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Permit CITY OF TIGARD f' `' PLUMBING PERMIT ' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00382 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/27/2011 Parcel: 2S102AA04201 Jurisdiction: Tigard Site address: 8955 SW COMMERCIAL ST Project: Essential Planning Group Subdivision: TIGARD HIGHWAY TRACTS Lot: 2 Project Description: Interior plumbing. 2/14/12, reprinted to add (8) replaced lays & (3) replaces water closets. Contractor: K & C PLUMBING INC Owner: BUTTERFIELD, CHARLES W JR & PO BOX 2124 MICHELLE S OREGON CITY, OR 97045 825 SW VIEWCREST DR DUNDEE, OR 97115 PHONE: 503 - 518 -0234 PHONE: FAX: 503 - 518 -1100 FEES Quantity Description Date Amount 4 ea Fixture /Sewer Cap 12/27/2011 $100.08 Specifics: 2 ea Floor Drain /Floor Sink/Hub 12/27/2011 $50.04 2 ea Urinal 12/27/2011 $50.04 Type of Use: COM 1 ea Water Closet 12/27/2011 $25.02 Class of Work: ALT 1 12% State Surcharge - 12/27/2011 $27.02 Type of Const: Plumbing Occupancy Grp: 8 ea Lavatories 02/14/2012 $200.16 Stories: 3 ea Water Closet 02/14/2012 $75.06 0 12% State Surcharge - 02/14/2012 $33.03 Plumbing Total $560.45 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 issu e, or if wor is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon U ity Notification Cen . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules direct qu-stions to OUN . • ailing 503.232.1987 or 1.800.332.2344. �\ I ued By: /41 Permittee •gnature: , L�7 lG� Call 503.639.4175 by 7:00 a.m. for the next available ' • pection 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. CITY OF TIGARD PLUMBING PERMIT 11 COMMUNITY DEVELOPMENT Permit #: PLM2011 00382 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/27/2011 Parcel: 2S102AA04201 Jurisdiction: Tigard Site address: 8955 SW COMMERCIAL ST Project: Essential Planning Group Subdivision: TIGARD HIGHWAY TRACTS Lot: 2 Project Description: Interior plumbing. Contractor: K & C PLUMBING INC Owner: BUTTERFIELD, CHARLES W JR & PO BOX 2124 MICHELLE S OREGON CITY, OR 97045 825 SW VIEWCREST DR DUNDEE, OR 97115 PHONE: 503 - 518 -0234 PHONE: FAX: 503 - 518 -1100 FEES Quantity Description Date Amount 4 ea Fixture /Sewer Cap 12/27/2011 $100.08 Specifics: 2 ea Floor Drain /Floor Sink/Hub 12/27/2011 $50.04 2 ea Urinal 12/27/2011 $50.04 Type of Use: COM 1 ea Water Closet 12/27/2011 $25.02 Class of Work: ALT 1 12% State Surcharge - 12/27/2011 $27.02 Type of Const: Plumbing Occupancy Grp: Stories: Total $252.20 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: � Permittee 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. 27 Dec 11 09:05a Russ 503- 518 -1100 p.2 Plumbing Permit A>pulication _ �� Building Fixtures FOR QF USE ONLY 11 City of Tigard b � �� ItOO" " � • Perot No.: 011J l�� /,/ ' /�- A Date/3 I m �/ n 13125 SW Hall Blvd., Tigard. OR 9722 rr •G 1, ether permit No.: i i e Phone: 503.7182439 Fax: 503.598.1960 O�v ■ G L . � I. �r - .. T IGARD Inspection Line: 503.639.4175 �'S � l . i ca Ws HI See Page for Internet: www.tigard.ar.gov ` .o1 ( (�0 Notified.'.SetMd: t/ cI Sapptenealal Infarmatioo TYPE OF WORK p � , ` FEE* SCHEDULE . ❑ New construction ❑ DemoMsoon For specialinlornlaeion use checklist. Description I Qtv. I Ea. f Total ® Addition/alteration/replacement 0 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 ® Commercialii SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi- family Eadr additional bsdtv'kilchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 8955 sw comrnercial st Catch basin or area drain 18.76 Drywall, leach line, or trench drain 18.76 City /State /ZIP: tigard or Fooling drain (no. linear ft.: ) Page 2 Suite/bldg./apt. no.: I Project name: �EzA4,2i1 aO /LiVlMI / Manufactured borne hoe utilities 50.03 Cross street/directions to job site: IVY Maruholac 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _j Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear B..: ) Page 2 Subdivision: 1 Lot no.: Fixture or item: Tax mapiparcel no.: Backfew pmventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 install 2 urinals Dishwancer 25.02 install 1 toilet Drinking fountain 25.02 install 2 floor drains Ejectors/sump 25.02 0 PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: Fixtureaewer cap if 25.02 0, Floor drain/floor sinklltub 2 25.02 50, t Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) j Ice maker 12.5 t ❑ 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: Sisk./basin /lavatory 25.02 City /StateiZll': Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub(shower /shower pan 12.51 E -mail: Urinal 2 25.02 50. Water closet 1 25.02 25.02 CONTRACPOR Water beater 37.52 ' Business name: K &C Plumbing, Inc Water piping/MIN 56.29 Address: PO Box 2124 Other: 25.02 City'State /ZIP: Oregon City, OR 97045 Subtotal ' , 4 Phone: (503)722 -9393 Fax: (303) 518 -1100 Minimum permit fix: 572.50 Plan review (25% of permit fee) CCB Lie.: 166699 / Q/ • Plumbing Lic. no.: PB5 "7/ /hy / ( State surcharge (12% of permit fee) t7)- Authorized sign .,, � TOTAL PERMIT FEE , :. ,i. RA Print name: lidss Cc Date: 12 - - 2011 T p application cxpine if a permit is not obtained within ISO days In ca after it bas been accepted as complete. *Pee methodology set by 'Fri-County Building Industry Service Board. 