Permit CITY OF TIGARD PLUMBING PERMIT
1 1 1 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00043
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/04/2011
Parcel: 2S113AC00103
Jurisdiction: Tigard
Site address: 7244 SW DURHAM RD, BLDG# M
Project: RSD Refrigeration Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Interior plumbing: Capping (1) sink and relocating (1) 2" floor drain.
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
1 ea Fixture /Sewer Cap 02/04/2011 $25.02
Specifics: 1 ea Sink 02/04/2011 $25.02
1 12% State Surcharge - 02/04/2011 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment - 02/04/2011 $22.46
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $81.20
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 1.800.332.2344.
Issued By� '— Permittee Signature: '
Call 503.639.4175 by 7:00 a.m. for the next available i - pec4ion 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 • each inspection.
Plumbing Permit Application 2// 4 - 7
Building Fixtures \\150 FOR OFFICE USE ONLY
Ci of Ti and Received P ermit No.: � M
IN
w 13125 SW Hall Blvd., Tigard, OR 972 \\ Plan
Date/By: , t ( 1 / ! Y" 1'�(j // eft 43 a JJJJJJ `l, P Ry e Other Permit No.: � 0 - h . t k �+ik,
Phone: 503.639.4171 Fax: 503.598.1 60 k D ateB : / (/tlr�
T I G A R D Inspection Line: 503.639.4175 r G� late ReadyBy: u y ®See ppl Page 2 for Information
Internet: www.tigard- or.gov n �' �. ` `l otified/Method: / 04& Suemental
TYPE OF WORK c �`l .�T�� ♦� 1 FEE* SCHEDULE
❑ New construction ❑ Demolition ` For special information use checklist
Description I Qty. I Ea. I Total
p �
�°�t Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
111 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building SFR (3) bath 500.32
ry g ❑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: 7l L/G/ Slv ,O,avLiaA4/e -' 3"7� Catch basin or area drain 18.76
City/State /ZIP: 7-0, &,4 q)2.1. Drywell, leach line, or trench drain 18.76
905/1 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: n 0 �. t
I` D 4
S vJ 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:
Tax map /parcel no.: Backflow preventer J 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/. Clothes washer 25.02
CAQ. 5 i t /CC-) r F/ oty-- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: P.),.., T Fixture/sewer cap 5-11v1( A 25.02 ,i25b Z
Floor drain/floor sink/hub i(�p / 25.02 y s - ; o Z
Address: / o S w Se
S 3 S� S IJI/or/ - 4- o-61 y Garbage disposal 25.02
City/State/ZIP: T t`y 2 on , S 2.1)-1 Hose bib 25.02
Phone: ( re3 ) Gy4_c3 c0 Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name: 0, X - i /l clsrcel:9 /
Primer 12.51
Contact name: Sce /`a ,
Roof drain (commercial) 12.51
Address: (7 p, k .„( 1 i , Sink/basin/lavatory 25.02
City/State/ZIP: Pc„,/-7 i U/j ,. g jZl Solar units (potable water) 62.54
Phone: 032 ) - 2 ( 60- 5 o C Fax: : (OS ) '-q ( 22-/ / Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal A t/
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 71 p"
C / c , Plumbing Lic. no.: 2-.4*- - 7 36 Pia Plan review (25% of permit fee) -
CCB Lic.: / 5
State surcharge (12% of permit fee) 7v
Authorized signs TOTAL PERMIT FEE _
Print name:� Date: 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.
I:\Building\Permits\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 - 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
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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
P 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
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
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" i ❑ Isometric or riser diagram is required for new buildings
3 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
- 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
•
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I: \Building \Permits \PLMF - PermitApp.doc 2
Accumulative Sewer Tally Parcel # 2S113AC00103
Tenant Name: RSD REFRIGERATION This SWR# NONE
Site Address: 7244 SW DURHAM RD, BUILDING M This PLM# PLM2011 - 00043
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 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 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 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 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 1 3 0 -1 -3
- Service 3 0 0 0 0 0
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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1 3 0 0 -1 -3
Current Fixture Value -3 divided by 16 = -0.2 Current EDU 1 EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -3 divided by 16 = -0.2 over (under) $ (820.00)
Enter EDU Change Here -0.2
Notes: * * *CR1:DI'I' * **
Authorized Name /Signature: BRANDEN '1'AGGART Date: 2/4/2011
Building Division
d ote: 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 \ SewerTallyShect-3600.xls 06/25/08