Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011- 00218
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07(19(2011
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 110
Project: Integrated Services Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Add (1) dishwasher, (1) garbage disposal, (1) lay, (2) urinal; replace (1) existing urinal.
Contractor: CASCADE PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES
2630 N HAYDEN ISLAND DR #3 ATTN: N PIVEN
PORTLAND, OR 97217 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 624 -6300
HONE: 503 - 289 -7095
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Dishwasher 07/12/2011 $25.02
Specifics: 1 ea Garbage Disposal 07/12/2011 $25.02
1 ea Lavatories 07/12/2011 $25.02
Type of Use: COM 3 ea Urinal 07/12/2011 $75.06
Class of Work: ALT 1 12% State Surcharge - 07/12/2011 $18.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $168.13
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, • • - is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility 'otification Cente . Those rules are set forth in OAR 952 -001 -0010 through O• • • - 001 -0090. You may obtain a copy of the rules
or •* ect questions to OUNC ' cal '•. 503.232.1987 or 1.800.332.2344. -
I-sued By: / Permittee ignature:
l / /!1.!�
JP! ✓
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 (2(5/1, 14 ,N r" A -
Building Fixtures RECEIVED f FOR OFFICE USE ONLY !
City of Tigard d 8 Received
Id.- Permit NO /ai aati --- d o � ��
n 131 SW Hall Blvd., Tigard, OR 9727JUL 0 8 2011 bate/By,
• Plan Review .:
• B . Otlte
Phone: 503,639,4171 Fax: 503.598.1960 Date /By; r Permit N /f_OO/6 •
TIGAK0 Inspection Line: 503.639.4175 CIT O F', TIGARD Date Ready /By: luri : El Sec Page 2 for
Internet: www.tigard- or.gov
CITY Notified /Method: il , Supplemental Information
TYPE: OF . . FEE* 'SCHEDULE 'r20 // t9J ,•
I=1 New construction ❑ Demolition par special infOr+>rorron rrse checklist.
Dcscri.tion Qt . Ea. Total
p +ddition /alteration /replacement ❑ Other: New I- 2- family dwellings (includes 10011. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling Commercial /industrial 437.78
bath 500.32
❑ Accessory building [] Multi- family
— Each additional bathikitchen 25.02
❑ Master builder ❑ Other: sprinkler ,
w
JOB SITE INFORMATION AND LOCATION Site utilities: MIN
Job site address: il 1 f 5 e..• v 014,-. Pet.nr � Catch basin or area drain 1 8. 76
Dr leach line, trench drain �
•
City/State/ZIP: t • y A Footing drain , linear
q Suite /bldg. /apt. no.: ( ® Project 1 amc,T}<}Q Ir - p{ 5e.".VI C o w 50.03
Cross street/directions to job site: Manholes 18.76 IIA
Water Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
storm sewer (no, linear ft.: ) Page 2
4 linear
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.:
valve 12.51
DESCRIPTION OF WORK • Backwater
— Clothes washer 25.02
Y t U{{lrN • . ♦ V1 041 Dishwasher ra 25 A2 . - .0 .
I-Q-Yl 4(0u t 14 ) , fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT '
Fixture/sewer cap . t
Name:
- Floor drain/floor sink /hub 25.02
Address: Garbage disposal mr, 25.02 PigrE
City /State /21P: Hose bib MIN 25.02
Phone: ( ) Fax:( ) Ice maker 12.51 MI
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Page 2
Business name: CASCADE PLUMBING COMPANY Medical gas (value: $ ) ■�
- Primer •
Contact name: CRYSTAL JONES Roof drain (commercial)
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Sink/basin/lavatory / 25,02
City /State /ZIP: PORTLAND, OR 97217 Solar units (potable water) 62.54
Phone: (503) 289 -7095 Fax: : (503) 283 -9514 Tub /shower /shower pan PIM
E-mail: CASCADEPLUM@YAHOO.COM QP 25.02 /
. Water CONTRACTOR
closet Water ,
Business name: CASCADE PLUMBING COMPANY
Address: 2630 N. I•1AYDEN ISLAND DRIVE #3 ♦ 25.02
City /State /ZIP; PORTLAND, OR 97217 Subtotal i
Phone: (503) 289 -7095 Fax: (503) 283 -9514 Minimum permit fee: 572.50
I I o > Plan review (25% of permit fee)
(((111 `vv�
IJ CCB Lie.: 120893 / Plumbing Lie. no.: 34-412PB i i
State surcharge (12% of permit fee) gr 0
Authorized signature: 11 . fr la— r 6 I ♦ .
Print name: CRYSTAL DONE r Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted no complete.
.....", i "Fee methodology set by Tri- County Building industry Service Board.
I:\riutldiug /Permitt \PLAMU -Perm@ • P d I Ol /00 4402 /COA4nvE8)
Ee /TO 39 d 3G DsdD iT96E8ZE09 17e :9T TT(3Z /80 /L9
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
• Site Utilities Qt Fee (ea) Total squ Footage: P ermit 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
Sower - 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 $L52 for
Other Ins eetions 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 ", 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.
