.02
CONTRACTOR .' `
• - Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: , S >, 9/ r Plumbing Lic. no.: Z G - 7 3 6/ -? /) -
State surcharge (12% of permit fee)
Authorized signatur .,,..N2 �`.,Z3 _ TOTAL PERMIT FEE � • ''9" This permit application expires if a permit is not obtained within 180 days
Print name: 1 c.i ,� /2 A A Date: j 0 - 5-i U after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
P' Building \Pcrmits\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 l 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 - lst 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
` each additional $100.00 or fraction thereof, to
Other Inspections OIC' Fees -Qty. Fee (e Total 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
-Tub/Shower as defined in OAR918- 780 -0040.
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 C regarding fixture work:
- Industrial g g
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory c) Q C
- 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 aid before the
Washer - Clothes p
Water Extractor plumbing permit can be issued.
Water Closet - Toilet 4 -f 2
Urinal I F Er
Other Fixtures:
1:\Building \Permits \PLMF - PermitApp.doc 2
Accumulative Sewer Tally Parcel # 2S113AA00300
Tenant Name: Service Partners ** *CREDITS * ** This SWR#
Site Address: 16320 SW 72nd Ave This PLM# 2010 - 00366
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 web 2 0 0 0 0 0
-3inch 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 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 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 1 3 1 3
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 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 3 18 1 3 -2 -15
Current Fixture Value -15 divided by 16 = -0.9 Current EDU 1 EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -15 divided by 16 = -0.9 over (under) $ (3,690.00)
Enter EDU Change Here -0.9
Notes: * * *CREDTI'S * **
Authorized Name /Signature: Debbie Adamski Date: 11/9/2010
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 Tally \Sewer I'allyShect- 3600.xls 06 /25/08