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Permit CITY OF TIGARD PLUMBING PERMIT 7 g COMMUNITY DEVELOPMENT Permit #: PLM2011 -00184 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/10/2011 Parcel: 1 S134AA02100 Jurisdiction: Tigard Site address: 10300 SW NIMBUS AVE PA Project: Spec Space Subdivision: SCHOLLS BUSINESS CENTER Lot: Project Description: Remove and replace (6) fixtures on existing rough -in. Cap (1) service sink. Contractor: ASSOCIATED PLUMBING CO Owner: HANSON, RONALD D 200NE VICTORY AVE "C" ROBINSON, CONSTANCE A GRESHAM, OR 97230 ROBINSON, CHESTER TRUST ET AL KENNEWICK, WA 99331 PHONE: 503 - 492 -1922 PHONE: FAX: 503 - 492 -1923 FEES Quantity Description Date Amount 1 ea Dishwasher 06/10/2011 $25.02 Specifics: 1 ea Fixture /Sewer Cap 06/10/2011 $25.02 3 ea Lavatories 06/10/2011 $75.06 Type of Use: COM 2 ea Water Closet 06/10/2011 $50.04 Class of Work: ALT 1 12% State Surcharge - 06/10/2011 $21.02 Type of Const: Plumbing Occupancy Grp: Stories: Total $196.16 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 Notific- . -- ter. 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 • .estions to O► C by calling 503.232.1987 or 1.800.332.2344. Issued ;y: r . PermitteeSigna •re: L t � 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 ,v Building Fixtures SO FOR OFFICE USE ONLY t� Received City of Tigard 0� s, u e °, r.)atc /far ' Pcrnu Nu. 13!25 SW I l ll Blvd., OR 9722 \\\ \� r � ��i Rcvic�� - _- r • ' � f I 'g/ i : ` . Phone; 503.639.4 F ax: 503 J" G' ii By: Other l'rnnfl No.: Inspection TIGARD 1 „ 50 975 inc: 3,63.41 0` �i Mac Internet; Li ga 3.63 .41 RcndyBr ,iris ( - GI � ,�\� O Notified/Meth Supplemental Information i 0 see Page 2 far • Tire: .OF W CII2IC \� FEE* . SCHEDULF ❑ NCW ec)t7SLn,FCtjOn ❑D emolition For .spec injormorron use eheckiin, - - i22 erip ion -.... (11,'. ` .. T'- • lia. ._I Tidal L Addition /alteration /replacement ❑ Other: New t- 2- family dwellings (Includes 100 li, for each utility connection) CATEGORY OF CONSTRUCTION SIR (I ) bath 7 _ - ❑ 1- and 2 (family dwelling ,LT•LOmmeretal /industrial Sr'R (2) bath 437.78 Accessory building .w - " SFR (3) hat, 500.32 g ❑ Multi- Family 0.32 Each additional bath/kitchen 25,02 0 Master builder ❑ Other: _ ry Fire sprinkler( s 9 ti.) page 2 JOB SITE INFORMATION AND .LOCATION Si re utflities: - - i ob site address: Catch basin or area drain 18.76 , e ,, jAittges„_. „ dl' __...._... .._,._.. _.. ........ City /$Late /7_IP: �- � O _-:' - -- C)rywcl leach line, yr trench drain -- -- 1$,76 �� . ... . ...._ / 7Z _. -. -. I•uotfn. drain (nu. linear f1.: ) Pagc 2 ✓? P / xi Project name; < __ - °• . - _- cp." ., s Menuaictured home utilities 50,03 Cross street /directions to job site: Manholes 1 8.76 a r N>°�5 ��. R drain connector 18.76 Sanitary, sewer (no. linear It: ) Page 2 - • Storm sewer (no. linear A,, ) Page 2 '" Water service (no. linear R.: 1 Page 2 Subdivision: i,ot no - _ „- fkrurcnritem: Tax leap /parcel no,: / - A A Oai1 t r:lackllu,r prevcntcr 31.27 D SCRIPT'ION OF WORK Y• f3ackWFllcr I2.�1. Clothes washer J5.02 ' -- picgwa7hc GAP ! w o`'k 4 r ' S A-Irr1/J Drinking fpunrain 25.02 2 Ejectors/sump -- 25 ()2 PROPERTY OWNER . W` ©'TENANT f tank 12.51 Name: ('ixtureIsewer 25.02 o - '° Floor drain /flour sink /huh 25 07, Address; <iarhagt disposal -_- __._. . p al 25,x12 C ity /Starc/ZIP: -° - - ...... _.. f lose bib 25.02 Phone: ( ) Fax; ( ) Ice maker 12.5 f ❑ APPLICANT lntcrcc tor/ sc trap 25.02 0 PERSON rca t I g Business name: - Medical gas (vnb.ic $ ) Page 2 - _........ -. _ Primer _.._ Contact name: 1 2.51 _ Address; - -- Fool' drain (commercial) _ 12.51 -- ... - --,... S l n l: /ba5111 /lavil to r} ] 5 .0 City/, talc /ZIP; - - -... -.._. Solar units (potable water) 62.54 Phone: - Faa,e; ; ( ) 'Pub /shmvcr /Shower pan 1 2.51 E i lrinal 25.02 Water closet. '... .CONTRACTOR _ -- 25,gz c� . y Water burlier Business name; . .... -.. _,. 37.52 - _ tom_ -.-� ::, _ !4__..,_Ce . water pij,inglr�wv 56.29 r, .V „r d • Address: fo „ Other: --- ..........._ L• '/ ' , 7'?aft y V C 15.02 City Sta /ZiP: l'.e/io n e 9 Subtotal IIN9tFlf Phone: (5 ) 4/.72, - ,1 z' Fax: (rte)) 4741"4. - + Plan Minimum permit rec: $72.50 - -- - _ titn l h 1 25 plumbing Lie CCB Lie.: 4,6-7 Pr8 11/51/2- . no,: _ Yitt P$ - -- - -- -- - - -... cvt +t ' %nl permit fcc) - -_' - rcharyc (12' Ynol' ,crmit a Authorized signature: ��� � 7( _. • ..._..__._. -..... _ 1 Fee) �l0 6.- - iJULC; - i IO, act mil nppII n lfternir hr4r. _-... TOTAL. PERMIT FI -;r; / y /�'" Print name: iSpC ./1 q ... t by _.....