27 Dec 11 09:05a Russ 503- 518 -1100 p.3 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee tea) Total Square Footage: Permit Fee: Footing drain - 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2.001 to 1600 5169.69 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 - lit 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 62.54 S1.00 to $5,000.00 Minimum fee $72.50 Stonn & Rain Drain - each additional 100' 37.52 55,001.00 to S10,000.00 $72.50 for the first $5,000.00 and $1.52 for ( )ty. Fee (�) Total each additional S100.00 or fraction thereof, to Other Inspections or Fees 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.D0/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. Inspections outside of normal husiueas 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 S 100.00 or fraction thereof. to Reinspection Fees 90.00;hr and including 550.000.00. Additional plan review for revisions 90.00:hr $50,001.00 and up $742.00 for the first S50,000.00 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 Nature 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. ❑ Any new commercial building with water service 2" and Bath - Tub/Shower l u tnziiWhirlpool greater, except systems designed and stamped by licensed Car Wash - Each Stall engineer. - Drive 'Ihru ❑ 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. Eve Wash Floor Drain'sink - 2 2, Submit 2 sets of plans with any of the above. - 3" 4 Isometric or Riser Diagram Car Wash Drain Garbage - Domestic non - food ❑ 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..ltefrig. 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 'L. fees assessed for the sewer increase must be paid before the Urinal ` plumbing permit can be issued. Other Fixtures: Accumulative Sewer Tally Ii i >: Tenant Name: ESSENTIAL PLANNING GROUP SWR # N/A Site Address: 8955 SW COMMERCIAL ST PLM # PLM2011 -00382 Parcel #: 2S102AA04201 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 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 2 4 0 -2 -4 - 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 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: - Lay/Bar - Non -Food Related 2 0 0 0 0 0 - Bradley 5 0 0 0 0 0 - Com /Sery /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 2 12 0 -2 -12 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 4 16 0 0 -4 -16 Current Fixture Value -16 divided by 16 = -1.0 Current EDU 1 EDU = $4,500.00 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -16 divided by 16 = -1.0 over (under) $ (4,500.00) Enter EDU Change Here -1 Notes: ** *CREDIT * ** Authorized Name /Signature: BRANDEN TAGGART X2449 Date: 12/27/2011 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 14 Feb 12 02:49p Russ 503 -518 -1100 p.1 PlumbinE Permit Application, rir A 1 cm Building Fixtures ' i tTA V- 11'5111j FOR OFFICE USE ONLY City of Tigard 201 Received . / !r / q Date /By: / �, - Permit No.: t at /.�/ jE2, � ` 13125 SW Hall Blvd., Tigard, OR 9722it c Received E. Plan Review • .1 , = Phone: 503.718.2439 Fax: 503.598.1960 T De/By: Other Permit No.: at Inspection Line: 503.639.4175 G1` OF g I r ® G 1 y 1 Date Ready/13y: y: tu< s: See Page 2 for T t GAR D Internet: www.ligard -or goy � �^ I � i S �� `+ Notified/Method: _ Supplemental Information "n t ,, .. ��+ i�i'- W FEE* SCHEDULE TYPE OF V4'ORK ir - ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total Addition /alteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utiii connection) CATEGORY OF CONSTRUCTION SFR (l) bath 312.70 ❑ 1- and 2- family dwellingotnmercial /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: g ! c 5L, (Ill/N.Qer c1/4., Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/State /ZIP: Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: 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: Lot no.: Fixture or item: ax mapipazcel no.: Backtlow preventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK S ,s Clothes washer 25.02 ifd4 { VQ 'ems 1 1 - 41 el - P2 vi'n' 4- Dishwasher 25A2 PP/ Z 0 1 / ! 1nI3 ,i2 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: Floor drainifloor sink/hub 25,02 Address: Garbage disposal 25.02 City/State/Z.IP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON ' Interceptor /grease trap 25.02 Medical gas (value: $ _) Page 2 Business name: Primer 12.51 Contact name: 12.51 Roof drain (commercial) Address: Sink/basin/lavatory R 25.02 200. !b City /State/ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub.!shower /shower pan 12.51 Urinal 25.02 E-mail: t Water closet 3 25 . 0 2 -1 75b CONTRACTOR p ( w Water heater 37.52 Business name: K i 0 pt U a+-a- v& .IYLC Water piping/DWV 56.29 f ,_ - Address: PG LB,(. 2 ] 2-4 Other: I 25.02 City /State /ZIP: r pi-.... ( ( t O 1 ?O q _ Subtotal 27 •al-- Phone: ) 7ZZ ; j 5C/ Fax: (,$ 5 - / << 0 a Minimum permit fee: $72.50 Plan review (25% of permit tee) CCB Lic.: f (0 �,.el 7 Plumbing L ic. no.: Pe c--- o O'L State surcharge (12% of permit fee) .3k Authorized sign; �" TOTAL PERMIT FEE 30S• . p �� - This permit application expires if a-permit is not -o ntained_witbin_180.days Print omit,. omit,. l! p e't � � Date: *fee methodology set by Tri- County Bu lding Industry Service Board after it has been