Permit " CITY OF TIGARD PLUMBING PERMIT
` { 7 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00054
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/17/2011
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11131 SW GREENBURG RD
Project: Jump Sky High Subdivision: Lot: 0
Project Description: Additional fixtures for new snack bar.
Contractor: TAPANI PLUMBING Owner: ROBINSON FAMILY TRUST
PO BOX 2350 BY E LEE & EVELYN L ROBINSON TRS
BATTLE GROUND, WA 98604 PO BOX 91305
PORTLAND, OR 97291
PHONE: 360 - 687 -3983 PHONE:
FAX: 360 -687 -4494
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/16/2011 $31.27
Specifics: 1 ea Expansion Tank 02/16/2011 $12.51
4 ea Floor Drain /Floor Sink/Hub 02/16/2011 $100.08
Type of Use: COM 1 ea Primer 02/16/2011 $12.51
Class of Work: ALT 3 ea Sink 02/16/2011 $75.06
Type of Const: 1 ea Water Heater 02/16/2011 $37.52
Occupancy Grp: 1 12% State Surcharge - 02/16/2011 $32.27
Stories: Plumbing
Total $301.22
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 qu tions to QUNC by calling / 503.232.1987 or 1.800.332.2344.
Issued By: , , j ; Permittee S'gnature: )0"
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.
Plumbing Permit Application
Building Fixtures R ECE ' / E D • FOR OFFICE USE ONLY
City of Tigard Received �/6 4, I Permit No.: 1 ,1.14 : 90//-67665 - 11
IN e
n 13125 SW Hall Blvd., Tigard, OR 97PP3 16 2011 Plan Review Date/By: /� .D
• Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.: L 3
/
Inspection Line: 503.639.4175 1® Da te Read /B Juris: 0 See Pa e 2 for
TI C�TY OFT y Ready /By: g
Internet: www.tigard-or.gov rte sic etn nit rc -tnl�l Notified/Method: /y f i Supplemental Information
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TYPE OF WOR 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
❑ 1- and 2- family dwelling jg Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler (_ sq. ft.) Page 2
c d I JOB SITE INFORMATION AND LOCATION Site utilities:
. Job site address: 11/ 3 I $W &-re r` Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tt(,, a f 4 OP q 7 Footing drain (no. linear ft.: ) Page 2
. "1 Suite/bldg. /apt. no.: Project name: `) IA,1 Sky )5 A Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Nilo 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: Lot no.: Fixture or item:
,\ i map /parcel no.: dT IS Backflow preventer / 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
A C: fi S l'Na6 / ' IOC ✓ a v t 40 Dishwasher 25.02
EK ( ti / .) 1,,i/79 Sku ]- i- Drinking fountain 25.02
Ejectors /sump 25.02
4 PROPERTY OWNER I ❑ TENANT Expansion tank I 12.51 12 - S
Name: j / �� �S � � t _ J 1Z( Fixture /sewer cap 25.02
Address: ���"`L' Floor drain/floor sink/hub y 25.02 00 • Cg
'� 6-re - " % Garbage disposal 25.02
City /State /ZIP: -5, � � �� / 9 .D,?- 3 Hose bib 25.02
Phone: ( ),4"7 3 , - _ 5-a 30 Fax: ( ) Ice maker 12.51
1:1 APPLICANT El CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business • Primer i 12.51 /2.-. 5 1
Roof drain (commercial) 12.51
Sink/basin/lavatory 3 25.02 76 : b"
Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
ti CONTRACTOR Water closet 25.02
Water heater 37.52 7 7 - Sa
Business name: T4 ot/Il Pik/4 n a, j t L Water piping/DWV 56.29
ct Address: . 1 . 35-6 J Other: 25.02
City /State /ZIP: (9 Lt. WA 90,6 Subtotal
Phone: (?bp) fj g - 7- 34 � 3 Fax (3 (gyp) ,k - 7_ 0-eq Minimum permit fee: $72.50
CCB Lic.: 645 q S$ Plumbing Lic. no.: 3�� Plan review (25% of permit fee)
e� / / State surcharge (12% of permit fee)
Authorized signature: -- p (OtO TOTAL PERMIT FEE Win.
Print name: j � � I( Date: J/ // This permit application expires if a permit is not obtained within 180 days
[�✓t "` •t' Y7 Q - 1G ( after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
C\ 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 - 1' 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
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.
Quantit 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 Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator I=1 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" ❑ 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
- Bradley
- Commercial 3* *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:
1:\Building\Permits\PLMF- PermitApp.doc 2
Accumulative Sewer Tally Parcel # 1S135BC01100
Tenant Name: Jump Sky High This SWI?,# 2011 - 00031
Site Address: 11131 SW Grccnburg Rd This P1.1\1# 2011 - 00054
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
13aptiscry /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
l 'e Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 4 8 4 8
- 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 HP) 32 0 0 0 0 0
- Industrial (over 5 lIP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 1 1 1 1
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 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 2 6 2 6
- 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 FOU Credit 0
TOTALS 0 0 _ 1 _ 2 7 15 6 13
Current Fixture Value 13 divided by 16 = 0.8 Current EDU 1 EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 13 divided by 16 = 0.8 over (under) S 3,280.00
Enter EDU Change Here 0.8
Notes: 1 sink is draining into 2" floor sink, so only counting the floor sink on this worksheet.
Authorized Name /Signature: Debbie Adamski Date: 2/16/2011
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 credos towards future system development charges.
I:ABuilding \Sewer Tally \Sewer'1'allyShect- 3600.xls 06 /25/08
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