Permit CITY OF TIGARD PLUMBING PERMIT
'! COMMUNITY DEVELOPMENT Permit #: PLM2011 -00261
TtGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08116/2011
Parcel: 2S 101 AD03100
Jurisdiction: Tigard
Site address: 6950 SW HAMPTON ST 320
Project: PCC Hampton Square Subdivision: WEST PORTLAND HEIGHTS Lot: PTS 1 -8
Project Description: Interior plumbing: Capping (1) break room sink.
Contractor: BEAVERTON PLUMBING INC Owner: WESTON INVESTMENT CO
13980 SW TV HWY 2154 NE BROADWAY
BEAVERTON, OR 97005 PORTLAND, OR 97232
PHONE: 503 - 643 -7619 PHONE.
FAX: 503 - 643 -7620
FEES
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 08/16/2011 $25.02
Specifics: 1 12% State Surcharge - 08/16/2011 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 08/16/2011 $47.48
Type of Use COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
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
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 1.800.332.2344.
Issued By:
-----
�� •ermittee Signature: •
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.
ritiatill LU
Plumbing Permit ApplicatioR G 15 2011 as 101 x,1
Building Fixtures I:()I: (.)rrt(r. I'yr. ()NJ.ti
City of Tigard `alb Ts� °as s tz lved
` � Pho ne: 503.718.2439 Fax: 503.598.1960 Date/By:.. Permit No.:
13125 SW Hall Blvd., Tigard, aJ �s►r�a3 i IVISI ; N Date/BY - /5 i -- nLrn 9r.) //- 00 ,?..c, i
■ Plan .. Other Permit No,: Pi.M20I 1-00253
By:
y.
1 f Inspection Line: 503.639.4175 l)xte Ready/Hy: hciu: 4I See PPao 2 for
- ' '' , I - i ' Internet: www_ti in'. ry
� Notified/Method! 176 , Supplemental i .a Su !il lard ♦ ! III'�1
IVr 411 I1111i, .'.4Ur li °,1�I h I ��p1�4 aiq' 1 'lllws i, ' i i�
�i i � ,��;�i�� ,. rYl4;' Ip'. H7 IC!,I illil ;��I @� Ip llq Rul ,;� -,�4 !I ?� � '. I II��IpR� �i�IQPp�t� 'l lipl�Wll'I';� t SIili�Ill �i J��.
❑ New construction rEl Demolition For special Information use checklist
Description I. guy. I Ea- I Total
ra ' f t 0 Other: New 1..2- family dwellings (includes 100 R. for each utility connection)
p�� ���
❑ Addition/alteration/replacement I I ryry
; nnljV '����V41mI �IaVIIQllllt i I : SPR(1)bath 312.70
❑ 1- and 2- family dwelling Olt Commercial/industrial SIR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
I Each additional bath/kitchen 25.02
ID Master builder 0 Other:
i °�i vll iUii4� �4w � I �u I IIU� �Illlw ll�,. o sill i Fire SprInICICr( sq. ) Page
a , ' ` (4! Y', O ,� k r ' 01 0Ml i 0 f.:0 i Site utilities:
Job site address: 6950 SW HAMPTON ST. Catch basin or area drain 18.76
City/State/Z1P: TIGARD, OREGON L)rywcll, leach line, cn trench drain 18.76
Footing drain (no. linear ft.: ,..,..,...,) Page 2
Suite/bldg. /apt. no.: 320 I Project name: HAMPTON SQUARE Mlulufactured home utilities 50.03
Cross streeUdirecti0 s to job site: Manholes 18.76
_
Rain drain connector 18,76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: r ,,, J Page 2
Water service (no. linear ft.: _ ) Pubic 2
Subdivision: . I Lot no.: Fixture or item:
Tax map/parcel no.: Bacldlt)w pm-venter 31.27
� liackwllter valve 12.51
alum h 'pl!'9a hull, �CIL " :` 4 . 'M 51 I �I °ilh4' :lIliIII iIP .i!Illllil�' tjllll IiIV�I�''''
Ctot washer 25,02
REMOVE ON 1REAK ROOM SINK Dishwasher 25.02
ON
Drinking fountain 25.02
Ejectors/sump 25.02
I ll ,, I P It li s , �R . ' 9 G .s .I I i l ¢ "I IL � �1 1 H , I I.L 1I l r i i " Expansion tank I 12.51
lxu�l , � tltl��l � �lllhliwlou � �� � {.7 �� � � III � �dIuII�� III 'I i �� iI ���,! "�,i,
Name: WESTON INVESTMENT
Fixture/sewer cap m � 25.02 AS, 1.)
