Permit CITY OF TIGARD PLUMBING PERMIT
' - COMMUNITY DEVELOPMENT Permit #: PLM2010 -00386
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2010
Parcel: 2S101AD03500
Jurisdiction: Tigard
Site address: 6600 SW HAMPTON ST
Project: Quest Diagnostics Subdivision: Lot: 0
Project Description: Interior plumbing: Capping (2) sinks, (2) water closets, (2) 3" floor drains, and adding (1) sink.
Contractor: RELIANT PLUMBING & MECHANICAL Owner: PACIFIC REALTY ASSOCIATES
11575 SW PACIFIC HWY STE 219 15350 SW SEQUOIA PKWY #300
TIGARD, OR 97223 PORTLAND, OR 97224
PHONE: 503 - 624 -6300
HONE: 503 - 246 -1201 •
FAX: 503 - 246 -1205
FEES
Quantity Description Date Amount
6 ea Fixture /Sewer Cap 12/14/2010 $150.12
Specifics: 1 ea Sink 12/14/2010 $25.02
1 12% State Surcharge - 12/14/2010 $21.02
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
•
Total $196.16
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or .:::.' :2344.
Issued By: "Ar7- Permittee Signature:
Call 503.63•.4175 by 7:00 a.m. for the next available inspection date.
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.
Dec. 10. 2010 11:30AM Relient Plumbing and Mechanical No. 0773 P. 1
Plumbin Perm A licatio 1 S tU
Building Fixtures C���� ��r > OR OFFICE r15E ONGIr '
CI of Tigard DEC 11 Received
fy g O L l� ®Z U DatfB 1.2 A0 /D Z g Permit No.: OiD, ei - - A
I lk
. n 13125 SW Hall Blvd., Tigard, OR 97223 Plan R view
s ; ` Phone: 503.639.4171 Fax: 503.59 Othe P ermit No.: A t tu a dato ,
9 OF TIGARD n et � y: 1Y �,
p BUI LDING DIVISION Dat Ready/13y: Juria: ES See Page 2 for
Internet; tvWw.liga f-'
rd Or,goV Notified/Method: �( 0 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 a. 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 ® Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Met:
Fire sprinkler ( sq. ft.) Page 2
2011 SITE INFORMATION AND LOCATION Site utilities:
Job site address: 6600 SW HAMPTON STREET
basin or arca drain J 18.76
Drywall- leach line, or trench drain 18.76
City /State /ZIP: PORTLAND, 01197223
Footing drain (no. linear ft.: ) Page 2
Suite/bldg,/apt. no.: Project name: QUEST DIAGNOSTICS Manufactured home utilities 50.03
Cross strcet/directions to, job site: Manholes 18,76
Rain drain connector 18.76
Sanitary sewer (no. linear R.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: _ J Lot no.; Fixture or Item:
Tax map /parcel no.: Backflow preventer 31.27
D ESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
DEMO /CAP (2) LAVS, (2) TOILETS (2) FLOOR DRAINS & INSTALL (1) SINK Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
• ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12,51
Name: QUEST DIAGNOSTICS INC Fixture/sewercap 25.02 /5 ( )
Floor drain/floor sink/hub 25.02
Address: 6600 SW HAMPTON STREET
Garbage disposal 25.02
City /State /Z1P: PORTLAND, OR 97223 Hose bib 25.02
Phone: (503)306 -1000 Fax: ( ) Ice maker �_ 12.51
rl APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: RELIANT PLUMBING & MECHANICAL INC, Medical gas (value 1 ) Page 2
` Primer 12.51
Conlaet name: ANDREW BOURKE
Roof drain (commercial) 12.51
Address: 11575 SW PACIFIC IIWY, SUITE 219 µ Sink/basin lavatory 1 25.02 25.02
City /State /Z1P: TIGARD, OREGON 97223 Solar units (potable water) 62.54
Phone: (503) 246 -I201 Pax:: (503) 246 -1205 Tub /shower/shower pan 12.51
E -mail: ANDREW@RELIANTPLUMAING.CONI Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name; RELIANT PLUMBING & MECHANICAL INC. Water piping/DWV 56.29
Address: 11575 SW PACIFIC IIWY, SUITE 219 Other: 25.02
City /State /ZIP: TIGARD, OREGON 97223 Subtotal
Minimum pennit fcC; $72,50 72,20 175; lit
Phone: (503) 246 -1201 Fax: (503) 246 -1205
CCI3 Lic,; 169844 SA�� ,-Plt1 :.. g Lic. no,: B117 plan review (25 % of pctmit fcc)
irf State surcharge (123/4 of permit fcc) 8.66 :� A
I ,,,
Authori2ed signature; i ., J TOTAL PERMIT PEE 80.86 V 1 G. 10
Thi permit a p il soalion expires Ito permit is not obteined within 180 days
Print name: ANDREW : 1 URIC Date 12!10 /IO after it has been aecepted es complete.
