Permit r y CITY OF TIG ARD PLUMBING PERMIT
II 2 ' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00206
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/30/2011
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 250
Project: Spec Space Subdivision: TIGARD TRIANGLE CENTER Lot:
Project Description: Install (1) breakroom sink, (1) water heater and (1) insta -hot.
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503-236-4152 PHONE: 503 - 624 -6300
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Sink 06/30/2011 $25.02
Specifics: 1 ea Water Heater 06/30/2011 $37.52
1 Misc Other Fee 06/30/2011 $1.00
Type of Use: COM 1 12% State Surcharge - 06/30/2011 $8.70
Class of Work: ALT Plumbing
Type of Const: g ea Minimum Fee Adjustment - 06/30/2011 $8.96
Occupancy Grp: Plumbing
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
issuanc- - • , . • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti • • 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
direct questions to OUNC by - ng 543.232.1987 or 1.800.332.2344.
Issued By: l9 Permittee Signature: /e
L i' —t . 1,
■
Call 503.639.4175 by 7:00 a.m. for the next available insp, tion 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
City of Tigard r6 \\ DateBy: f/ Permit No 1/ ..
lig • ■ 13125 SW Hall Blvd., Ti • • 3
Plan Review
64 0 4
Q view Other Permit No.: r
■
Phone: 503.718.2439 F: 98 �Q69 , Date/By:
tP� / / -, / ;3
`\\ r QC y:
Inspection Line: 503.639.41 v .c \O - `
T I G A R Internet: www.ti ard - or. ov \ \ Date Ready/By: luris: ® See Page 2 for
g g ; (I ,� • Notified/Method: Supplemental Information
TYPE OF WOR*C FEE* SCHEDULE
❑ New construction [i
�nol
� t i on special Fo r s ecial in ormation use checklist
Description I Qty. I Ea. 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 ❑ 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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: j. S a S 5 w c e r/4 w V Catch basin or area drain 18.76
/ Drywell, leach line, or trench drain 18.76
City /State /ZIP: 7 j4.../ , aye - ' 7 J Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: c -JV I Project name: 5P 6/ E., Manufactured home utilities 50.03
Cross street/directions to job site: v• 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.: AS. ( /I - 7O c) Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
/ S / 0- 4 Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: y A c yi- Fixture /sewer cap 25.02
Address: f Floor drain/floor sink/hub 25.02
ddress:
� 5) �Zi S 1 Sea ,, a i a �'� r u a `/ Garbage disposal 25.02
City /State /ZIP: 7 6JV/ 9 ) yay Hose bib 25.02
Phone: (S G .) C,_ q - C 3 G C Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name: 0,a Q „` eit„,a4y _ _ /1/1411 A�1.(C, e /
� Primer 12.51
Contact name: Tt e
Roof drain (commercial) 12.51
Address: /®G / c A At - 70( Sink/basin/lavatory / 25.02 )_ 5 0
City /State /ZIP: Ay-)C 02 , 9 ) _ q 2 Solar units (potable water) 62.54
Phone: (.5 -tc, 7ac . - ,y g (' Fax: : ( ) 19G -y .,/ 8 Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet g$ 25.02
Water heater / 37.52 '3/. lj 1"'
Business name:
Water g� 1 in WV 56.29
P�P
Address: Other: ,i - a XG/ ( 25.02 21"02
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7„,1 .
Plan review (25% of permit fee)
CCB Lic.: r 96 9(9 Plumbing Lic. no.: ). C 3 G t /3 State surcharge (12% of permit fee) I 7O Authorized signature: Xi TOTAL PERMIT FEE �c
Print name: 1" Date: G -1 - t( 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)
PlumbinE 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
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 ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub /Shower ❑ Any new commercial building with water service 2" and
Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
4 " Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic - food
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMF - PermitApp.doc 02/24/2011 2
Accumulative Sewer Tally Parcel # 2S101AD03200
Tenant Name: Spec Space This SWR# N/A
Site Address: 12909 SW 68th Pkwy #250 This PLM# 2011 - 00206
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
- 3inch 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 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 1 2 1 2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- 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 0.2 3.2
TOTALS 0 0 0 0 1 _ 2 1 _ -1.2
Current Fixture Value -1.2 divided by 16 = -0.1 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -1.2 divided by 16 = -0.1 over (under) $ (410.00)
Enter EDU Change Here -0.1
Notes: ** *CREDITS FROM PLM2008 -00003 APPLIED. REMAINING CREDIT OF .1 STILL AVAILABLE,
Authorized Name /Signature: Debbie Adamski Date: 6/30/2011
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 \ SewerTallySheet-4100.xls 07/01/10