Permit � � CITY OF TIGARD PLUMBING PERMIT
' ''-' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00021
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/25/2011
Parcel: 1S134A006200
Jurisdiction: Tigard
Site address: 10565 SW NIMBUS AVE 100
Project: TSE Subdivision: Lot: 0
Project Description: Add (3) new sinks.
Contractor: POWER PLUMBING CO Owner: ROBINSON, CONSTANCE A &
PO BOX 19418 ROBINSON, LYNN ET AL
PORTLAND, OR 97280 BY KG INVESTMENT MGMT
10240 SW NIMBUS AVE #L3
PORTLAND, OR 97223
PHONE: 503 - 244 -1900 PHONE:
FAX: 503 - 244 -8825
FEES
Quantity Description Date Amount
3 ea Sink 01/20/2011 $75.06
Specifics: 1 12% State Surcharge - 01/20/2011 $9.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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 q • ions ; • UNC b calling 503.232.1987 or 1.800.332.2344.
Issued . y: _ , /,' o ! Permittee Signatu r ,
Call 503.639.4175 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.
Accumulative Sewer Tally Parcel # ii-S134AD06200; - M - • -
tenant Name;•:fSE.Inc x _ '' • . • • . ' • F x -. This SWR# • 20 . 1.1: 000166 -
c: • ' _ts ':
;itcAdilress: - 1'05 6 5 - SW.Niinbus #100 „ ",>. This PLM# 201 -00021 _ • ' .
ixrurc Value Previous Previous Credits Capped Fixture Fixture New Ncw
• # value capped off value added added total total
count off #s count # value #s values
3aptiscry /Font 4 ' 0 > �s a,1,1 0 0 0 0 • 3ath - Tub /Shower 4 .: 0 ' , ` +.; '?' 0 . . 0 0 0
- Jacuzzi /Whirlpool 4 t 4 0 ¢•`r " °� -Y `; 0 " ?
0 0 0
ar Wash -Each Stall 6 ' . 0 •° � , 0 0 . . e 0 0 0
- Drive through 16 0 0 , 0 0 0
2uspidor /Water Aspirator 1 .. 0 ; r7:: ", ' 0 0 0 0
-
Dishwasher - Commercial 4 0 ';," .'r; 0 0 0 0
Domestic 2 0 0 ., 0 0 0
Drinking, Fountain 1 - . _ ; 0 •, ''''',""-..-„°, 0 0 0 0
l'yc Wash 1 . .. . 0 :'i:. - • : . 0 .. - 0 0 0
.door Drain /Sink - 2 inch 2 , •-- . ••,y 0 -'9„ , 0 r 0 0 0
- 3 inch 5 0 4 .. 0 .. 0 0 0
- 4 inch 6 .';a °.'•,4; 0 . ::.t,` r ' 0 0 0 0
- Car Wash Drn 6 !E,' '':',"-•:::: 0 'f . % " 0 0 0 0
Darbage Disposal
- Domestic (to 3/4 I -1P) 16 • r 0 . ar't:', 0 .: . ■ 0 0 0
- Commercial (to 5 1 -IP) 32 0 0 . -- 0 0 0
- Industrial (over 5 1 -1P) 42 . , 0 •- . 's 0 - , 0 0 0
ce Machine /Refrigerator Drain 1 0 ._ . 0 0 0 0
Dil Sep (Gas Station) 6 0 0 ,, :- 'I;. ,7. , 0 0 0
.2ec. Vehicle Dump station 16 :' :s' ? ;� 0 , ' .: 0 „ ,- 0 0 0
;flower - Gang (per head) 1 - <. r P •' 0 .° ..-;; . 0 , , . � 0 0 0
Stall 2 'a 0 •s 0 : 0 0 0
;ink - Bar /Lavatory 2 : ;. I:: , 0 . "= „ > t ,' m ., 0 0 0 0 • Bradley 5 0 ' '. 0 ., 0 0 0
- Commercial 3 • , • 0 ; ' }r ,'i 0 . : 3', 9 3 9
- Service 3 - • 0 0 0 0 0
swimming Pool Filter 1 0 • • , ,",.'''7, : • 0 0 0 0
Washer - Clothes 6 - . 0 . ' .,. 4 0 ..' 0 0 0
Water Extractor 6 0 0 t. 0 0 0 •
Water Closet - Toilet 6 0 <y'v 0 , 0 0 0
Jrinal 6 - .„• 0 0 0 0 0
Previous EDU Count - _ 0 0
Capped EDU Credit ' • • 0
[D I'A S 0 _ 0 0 0 3 9 3 9
Current Fixture Value 9 divided by 16 = 0.6 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 9 divided by 16 = 0.6 over (under) $ 2,460.00
Enter EDU Change Here ; . 0
'Jotes:
Authorized Name /Signature: Debbic'rAdaritski - , . „i - - • Date: . - .1/2072011
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.