___ ���� ca if n prrntlt is net obtained within IRO days been accepter! as complete. "Fec methodolo •y s et b, Tri- County Buildiul* industry- Service Bmrd. I t av lld ingtPermllsIPLM lb.PermlrApp.dac nlm 445-41 STll(7/n:icOM/wfa) Piumbin Permit Applicim - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire uppression Systems: Site Utilities Qty. rocs (en) Total Square Footage: Permit Fee: Footing drain - 1'a 100' 50.0:1 1170-2,000 $12L911 " ,. Footing drain - each additional 100 :17,57 Z,71QI to 3.(70(1 — - $165).69 — _...... 3.6(11 lu 7 $233 '20 3 — - - -_ Sewer - 1st Too' f7 7.701 1I1d ' ErcaiCr $377.54 Sewer - each additional 100' 37.52 "''• " Water ServiCC - Ist 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 • ,. --•— • Storm & Rain Drain - ist 100' {,7..54 Valuation: ,., Pe rmit Fee: torm & Rain Drain -each additional IUO' 37.52 $1,00 to $5.000,90 Minimum fee $72,50 S o. -- $5,00 f ,00 to $10,( 0(l 00 $72.50 for the (ir5( $5,000.0(1 and $1 for Other Ins' ectio>ys or Fees Qty. Fee (ea) Total ' each additional $ I00.00 or fraction thereof, to to $5 Inspection of cxisii,Tg plumbing or for �� „ and including $10,000.00. which no fee is specifically indicated 90.00 /hr $ I0,00I.00 to $25,(100,(1(1 $148,50 for the first $10.000.00 and $ 15.1 lhr w hich o char�c- 117, hour) each additional $100.00 or fraction thereof, to (minimum outside of horn,, hnsincss 90.00 /hr - $ _ and inclt1Ch11 $25,000.00 ..,. lout's (minimum charge -2 hours) 2 5,0(1!,0(1 (1.000.0(1 $379,50 for the first $25.000,0(1 and $1.45 for Reinspcction Fees 9O,0O /hr each additional $100.00 or fraction thereof. to _ 5742.00 fur the first 556,000,00 and $1,20 for and includm4, $50.000.00. Additional plan review for revisions 90.00/hr 550.001.00 and up (minimum charge - hour) _.,.__.. __ _each additional $100,00 or fraction thereof. SiiViotalt Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes", please indicate work performed by fixture. Failure to Plan Review for .Plumbil Installations F Isin review is required for any of the following. accurately report fixtures could result in increased sewer fees'. Please cheek all that apply. Quantit b e Work Performed ❑ Any new commercial esystems s d o s ing with water service 2" and Fixture Type: Replace greater. excepl t s systems designed and stamped by licensed tislatln; engineer. 13apestry/r -n.t Bath •Tub/Shnwcr ❑ New exterior plumbing site utilities for any complex structure Jacuzzi/Whirl ool as defined in OAit91 8- 780 - 0040. Car Wash -each Bran ❑ Medical gas and vacuum systems file health care facilities. Drive Thru ❑ Any multipurpose lire sprinkler system. Cus•idnrlwatc,' ;rtl0r ❑ Any complex muclure as &tined in OAR918•780- 0010. Dishwasher - Commercial Domestic 11111N11 $ubmft 2 sets of plans with any of the a bove• Drinkin_ Fountain Eyc Wash ■ Isometric or Riser Diagram Floor Drain /sink 2 - Ei Isometric or riser diagram is required for new buildings q~ that meet the qualifications above. Car Wat Drain ciarbage Car IIIIIIIIII Disposal •Commercial MIN Industrial Comments regarding, fixture work: lee Mach,/Rcfri_. Drains oil Sc aratnr Gas Station — W Oc oil oast Dump Station MEM Shower -Gang -Stall ��� �._. Sink -Bar/Lavatory - Bradley _ . - Commercial KINN *Note: if the fixture work tinder this permit results in an - Service increase of sewer L ;CUs, a sewer permit will he issued and w — S • 1'o r Washer • Clothes fees assessed for the sewer increase must he paid before the Water Extractor _� plumbing permit can be issued. Water Closet - '1'nilcl Urinal Other Fixtures; C Users \Ocaner \Deskt0p1Document..s \Documents\ Permits 1Tigard Plmb.d02 Accumulative Sewer Tally Parcel # 1S134AA02100 Tenant Name: Spec Space ** *CREDITS * ** This SWR# N/A Site Address: 10300 SW Nimbus PA This PLM# 2011 - 00184 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 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 - 4inch 6 0 0 0 0 0 - Car Wash Drn 6 0 0 0 0 0 Garbage Disposal - Domestic (to 3/4 HP) 16 0 0 0 0 0 - Commercial (to 5 I-IP) 32 0 0 0 0 0 - Industrial (over 5 HP) 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 0 0 0 0 - Service 3 0 1 3 0 -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 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 = $ 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: ***CREDITS*** Authorized Name /Signature: Debbie Adamski Date: 6/10/2011 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. L \Building \Sewer Tally \SewerTallySheet- 4100.xls 07/01/10