Permit t CITY OF TIGARD PLUMBING PERMIT
°li 11 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00260
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/12/2011
Parcel: 2S 113AB01201
Jurisdiction: Tigard
Site address: 16280 SW UPPER BOONES FERRY RD
Project: Spec Space Subdivision: Lot:
Project Description: Interior plumbing: Replacing (1) urinal, (3) water closets, (1) sink, and capping (1) sink.
Contractor: CASCADE PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES LP
2630 N HAYDEN ISLAND DR #3 ATTN: N PIVEN
PORTLAND, OR 97217 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 289 -7095 PHONE:
FAX: 503 -283 -9514
FEES
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 08/12/2011 $25.02
Specifics: 1 ea Sink 08/12/2011 $25.02
1 ea Urinal 08/12/2011 $25.02
Type of Use: COM 3 ea Water Closet 08/12/2011 $75.06
Class of Work: ALT 1 12% State Surcharge - 08/12/2011 $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, 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 questions to OUNC by calling 503.232.1987 or 1.800..,2344, -_,
Issued By: : Permittee Signature: /
4114 /
Call 03. • 39.4175 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 A>pplicatioln , ; I .1 F* o?G
Building Fixtures \\ FOR OFFICE USE O 1.\
City of Tigard ✓ 1 ti � Received .�_
14
q 13 125 SW Hall Blvd., Tigard, OR 972 Permit No.: . a !
- !. � Date/By:
G „t.••ZV plan Review
Phone; 503.639.4171 Fax: 503.598. 0 '� Date/By: Other Permit No.:
Inspection Line; 503,639,4175 Date Ready/By: tun Sec Page i G A R...0 I nternet; www.ti d -or. ov y sy e 2 for
g
g Notified/Method: - y Supplemental information
TYPE OF WORK; '. FEE" SCHEDULE
❑ New construction ❑ Demolition Forspedal information use checklist.
Description I Qty. J Ea. I Total
p dditionlalteration/rcplaccmcnt ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312,70
SFR (2) bath 437.78
❑ 1- and 2- family dwelling mmercial /industrial .
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: ) Logo 0pp 190146 , a(r,rer Catch basin or area drain 1$.76
City /State /LiP: /� ,.,� 1 /, ��c �• Drywall, leach line, or trench drain 18.76
( 1 ` i Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.; Project name; AP. th - • � : ufaetUred home utilities 50.03
I . •
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 it,; _^) Page 2
Water service (no. linear ft.: _ ) Page 2
Subdivision: I Lot no.: Fixture or item: f
Tax map /parcel no.: Backflow preventcr 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes wisher 25,02
. ° ....et 0 -, .wiw . / I Dishwasher 25.02
• Y J ,- a _ 0, 4 Drinking fountain 25.02
m ne ` i L_. Ejectors /sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture/sewer cap
Name: i 25.02 ,1,5 ()),.
Floor drain /floor sink/hub 25,02
Address:
. .. Garbage disposal 25,02
City /State /ZIP: Hose bib 25.02
J
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name; CASCADE PLUMBING COMPANY Medical g as (value $ _ Page 2
Primer 12,51
Contact name: CRYSTAL JONES
Roof drain (commercial) 12,51
Address: 2630 N. HAYDEN ISLAND DRIVE #3 _ Sink/basin /lavatory ' 25.02 0 ., 5.U).
City /State /ZIP: PORTLAND, OR 97217 Solar units (potable water) 7 62.54 '
._.. - --
Phone; (5(13) 289 -7095 Fax: : (503) 283 -9514 Tub /shower /shower pan 12.51
E -mail: CASCADEPLUM @YAI -IOO.COM Urinal 25.025% 1:7?-
Water closet 25.02 " t ,e4
CONTRACTOR
Water heater 37.52
Business name: CASCADE PLUMBING COMPANY Water piping/DWV 56.29
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Other: 25.02
City /State/ZIP; PORTLAND, OR 97217 Subtotal )5 1 ,
Phone; (503) 289 -7095 Fax: (503) 283 -9514 Minimum permit ibe: $72.50
Plan review (25% of permit fec)
CCB Lie.: 120893 Plumbing Lie, no.; 34 -412PB
State surcharge (12% of permit fee) •
Authorized signature: L — 4 'AO • , 4 TOTAL PERMIT FEE } !P', /27
This permit Rpplicatioi expires if s permit is riot Obtained within 180 days
Print name: CRYSTAL JON Date: orosr it bet been accepted as complete.
w A "Fee methodology set by Tri- County Building Industry Service Board.
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total • S quare Footage: Permit Fee:
Footing dram - 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 $23320
Sewer 1st 100 62.54 7.201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st i00' 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 brain - 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 Q Fee (ea) Total each additional $100.00 or fraction thereof, to
and including $10,000.00.
Inspection of existing plumbing or for 510,001.00 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 busineis 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
Rcinspection Fees
90.00 /hr and ineludint$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,
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
r Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower El New exterior plumbing sitc utilities for any complex structure
-Tub/Shower -. as defined in OAR918 -780 -0040.
Car Wash -Each Stall Li Medical gas and vacuum systems for health care facilities.
-Drive Stall
1=1 Any multipurpose fire sprinkler system.
Cus i idor/ Water Aspirator ❑ 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
- 3-
that m eet the qualifications above.
-4 q
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Maeh, /Refrig, Drains
Oil Separator (Gas Station) _
Roc, 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 •
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet - Toilet '
Urinal .._
Other Fixtures:
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Accumulative Sewer Tally
: Tenant Name: SPEC SPACE SWR #
Site Address: 16280 SW UPPER BOONES FERRY RD PLM # PLM2011 -00260
Parcel #: 2S1 1 3ABO1 201
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -'l'ub /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
- 4 inch 6 0 0 0 0 0
- Car Wash 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:
- Lav /Bar - Non -Food Related 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Com /Sery /Util - Food Related 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 = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -3 divided by 16 = -0.2 over (under) $ (900.00)
Enter EDU Change Here -0.2
Notes: ** *CREDIT * **
Authorized Name /Signature: BRANDEN TAGGART Date: 8/12/2011
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.
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