: \Building \Sewer T ally \ScwerI'allyShcet- 3600.xls 06/25/08
J AN /19/2011 /WED 10 51 AM POWER PLUMBING FAX No, 503 244 8825 P. 002/004
Plumbing Permit ApplicatioRE F l
lding Fixtures FOR UFFICE USE ONL\
City of Tigard JAN 19 2011 Received , Ar� 1 0 PerotitNo.: 00,/,,,„-_,c,a
. q 13125 SW Hall Blvd., Tigard, OR 97223 p
Phone 503.639.4171 Fax: 503 -59$• OF TIGli 1D D eµ Other Permit No,: Of , 4 .. • o
T I G A R Li Inspection Line: 503.639 0 Date Ready/By: See rage Z for
Internet: wrnv.tigard or.gov BUILDING DIVISION tuns: Notified/Method: Supplemeotallnformation
r rs , rr , t f> } n r . z* ,: t -- T -77.7 -""f - l .: r' fir' - t 7 § 7 Y.
H�i��`� -� i ' tt� '� , (�y�' r' �• f .i. ' '��C .`�yj' � � � G,�7 a f , 1 I �- !�1�4� -""li I �. � .� .�- r "';�2 f � ,..^14"C 4. , 'rvTRF'� - rr^"'"'
B� �1' i t i $ I r "" I ! ) .:e� �17./ 1 F (0 '!�i t5 4 9 �I� I•.J , �#1. dCC 'v+t ,`., , ' : rv; 1 i L ''^,: T n ,lrl CFr' r I. { H
L'11wN�wC�. ,+ .!ttft���.��: ",.._�t�.l.� : 1 .;:ufrt ..: sal :u�:......�'a1:c.'��, a:' � A? G. a�... � l�iR.' �„ i�. s.: u�tni :�Jbrl'flh: „S'a�i'13
❑ New construction • ❑ Demolition For special information use checklist.
Descri.tion a . Ea, Total
►'4 Addition/alteration/replacement . Other: New 11 -2- family dwellings (includes 100 ft. for euch utili connection)
ur ta'r ' " i t'MU")'i± fi trr e,rT'Wni MU o c p .�!I cktrl �CT"1 1 ,r t M 'M nait i ° : � SFR (1) bath 3 2.70
t' • ∎- n,. i .,1...0 u�, 4t ..,t:ea ....z.4..- ' ,. '`• Elf .tl,. �:� >,.6',_If ..1:411 •A • , () 1
❑ 1- and 2- Family dwelling Az Commercial/industrial
SFR (2) bath 437.78
❑ Accessary building ❑ Multi- family spit (3) bath 500,32
Each additional bath/kitchen 25.02
0 Master builder ❑ Other
� , K �: ,rb t;;:WC di r ° (rt tb , +' a"'H. > �j' ;"tiT *T'I" S l v Fire sprinkler ( sq. ft) Page 2
�µC, ,.n ; M V�, �+a I y, rr 11 y � i • :v ,l tc:., - f r � l i z. 717.J��J,.l r-,4 . k . S ntllltle9
GY, ...tt •: .• P • sk • .. (•.:7im'?,.,'- el.... 3 :3� i ^�L` n..-t . :h s- :tu08ID.r' • . r t . 2!,
Job site address: j 054,6 sw \ Catch basin or area drain 18.76
1 T mb� AJ CXLU i Dtywell, leach line, or trench drain 18.76
City/state/ZlP: T t C c - 9 J
r ,�� Footing drain (no. linear It,; ) � Page 2
ldg.
