Permit CITY OF TIGARD PLUMBING PERMIT
111 11 �t COMMUNITY DEVELOPMENT Permit #: PLM2011 00039
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/01/2011
TIGARD Parcel: 1 S 135 B B00500
Jurisdiction: Tigard
Site address: 10355 SW CASCADE AVE
Project: Fisherman's Marine & Outdoor Subdivision: Lot: 0
Project Description: Cap main sewer line, install (1) drinking fountain, (2) 2" floor drains, (2) lays, (1) breakroom sink, (1) mop sink, (1)
urinal, (3) water closets & (1) water heater.
Contractor: RAY'S PLUMBING Owner: RAM /CASCADE CENTER LLC
P.O. BOX 685 BY ELLIOTT ASSOCIATES INC
BRUSH PRAIRIE, WA 98606 901 NE GLISAN ST
PORTLAND, OR 97232
PHONE: 360- 892 -8700 PHONE:
FAX: 360 - 892 -9644
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 02/01/2011 $25.02
Specifics: 1 ea Fixture /Sewer Cap 02/01/2011 $25.02
2 ea Floor Drain/Floor Sink/Hub 02/01/2011 $50.04
Type of Use: COM 4 ea Sink 02/01/2011 $100.08
Class of Work: ALT 1 ea Urinal 02/01/2011 $25.02
Type of Const: 3 ea Water Closet 02/01/2011 $75.06
Occupancy Grp: ea Water Heater 02/01/2011 $37.52
Stories: 1 12% State Surcharge - 02/01/2011 $40.53
Plumbing
Total $378.29
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 ollow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -1190. You • obtain • /py of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800. 44.
Issued By; e - ittee Signature
Ca ° • 175 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 # 1S135BB00500
Tenant Name: Fisherman's Marine & Outdoors This SWR# 2011 - 00026
Site Address: 10355 SW Cascade Ave This PLM# 2011 - 00039
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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 2 4 2 4
- 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 HI') 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 3 6 3 6
- 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 0 3 18 3 18
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 2 32
TOTALS 0 0 0 0 11 _ 38 11 _ 6
Current Fixture Value 6 divided by 16 = 0.4 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 6 divided by 16 = 0.4 over (under) $ 1,640.00
Enter EDU Change Here 0.4
Notes: Capping sewer line to entire building. Previous billing rate was 2 EDU's per Jamie Greenberg.
Authorized Name /Signature: Debbie Adamski Date: 2/1/2011
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 \Sewerl'allySheet- 3600.xls 06/25/08
Plumbing Permit Application-
Building Fixtures FOR OFFICE USE ONLY
City of Tigard B 01 r ' Received PL N �o` /'6003?
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
- Jim p
Date/By: Permit No.:
Phone: 503.639.4171 Fax: 503. Other Permit No.:o4 / ».r
Inspection Line: 503.639.4175��F TIGARD Date/By:
TIGARD �I(�I,P1N(}'I�T� N Date Notified/Met y. luris: El See Page 2 for
Internet: www.tigard- or.gov Iplt�1'r( di? Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I 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
❑ I - and 2- family dwelling ® Commercial /industrial SFR (2) bath 437.78
❑ Accessory building SFR (3) bath 500.32
❑ 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: 10355 SW Cascade Ave Catch basin or area drain 18.76
City /State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Fishermans Marine 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 ft.: ) Page 2
Subdivision: �� I Lot no.: Fixture or item:
e7
Tax map /parcel no.: / , 55-6-to 0 s 730 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Demolition of fixtures and build new restrooms
Dishwasher 25.02
Drinking fountain 1 25.02 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap / 25.02 as. a 2
Floor drain /floor sink/hub 2 25.02 50.04
Address:
Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 4 25.02 100.08
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 1 25.02 25.02
CONTRACTOR Water closet 3 25.02 75.04
Water heater 1 37.52 37.52
Business name: Rays Plumbing Water piping/DWV 56.29
Address: PO Box 685 Other: 25.02
City/State /ZIP: Brush Prairie, WA 98606 Subtotal
Phone: (360) 892-8700 Fax: (360) 892-9644
Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lie.: 33217 Plumbing Lic. no.: 37 - 149PB State surcharge (12% of permit fee)
Authorized signature: X // TOTAL PERMIT FEE 5 7 -. '
Print name: 7 rG ✓CJ_ e � Date: el/1/1( This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
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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 - 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 - 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
Q ty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Other Inspections or Fees 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 ❑ New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower as defined in OAR918- 780 -0040.
-Jacuzzi/Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall
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 1 *I at
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" - �. c� ❑ 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 Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory A . 33
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service E 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
plumbing permit can be issued.
Water Extractor p um g p
Water Closet - Toilet 3
Urinal � I
Other Fixtures:
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