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Permit
71 r Y p CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2011 00236 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/21/2011 Parcel: 2S102BD01600 Jurisdiction: Tigard Site address: 9845 SW WALNUT PL Project: United Methodist Church Subdivision: Lot: Project Description: Cap (1) lay and (1) urinal. Install new coffee station, (1) dishwasher, (1) hub drain, (2) sinks & (1) water heater. Contractor: OWNER Owner: TIGARD COMMUNITY METHODIST CHURCH 9845 SW WALNUT TIGARD, OR 97223 PHONE PHONE: FAX: FEES Quantity Description Date Amount 1 ea Dishwasher 07/21/2011 $25.02 Specifics: 2 ea Fixture /Sewer Cap 07/21/2011 $50.04 1 ea Floor Drain /Floor Sink/Hub 07/21/2011 $25.02 Type of Use: COM 2 ea Sink 07/21/2011 $50.04 Class of Work: ALT 1 ea Water Heater 07/21/2011 $37.52 Type of Const: 1 12 %.State Surcharge - 07/21/2011 $22.52 Occupancy Grp: Plumbing Stories: Total $210.16 • 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. '• • - liter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direc estions to OU ► •y calliu • 503.232.1987 or 1.800.332.2344. Issu: d By: , / , Permittee Signature: . r 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 RECEIVED FOR OFFICE USE ONLY • Ci }� of Tigard Received r / Permit No.: (. d , // ` ` ^ /� 1 .4 13125 SW Hall Blvd., Tigard, OR 97223 JUL 21 2011 Plan Review ' I 0 Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit No.: TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: lulls: El See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction 0 Demolition For special information use checklist Description I Qty. 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: q vy3 S (..4-2 I,(ia4,( tit )7 ju,G e..- Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: (779,,k1/4 �2 ©, 7 ��3 �P lI � J}-- Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name:c L 7 p / 3 l 4 j 1 ' v ln- 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 31.27 DESCRIPTION OF WORK, Backwater valve 12.51 n Clothes washer 25.02 V�QUO t✓ e- 0 .l rY•lu -\ - Dishwasher f 25.02 aC. r ►r ,eS °- I0`57 R"C-(/ Drinking fountain ` 25.02 I=CJ .r i.--1 0 Ejectors /sump 25.02 ❑ PROPERTY OWNER . ❑ TENANT Expansion tank 12.51 t ,/ ^ ! //� / Fixture /sewer cap 25.02 Name: -1 17 ae- d (i a el e- @ac' Cie tJ vr`(� Floor drain/floor sink /hub r 25.02 e Address: c _s"i.[J l.UCkjNLi r- l pt` Garbage disposal 25.02 City /State /ZIP: ,(i, 0 7 7�Z Hose bib 25.02 Phone: (5 ) c� 3/ 3 / '/ Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer . _ 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory e 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 Water closet 25.02 CONTRACTOR ' - Water heater ( 37.52 Business name: 0 p.Ee Y` Water piping/DWV 56.29 Address: Other: 25.02 City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lie. no.: Plan review (25% of permit fee) rs State surcharge (12% of permit fee) Authorizes r .� r il l / TOTAL PERMIT FEE0. Print name: o is 1 U) . � � ) y � Date: 74/(// 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:\ Buil ding\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fcc Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1s' 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 Plari 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 I ❑ 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. Isometric or'Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings • Garbage - Domestic -non -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 I - 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 L plumbing permit can be issued. Other Fixtures: I:\ Building \Permits\PLMF- PermitApp.doc 02/24/2011 2 14 - Acc umulative Sewer Tally Tenant Name: United Methodist C hurch SWR # N/A �`�� Site Address: 9845 SW Walnut P1 PLM # 2011 -00236 Parcel #: 251026D01600 Value Previous Previous Credits Capped Fixture Fixture New New Fixture # 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 1 2 1 2 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 HP) 16 0 • .. 0 0 0 0 - Commercial (to 5 HP) 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 • 1 2 2 4 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 Wafer Closet - Toilet 6 0 0 0 0 0 Urinal 6 0 1 6 • 0 -1 -6 Previous EDU Count .0 0 Capped EDU Credit 0 TOTALS 0 0 2 _ 8 3 6 1 -2 Current Fixture Value -2 divided by 16 = -0.1 Current EDU 1 EDU = $4,500.00 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -2 divided by 16 = -0.1 over (under) $ (450.00) Enter EDU Change Here -0.1 Notes: ** *CREDITS * ** Authorized Name /Signature: Debbie Adamski Date: 7/21/2011 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- 4500.xls 07/01/11