Suite pt no.: Project name: T v -\- , 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
Water service (no. linear It.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: /5 f ' I a40 Backflow preventer 31.27
„�p �rn Inn i } % a .. r t :x2iie e 1 <tt t I,m 7 T f,i , ,. , ' ater valve 12.51
`ti rd.r r 1, 1 ",irr/�tv,' y it 9S � I te C k0 . ,..0 m ,r, ) rav , ., .. '� w itf "7 , � ec'.1CW
- Clothes washer 25.02
(' 3 K.-) ' 5 n K4-, Dishwasher al 25.02 imi
Drinking fountain 25.02
Ejectorslsump 25.02
- ' 4'ipr e , u rY w wp t w y s sc ru k nl lv " "t:1t)' �,AT -11 Expansion tank
C S:.,. -:1 4'..,,44++ - � ,r �'L. '$ d in. , Yr. Wirt;A Z A d,•14: ;;
Y - 4.. n L'.
Fixture/sewer S
r. � , Fixture/sewer cap 25.02 ill
Name: KG rivC �Me � e ` Floor drain/floor sink/hub 25.02
Address: 10 1 -[O St,..) "^ -- Av t L 3 Garbage disposal ■ 25.02
City /State/ZIP: Pbcic`a,M•9, CA. . ci 7..D a 3 loose bib 25.02
Phone: ($03) 5`jg - g -s • Fax: (503) 558 - 998'a Ice maker ■ 12.51
DEng },cam 1 /� +, wtt�t 'mot {r of a� =.
C! r, 1 �_. anW� ' :'It`j�...�,"+.i. + 1 -�s i ma c. wrr :t.'0 "'in�° ` „F t interceptor /gre'ma trap 25.02
Business name: Medical gas (value: $ ) Page 2
Pou��s Pt u�+•b , rr. c�.
uROOe `, ' 1 Primer 12.
Contact
M . h� , W i<n Roof drain (commercial) 12,51
Address: _ . l l 31.0,.) M. _ . a ... " 61 u sink/basin/lavator 3 25.02 7 . O _
City/State/ZIP: o _ • g , _ Solar units (potable water) 62.54 _
Phone: (60S) e} t. y _ k g pO Fax: : 6-03) , / j 6 Tub /shower /shower pan 12.51 NMI
E -mail: / iK c- .1t . , n co,co
25.02
�'"f S`j1i 4 o 11k J y (G1 n E' P i k 1 1 n1 qt {IzY •... 1. 'i 25.0 2 M
ti: ee'-' ,. ' ftE�,:. it i- ct^ t^ 1t r_r"..'FLL_4.� 1 -11-: a' �-1. :i P , t ,k .. _ Water heater 37.52
Business name: O�� � y �T� ; , R C� l [) , f� 1 Water piping/DWV 56.29
_.Addtess: � (.Q ' b- 0 -1 -t, i _other! -23 -02 -
City/State/ZIP: fl 31,_ f DR, q7. - Subtotal 75.x6
Phone: (6b , 3) y q q, _ ) 9 Fax: (6 „<„,/y -88 g 5 Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lie.: 6 Plumbing Lie. no. :Z ( p6 State surcharge (12 °!0 of permit Fee) p , ,
1
Authorized signature: _ TOTAL PERMIT FEE 19BM
r Tbia permit application expires if a permit is not obtained within 180 days
Print no ne: i2_�� 1 0. f G.n I Aate: 'r after it has been accepted as complete.