'Fee methodology set by Tri- County D ui1ding Industry Service 13orrd,
I: Tvilding\ Permil .TLMU- PermitApp.dnc 10 /01/09 440- 45161(10 /01 /COwIYr:B) V �Cr4y
` n it S' Si� c� MMN - e Y
i A iN710 P, T.
Dec, 10. 2010 11:32AM
Rel ent Plumbing and Mechanical No. 0774 P. 1
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty' Fee (ca) Total Square Footage: Permit Fee:
Footing drain - Ir' I00' 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 ry
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
Stomt & Rain Drain - each additional 100' 37.52 $5,001.0010 510,000,00 572,50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Ql Fee (ea Total each additional $100.00 or fraction thereof, to
and including 510,000.00.
Inspection of existing plumbing or for 510,001,00 to 525,000.00 $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 thcrcof, to
(minimum charge —1/2 hour) and including 525,000.00,
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 thcrcof. to
Rcintpection Pecs 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and tip $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 ail 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
_ Previsus • Capped Added Exlsllnp engineer.
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
Bath -Tub /Shower as defined in OAR91S- 780.0040.
-Jacuzzi/Whirlpool
Car Wash -Each Stall 1:1 Medical gas and vacuum systems for health cart facilities.
Drive That El multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 -780 -0040.
Dishwasher - Commercial
1Jomcstic Subunit 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
- 3" 2 that meet the qualifications above.
- 4"
Car Wash Drain
Garbage - Domestic
Disposal -C dmstria(tal Comments regarding fixture work:
Ice Mach. /Refrig, Drains -
OiI Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory _ . _ 2 1
- 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
WaterExiractor plumbing permit can be issued.
Water Closet - Toilet 2
Urinal _
Other Fixtures; f I G O1 0
http: / /www. tigard -or, gov /ci ty_hall/ departments /cd /docs/IL1v1P- PermitApppdoc
Accumulative Sewer Tally Parcel # 2S101ADO3500 ' ` '
Tcnant,Name: QUEST DIAGN,OSI'ICS This SWR# NONE',. . •
Sitc.Address: 6600 SW`HAMPTON<S-1REET . ° ;',.: ' This PLM# ' PLM2010- 00386 , - ' .
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 , - `i , 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 2 10 0 -2 -10
- 4 inch 6 ,' 0 0 .. 0 0 0
- Car Wash Drn 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 . v 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 s; <. 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 4 l : 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 1";1'i`, 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0
Water Closet - Toilet 6 0 22 12 0 - -
Urinal 6 0 0 , 0 0 0
Previous EDU Count , , 0 0
Capped EDU Credit r 0
TOTALS 0 _ 0 6 26 1 2 _ -5 -24
Current Fixture Value -24 divided by 16 = -1.5 Current EDU 1 EDU = 5 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -24 divided by 16 = -1.5 over (under) $ (6,150.00)
Enter EDU Change Here . -1:5,
Notes: ** *CREDIT* **
Authorized Name /Signature::BRANDEN, lAGGART'X2449 _ Date: ' " ,12/10%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.
L\ Building \Sewer Tally \Sewerl - allySheet- 3600.xIs 06 /25/08