Quanti by (Fixture)‘ formed ❑ 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
. C4/tl, // as defined in 0AR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash -L=ath Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive Stall ❑ Any multipurpose fire sprinkler system.
Ctis��idor /Water Aspirator ❑ Any complex structure as defined in OAR918 -7$0 -0040.
Dishwasher - Commercial
- Domestic _ i 1 7 Submit 2 sets of plans with any of the above.
Drinking Fountain . , .. .
. .
Lye Wash Isometric or Riser Diagram
Floor brain/sink 2" __ — ❑ Isometric or riser diagram is required for new buildings
3 ' that meet the qualifications above.
_ 4 ..
Car Wash
Drain M G D n e0/I 3 7A 5 i /.? 7)
Garbage - Domestic r '✓ �J
Disposal - Commercial
- industrial Comments regarding fixture work:
Ice Mach. /Refr g. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
•
Sink - Bar /Lavatory i
- 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 xtr lthcs
Water plumbing permit can be issued.
F„�trgetOr
Water Closet - Toilet
Urinal
Other Fixtures:
C:1Documents and. Settings \Cascade Plumbing \Desktop \PL,MF- PetmitAppzdoc
£0 /Z0 SeJdd 3G00300 bt56£8Z£09 b0:5t TTOZ /80/L0
Accumulative Sewer Tally Parcel # , ? , ' &,, 5
v-
` S ervices:. Y ` .;' " . � , „, ”- . This SWR# ,SWR2011 all; ",' € M, d^'l
Site :Address_' '15115 SW Sequoia.Paikway, Sfe': :110, 3, - . `,7, This PLM# !PLM2Q1 ;1= 0021.8.,, a ..` ,r ''.;
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
" 0 _' 0 r " V ,
Baptisery/Pont 4 0 0 0
g'sr -�.:'
Bath - Tub /Shower 4 . ,O 0 '� ` - 0 ,1 0 0 0
°',: '
- Jacuzzi /Whirlpool 4 a: 0 , *3t, 0 _ 0 0 0
Car Wash - Each Stall 6 °° e 0 x, 0 ' 0 0 0
- Drive through 16 ,,: _ 0 „ 3 , '° „ a 04° 0 0 0
Cuspidor /Water Aspirator 1 .. 0 0
V 0 0 0
Dishwasher - Commercial 4 i`,`. ;`: o y,” :' o .r .
Domestic 2 0 a °'P'',` 0
• v'. ,s 2 1 2
v. Drinking Fountain 1 s -y` - ", . 0 , „ , ` 0 �' 0 0 0
,. i ce.: -. 0
Eye Wash 1 „ 0 0 0 0
Floor Drain /Sink - 2 inch 2 -'r 0 0 9 iei. 0 0 0
- 3 inch 5 N, -'-,;Y . _ 0 '�, ,: t: .. 0 f" - ' ", 0 0 0
- 4 inch 6 , 0 x. 0 aN ` 0 0 0
- Car Wash Drn 6 " . / ''a 0 1 * 1 n 4 : 0 ," 0 0 0
Garbage Disposal
- Domestic (to 3/4 1 -[P) 16 ----. / , 0 . _ t- 0 a '' 0 0 0
- Commercial (to 5 HP) 32 ': '" 0 , ; ,' 0 1 :I � , . - 0 0 0
- Industrial (over 5 HP) 42 .r te 0 -; „. r. 0 � , < p 0 0 0
Ice Machine /Refrigerator Drain 1 ... 0 0 s; '''',, 0 0 0
Oil Sep (Gas Station) 6 0 ' - 0 , . Vi a. 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 ; . v i 2 1 2
- Bradley 5 '"I t , '� 0 -' F :. '. 0 ,a Or' ,r° 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 'r : . er. 0 . "- 0 , v X 0 0 0
Water Closet - Toilet 6 .i ; 0 0 ,g�;i °` 1 0 0 0
Urinal 6 !'. . 0 ,y r `% 0 2,_, /', 12 2 12
s -
r.•. ,
Previous EDU Count 44 ax a 0 0
Capped EDU Credit
_ �r1: 16
TOTALS 0 0 0 0 4 16 4 0
Current Fixture Value 0 divided by 16 = 0.0 Current EDU 1 EDU = $ 4,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 0 divided by 16 = 0.0 over (under) $ -
Enter EDU Change Here i ', .4':k.,- "..i•!
Notes: 7/19/11, 1 EDU credit used from PLM2003- 00356. No remaining credits from that permit. D Adamski.
Authorized Name /Signature :'Dianna Hciwse. "s', '`' a ',' . ! Date: r. ,, 7/-12%2011 `," ",. , 4,4r , • 'Al , , d
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 "I ally \Sewer1'allySheet- 4500.xls 07/01 /11