'Fee methodology set by Th- County Building Industry Service and
cA&ultlinTermits1PI.MU Petm(Wpp.doc 10/01/09 44046167(10/02/COM/WEB)
JAN/1/U!!/'NU 1U:51 AM AMEN PLUM:31NC ifAX Na, 503 244 0025 K003/004
P1umbin Permit A lip cation - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su • • ression S stems:
i L.. 71. ^y 11,' ^ la : e . {':.d m,Sisi ?,M "S"N r�;1.LY ' : ' ,, i T
;91.7.3}"y' I_ , , ,7,yt 7'" 1"i;', k, v f!{l' it, n a .u¢ tr. •„r•
Y�r�(rr..l 4. . .v : }I t ? u�.4 t 4;;; -, ' , w J' r � t ! • q !�� 4 �,. 4,44 r � r rU 5.0 4 , } r � i �)..�1�7 , .. 1
RAIL �e1a �; ,t t 1 { ..k I f { i �$t ,� ° ", t "c J.t Y;� r .4 a ,.:' , P F
.. L"�A,..a�uc ..r_ .z;. r � ,i ,. .... a.x tr.(t`...._.0 t ;1 rl.,f, +u .rl..er;,.,t rd „...e ,..M �.r , f.,,n;,. ,�..r ,.�... .,f. mr�r. -n � Y. r f ,t { .�{:1J . 1 rl r_N �1• � :..�_ . �.}t,.{a'i�..r.._xa:
Footing drain -1" 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2001 to 3,600 $169.69
Sewer - 1st 100' 62.54 MN 7,201 and 7,200 e $233.20
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 ' l t l 1 ,{ c Y 1 �C rl r I1 '' „ Y.. r i r r P ` ., N r 1 } „` • 7:,%...'„-,:,..^.''i-r,...-,`
Storm 8c Rain Drain 1st 10 1141111111111 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rana 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
c t i , r 1, r , ,, t �'�++ y t � ` �, t � each additional $100.00 or fraction thereof, to
{ t,.j `£ tl t a M I 1 t .f7 ' w .- } I > 5-r- :f r
r �
:.nz..vr r��:,r��r��, ,�r'�- ro�n._t( ?'k. �: ,.�'.,%rr *, . mstr /'V' 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 char • e -1/2 hour and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 1 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum char _e -2 bolus 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 eh ;e -1/2 hour) each additional $100.00 or fraction thereof.
Subtotal: .11111111.1111111111111
Commercial Fixture Work:
Are you capping, adding or replacing fixtnres_ if "yes", f,.
, ,, k ; 1. a)1ly } ,tei,.,2 li i: ki i r t 7 ` r e 5,4 >
please indicate work performed by fixture. Failure to Plan, review is required for any of the following_
accuratel re ort fixtures could result in increased sewer fees *. PIease check all that apply.
i. " i, , -i;; ${ air4 µatr1. R. idaioiii r.•.}'(k3 - titan. mid eiroriiied,. ❑ Any new commercial building with water service 2" and
/.�i k;•'% d lrst t greater, except systems designed and stamped by licensed
:',1: °,.. _ , ;. , ;1. " : Sevt. � i 11111 engineer.
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
• " Bath ' - Tub/Shower as defined in OAR918- 780 -0040.
- 3acuzzi/Whirlpoo]
- Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -E
-E tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator - . . CI Any complex structure as defined in OAR918 780 - 0040_
Dishwasher - Commercial
•
Domestic - Submit / sets of plans with any of the above.
Drinkin Fountain
m, L 1 r y ,
• Eye Wash =rr%F r N N 1r t , f ' OW t l e ' rd'M t 1 " '. ' � r "� 7" 707767: 73 5T"'"7-74 S
.i..» a7 , I,1 r I,If r a�, ;, r �_': i�...:t". "[
.. . Floor Drain/sink - 27 .. - • -•• • PI Isometric or-riser-diagram is required for new buildings • " " --
3., that meet the qualifications above.
.q'
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial • Comments -regarding-fixture work: •
Ice MachiRefrig. Drains
Oil Separator (Gas Station) -
Rec. Vehicle Dump Station
Shower -Gang
_
-Stall
$ink - Bar/Lavatory ,
-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 Finer ._-. fees assessed for the sewer increase must be paid before the
Washer -Clothes
Water Extractor
plumbing permit can be issued.
Water Closet - Toilet_ ,
Urinal .
Other Fixtures: -
http : / /www.tigard- or.gov/ city_ hall /departrnents /cd/docs/PLMl - PetmitApedoc