Address: 2154 NE BROADWAY Floor drain /floor sink/huh 25.02
- Garbage disposal 25.02 nn
City/State/ZIP: PORTLAND, OREGON 97232 Hose bib 25.02
Phone: ( ) Fax: ( ) ice maker 12.51
.._ v., : 4 I I l PPLIC ' : 0,0t 'ACE" A 1* '"' Intcrccptor /grease trap - 2502
Business name: BEAVERTON PLUMBING, INC Medical gas (value: $ ) Page 2
Contact name: CASEY STEPHENS Primer 12.51
Roof drain (commercial) ,r 12.51
Address: 13980 SW 11JALATIN VALLEY 11WY Sink/basin/lavatory 25.02
City /State/ZIP: BEAVERTON, OREGON 97005 Solar units (potable water) 62.54
Phone: (503) 643.7619 Fax: : (503) 643.7620 Tub /shower /shower pan 12.51
E -mail: Sue@heavertonplumhing.com Urinal 25.02 ,
Wa ter closet 25.02
n .i: .'46 li4 i N7,'..i.,Ik u ��� i� i' , ,il f ; 4 d I . ;Ilh :- : r4n; ; Water heater 37.52
Business name; BEAVERTON PF.IJMBING, INC Water piping/i)W V 56.29
Addresii: 13980 SW TITALTTN VALLEY HWY Other: 25,02
City /State/ZIP: BEAVERTON, OREGON 97005 Subtotal
Phone: (503) 643.7619 Fax: (503) 643.7620 Minimum permit fee: $72.50 72.50
CCI3 Lic.: 12889 Plumbing Lic. no.: 34-4PB Plan review (25% of permit fee)
Co .. State surcharge (12% of permit fee) 8.70
Authorizedsignature; o� ‘ CljT TOTAL PERMIT FEE f 81,20
Print name SUSAN DEAN Date: 8/12 /11 'This permit application expires if a permit is not obtained within 180 days
after It his heen accepted as complete.
"Fee methodology set by Tri- County Building industry Service hoard,
I:l HuildingleermitePl .M0- PematApp.doe 1 O/m 44046I6T(I0/02JCONr/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su • ression S stems:
• Gr�'��1[!��
iw I �lili0
Hooting drain - 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 ..y... -.
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' (12.54
Medical Cos S
Water Service - each additional 100' 37.52,. ttbn. ���ill�+ ^ °d • lee:
` • t
$1.00 t a
Storm & Rain Drain - 1st 100' 62.54 o $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
qty, Fee;() 'total cach additional $100,00 or fraction thereof, to
ti ler Sp C i 1hS I Ur l ` • • „ ... „, yr d, a rim and including $10,000.00. •
Inspection of existing plumbing or for $111,001.00 hi $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/br each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and includin &$25,000.00.
Inspections outside of normal business 90.00/hr $25,001,00 to 550,000,00 $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/br and including $50,000.00.
Additional plan review tar revisions 90,00/hr $50,001.00 and up $742.00 for the that $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? ff "yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantly b nature , ' . .l l rt vt cv rr U lr> y 1 .; .ngta li 1.
Fixture Type for Reptacel •
Work Perturmtd: • �'e�ped Added Retpcate ~ Plan review is required for any of the following.
•
Baptistry/Mont _ Please check all that apply.
Bath - Tub /Shower CI 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 CI New exterior plumbing site utilities for any complex. structure
Cuspidor/Water Aspirator as defined in 0AR918- 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 OAR91 8 -780- 0040.
Eye Wash _
Floor Drain/sink - 2" Submit 2 sets or plans with any of the above.
-3"
Car Wash Drain }�YIInI JI1i• . !! ' +�f 7 • l if 3a)tfT:
Garbage Domestio - frrod ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial - food related _ -
Ice Mach /Retrift. Drains
Oil Separator (Gas Station) - Comments regarding future work:
Rec. Vehicle Dump Station .
Shower - .fang
-Stall
Sink/I .av -Non -food related l
- Bradley
- Commercial -food related _
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Ex ructcr increase of sewer E1)Us, 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:
http: / /www. tigurd- or. gov/ ei ty_hall /departtnents/cd/docs/P l .M F-Perm itApedoc
Date: 8/8/2011
Please FAX this completed and signed form to 503598.1960.
To protect credit card information, do not email this form.
This form will be destroyed after your payment has been processed.
1:\$uilding \Forms \PaymcntAuthorization,doc 02/08/2011
Accumulative Sewer Tally
e 4 Tenant Name: PCC HAMPTON SQUARE - ' SWR #
Site Address: 6950 SW HAMPTON ST. • PLM # PLM2011 -00261
Parcel #: 25:1:01 AD03100_ ..
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: - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 ', 0 t : 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 HP) 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 ; r - 0 0 0 0 0
Shower: - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 4. ;: „4. ' 0 z 0 0 0
Sink:
- Lav /Bar - Non -Food Related 2 -, 0 "'- I`:, 2 0 -1 -2
- Bradley 5 . 0 0 0 0 0
- Com /Serv/Util - Food Related 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 5 0 0 0
Previous EDU Count ' `_ z ° 0 0
Capped EDU Credit - 0
TOTALS 0 0 1 2 0 0 -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
Notes: ** *CREDIT * **
Authorized Name /Signature: BRANDEN:TAGGARI . . Date: 8/16/2011
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 \Sewer I'allySheet- 4500.xIs 07/01/11