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Permit W CITY OF TIGARD PLUMBING PERMIT lig , COMMUNITY DEVELOPMENT Permit #: PLM2012 00008 TEGAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/13/2012 Parcel: 2S113AA01000 Jurisdiction: Tigard Site address: 16578 SW 72ND AVE B9 Project: Spec Space Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C Project Description: Relocate (2) lays, (2) water closets, (1) sink and (1) water heater. 1/19/2011, REPRINTED for the following: Relocating (1) 2" floor drain, (1) sink and capping (1) drinking fountain. Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES PO BOX 14701 ATTN: N PIVEN PORTLAND, OR 97293 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 P PHONE: 503 - 624 -6300 PHONE: 503 - 236 -4152 FAX: 503 - 296 -2218 FEES Quantity Description Date Amount 1 ea Sink 01/13/2012 $25.02 Specifics: 2 ea Lavatories 01/13/2012 $50.04 2 ea Water Closet 01/13/2012 $50.04 Type of Use: COM 1 ea Water Heater 01/13/2012 $37.52 Class of Work: ALT 1 12% State Surcharge - 01/13/2012 $19.51 Type of Const: Plumbing Occupancy Grp: 1 ea Fixture /Sewer Cap 01/20/2012 $25.02 Stories: 1 ea Floor Drain /Floor Sink/Hub 01/20/2012 $25.02 25 Plumbing Permit 01/20/2012 $25.02 g 12% State Surcharge - 01/20/2012 $9.01 Plumbing Total $266.20 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 i - p- tion date. This permit card shall be kept in a conspicuous place on the job sit: . til completion of the project. Approved plans are required on the job site at the time of each inspection. • I li 1 , • CITY OF TIGARD PLUMBING PERMIT .' COMMUNITY DEVELOPMENT Permit #: PLM2012 -00008 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/13/2012 Parcel: 2S113AA01000 Jurisdiction: Tigard Site address: 16578 SW 72ND AVE B9 Project: Spec Space Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,E Project Description: Relocate (2) lays, (2) water closets, (1) sink and (1) water heater. Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES PO BOX 14701 ATTN: N PIVEN PORTLAND, OR 97293 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 P PHONE: 503 - 624 -6300 PHONE: 503 - 236 -4152 FAX: 503 - 296 -2218 FEES Quantity Description Date Amount 1 ea Sink 01/13/2012 $25.02 Specifics: 2 ea Lavatories 01/13/2012 $50.04 2 ea Water Closet 01/13/2012 $50.04 Type of Use: COM 1 ea Water Heater 01/13/2012 $37.52 Class of Work: ALT 1 12% State Surcharge - 01/13/2012 $19.51 Type of Const: Plumbing Occupancy Grp: Stories: Total $182.13 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 • I wor suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility otification Center. The e rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or di—ct questions to OUNC .� cal' . 503.232.1987 or 1.800.332.2344. Iss ed By: / , , , Permittee Signature: r0 / AV Call 503.639.4175 by 7:00 a.m. for the next available in ..irion 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. Plumbin . Permit A • • licatio I Building Fixtures WI a� IOR c)l I l( l: l se O�l.l M Ci of Ti an d �� , ' r R eceived • III `� g Date/By: i Permit No.: a 13125 SW Hall Blvd., Tigard, OR 9� Phone: 503.718.2439 Fax: 503.59 o1r� Plan Review Other Permit No.: Date/By: T l G A R �� Inspection Line: 503.639.4175 \ 1 g �- Date Ready/By: � Sufis: ` M See Page 2 for Internet: www.tlgard - or.gov \P\V Notified/Method: ' /std I Supplemental Information „jail TYPE OF WORK , �G' o FEE* SCHEDULE ❑ New construction ❑ Dam. i '', GI For special information use checklist Description I Qty. I Ea. I Total R Addition/alteration/replacement ❑ 8 -r: 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: 6 ---7 t . s ,w 7,2: 14-d Catch basin or area drain 18.76 City /State /ZIP: Drywell, leach line, or trench drain 18.76 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: 6Pet. 6P/3 cC Manufactured home utilities 50.03 Cross street/directions to job site: Cic / - /✓ p Lijoe.,,l,g Manholes 18.76 / - L-r- Aid 7b ; /7 - Rain drain connector 18.76 O� � Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear fl.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: 014 , ' 3 A A 0 1006 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: �`JT Fixture /sewer cap 1 25.02 '' - 01- n Floor drain/floor sink/hub / 25.02 t/�� Address: /�53 fwSe oc, Pr'4 o/ Garbage disposal 25.02 City /State /ZIP: Pic 7 ] .2.? Hose bib 25.02 Phone: (5 ) > ) 44 - 63 co Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: 0Qa,.. Lt,,, 0-. / i- A..,b j / Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: $ rrs Roof drain (commercial) 12.51 Address: / a ,A X J t I Sink/basin/lavatory / 25.02 4 Z CJ .