Permit CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit #: PLM2010 -00392
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/22/2010
i {aAR.D Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15951 SW 72ND AVE
Project: Miller Paint Subdivision: OREGON BUSINESS PARK III Lot: 38
Project Description: Relocate: (1) water closet, (1) lay, (1) floor drain, (1) breakroom sink, (1) water heater. Adding: (1) laundry tray.
Capping: (1) water closet, (1) lay & (1) floor drain.
Contractor: Owner: PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE
PHONE: 503 - 624 - 6300
FAX:
FEES
Quantity Description Date Amount
3 ea Fixture /Sewer Cap 12/22/2010 $75.06
Specifics: 1 ea Floor Drain /Floor Sink/Hub 12/22/2010 $25.02
1 ea Primer 12/22/2010 $12.51
Type of Use: COM 1 ea Sink 12/22/2010 $25.02
Class of Work: ALT 1 ea Laundry Tray 12/22/2010 $25.02
Type of Const: 2 ea Lavatories 12/22/2010 $50.04
Occupancy Grp: 1 ea Water Closet 12/22/2010 $25.02
Stories: 1 ea Water Heater 12/22/2010 $37.52
1 12% State Surcharge - 12/22/2010 $33.03
Plumbing
Total $308.24
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, o work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rul- adopted by the Oregon
Utili otification Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may 'obtain a copy of the rules
direct questions to OU .y c:llin• *3.232.1987 or 1.800.332.2344.
Issued By: � / Permittee Signature: '
Call 503.639.4175 by 7:00 a.m. for the next available inspec )" date.
This permit card shall be kept in a conspicuous place on the job site until pletion of the project.
Approved plans are required on the job site at the time of ea ' inspection.
Accumulative Sewer Tally Parcel # '251 " .
Te N'ame: Mi11erPatnt. *',* *CREDIT * * * This SWR# iN /A ,': - -
Site�Address: 1595.1 - SW./2nd _' ,.. _: > :;.; This PLM# :.PLM201'0 00392 , ;
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
- 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 ' f 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 »: 0 1R;. . 2 0 -1 -2
-3inch 5 3 ,,. ; 1 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 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 ,,, 0 0 t' nt n 0 0 0
Ice Machine /Refisigerator Drain 1 ,, 0 . 0 :� 0 0 0
Oil Sep (Gas Station) 6 0 = ,f 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 ,,. , : TI 0 _. ry. 0 0 0 0
- Stall 2 °' 0 •. .... 0 ,', ;' -. 0 0 0
Sink - Bar /Lavatory 2 , ' 0 :; , 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 3
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 . ',; 0 - ..,, 0 „ 0 0 0
'. 0 F;
Washer - Clothes 6 0 0 0 0
Water Extractor 6 0 0 axe -•s 0 0 0
Water Closet - Toilet 6 0 ' a ,,1, z,; 6 0 -1 -6
Urinal 6 r -:
Previous EDU Count , ` '. 0 0
Capped EDU Credit 0
TOTALS 0 _ 0 3 10 1 3 _ -2 -7
Current Fixture Value -7 divided by 16 = -0.4 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -7 divided by 16 = -0.4 over (under) $ (1,640.00)
Enter EDU Change Here , :, •':'='0:'.4* :.-,'
Notes: ** *CREDITS * **
Authorized Name/Signature: ,Debbie Adamslu ,,,,, `, . ., „ -,, s . -., Date: . ....... i2/'22/20 10 • - - ,
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 \ SewerTallySheet- 3600.xls 06/25/08
Plumbing Permit AnplicatipirrCil tED
Building Fixtures FOR OFFICE USE ONLY
City of Tigard DEC 2 2 2010
Date/By: t� a I a , 44 Permit No.: ` U (�QID 3F2-
v 13125 SW Hall Blvd., Tigard, OR 97,4 Plan Review
' C : Phone: 503.639.4171 Fax: 503 .598 1 OCF TIGARD Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD Ready /By: g
BUILDING DIVISION Date Read B luris: I3 See Page 2 for
ar Notified/ Internet: www.tigard-or.gov ov
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
K , 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 1=1 Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder El Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / `15 / - (--t--'72. f`` Catch basin or area drain 18.76
City /State /ZIP: °/ I ,)r j. Oil- , S�) ZL ti/
Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 4 ,, / A , , 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
n Water service (no. linear ft.: ) Page 2
Subdivision: A .1 `a D Q Q 7c / I Lot no.: Fixture or item:
Tax map /parcel no.: ( Backflow preventer 31.27
DESCRIPT ION OF WORK Backwater valve 12.51
Clothes washer 25.02
/9 44, c., , < .. /G ' 'l /4,2.. Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: ,'`: f- f Fixture /sewer cap 25.02
�'l.•s
Floor drain /floor sink/hub / 25.02
Address: / , 3 S L e w C * ) 6 i Z. / A u- x/ Garbage disposal 25.02
City /State /ZIP: r ;,•5 ,y,,.d - ("17, S ) L L'1 Hose bib 25.02
Phone: ( 5; *) C z ' - C 36 Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
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Business name: a d I /t/ c i),.�
J - 0,..4 ,
/ ,L- 1 5 e -t G / Medical gas (value: $ ) Page 2
Contact name: Primer / 12.51
-e. X al, Roof drain (commercial) 12.51
Address: 6 O. Ao'( / i<7G l in asirta a� ) I' . fr •IX' ( 25.02
City /State /ZIP: ��yf , > /i _ 9 7 L9' 3 Solar units (potable water) 62.54
Phone: (57--3 ) ) '- `3 4 eC Fax: : ( Z") 5 C 3 a / c Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet ( 25.02
CONTRACTOR
Water heater 11 37.52
Business name: Water p tp in g/ DWV 56.29
Address: Other: c. / _ 4, / -.L,l ✓ 3 25.02
City /State /ZIP: / .117 Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: / ii_/ 57`) Plumbing Lic. no.: 6 '- 7 3 C�� Plan review (25% of permit fee)
State surcharge (12% of permit fee) :��/ /
Authorized signature C.� TOTAL PERMIT FEE (((((( This permit application expires if a permit is not obtained within 180 days
�
Print name: /(,.<3S Date: 2. L L -( (J after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Buil dineermits\PLMU- PermitApp.doc 10/01/09 440- 4616T(l0 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
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Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
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 Perform ❑ Any new commercial building with water service 2" and
Fixture Type: Re ace \ greater, except systems designed and stamped by licensed
Previous Capped Added E sting I � r IT engineer.
Baptistry/Font
Bath Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
Jacuzzi/Whirlpool 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
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Eye Wash I Isometric or Riser Diagram
Floor Drain/sink - 2" r ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
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 j 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
Water Extractor plumbing permit - Clothes ( lumbin ermit can be issued. p
Water Closet - Toilet
Urinal
Other Fixtures:
I : \Building\Permits\PLMF- PermitApp.doc 2