- City /State /ZIP: .,,T. on _ e, 72_ S ) Solar units (potable water) 62.54 Phone: (5a) ) 7$0 - 9 C Fax:: (4 ) 2 5' -si /e Tub /sho'wer /shower pan 12.51 E -mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: p p g/ eL. Q/0/1"-t__ Water i m DWV 56.29 Address: Other: 25.02 City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 '7.5 C o CCB Lie.: f t j y it Plumbing Lic. no.: 1 6 - 7 3 (. Plan review (25% of permit fee) � S ta te surcharge (12% of permit fee) 7 -,/ �� Authorized signatu' - TOTAL PERMIT FEE Tit, 4) Print name: This permit application expires if a permit is not obtained within 180 days � . Date: IC r - /2 after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1 \ Building \Permits\PLMU- PermitApp.doc 10/01/09 4404616T(10/02/COM/WEB) Plumbing Permit Application Building Fixtures R E E J V E D FOR OFFICE USE ONLY Received Date/By: Received / /o! City of Tigard 2 / � „ G Permit No.: I 114 - + / �e�� "'�` ' MI 13125 SW Hall Blvd., Tigard, 97223 " Plan Review / C Phone: 503.718.2439 Fax: 503.598.1960 3 2012 Date/By: Other Permit No.: G ���� s- TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard- or.gov ,t i'\ OF TIGARD Notified/Method: Supplemental Information TYPE OF WORK I LVINCI DIVISION FEE* SCHEDULE E l New construction ❑ Demolition For sr ecial information use checklist Descri.tion Q . Ea. Total V 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: / 6j� `-- S sc,� 7/, A-� Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: To), a On_ C - Footing drain (no. linear ft.: _ ) Page 2 Suite/bldg. /apt. no.: I Project name: 5 ",_ / 6 5 7 g 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 7 / 1-e /) Clothes washer 25.02 �(� �I t � /i+ o S Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 ?(Vi" `C'P(n,5 Address: Floor drain /floor sink /hub 25.02 t5 _. pr c) Garbage disposal 25.02 City /State /ZIP: TI( ARC) OR- q . 7- 9.,.' Hose bib 25.02 Phone: (fogy ) 4 (y^ j (7595 Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: ��/ Roof gas (value: $ ) Page 2 VVv` Primer 12.51 Contact name: 6-1 Roof drain (commercial) 12.51 Address: }} Sink/basin/lavatory 25.02 City /State /ZIP: �ll Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 CONTRACTOR Water closet 25.02 �,, �� Water heater ' 37.52 a Business name: c-t 1 1..�1$K�t -1} pliA •Y\ I Water piping/DWV 56.29 Address: V Q tok (15 l Other: 25.02 City/State /ZIP: Pa ��ts 0 1-312- 9-7-9c't 3 Subtotal Phone: (tr3)3g0 -C( Lk<Ro Fax: (503 ) 1.. 2 \ \,, Minimum permit fee: $72.50 CCB Lic.: i54 kd Plumbing Lic. no.: 2 4 - �'3(� p� Plan review (25% of permit fee) State surcharge (12% of permit fee) � Authorized signature: , ,, �+ � TOTAL PERMIT FEE (gg. 1 Print name: ,_1 Date: 3 - / 2- 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. P\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit 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 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 * . Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2" and greater, except systems designed and stamped by licensed Bath: - Tub /Shower - Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918- 780 -0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918- 780 -0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: - 2" 3" Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings - Car Wash Drain Garbage Domestic non - food that meet the qualifications above. Disposal: - Domestic food related - Commercial food related - Industrial food related Ice Mach./Refrig, Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower: -Gang -Stall Sink: - Lav/Bar non -food related + - Bradley - Com/Serv/Util food related - Service *Note: If the fixture work under this permit results in an Swimming Pool Filer increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes fees assessed for the sewer increase must be paid before the Water Extractor p Water Closet - Toilet plumbing permit can be issued. Urinal Other Fixtures: I: \Building\Permits\PLMF- PermitApp.doc 08/04/2011 2 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit 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 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 Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2" and greater, except systems designed and stamped by licensed Bath: - Tub /Shower - Jacuzzi /Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918- 780 -0040. Cuspidor /Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918- 780 -0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain /sink: - 2" 3 " Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non - food that meet the qualifications above. Disposal: - Domestic food related - Commercial food related - Industrial food related Ice Mach. /Refrig. Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower: -Gang -Stall Sink: - LavBar non -food related - Bradley - Com/Serv/Util food related - Service *Note: If the fixture work under this permit results in an Swimming Pool Filer increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes fees assessed for the sewer increase must be paid before the Water Extractor P Water Closet Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\ Building \Permits \PLMF - PermitApp.doc 08/04/2011 2 III Accumulative Sewer Tally s Te nant Name: Spec Space * *CREDITS ** SWR # N/A 1 liAtl Site Address: 16578 SW 72nd Ave PLM # 2012 -0008 Parcel #: 2S113AA01000 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 1 1 0 -1 -1 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 IIP) 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: - Lav /Bar - Non -Food Related 2 0 0 0 0 0 - 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 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 1 1 0 0 -1 -1 Current Fixture Value -1 divided by 16 = -0.1 Current EDU 1 EDU = $4,500.00 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -1 divided by 16 = -0.1 over (under) $ (450.00) Enter EDU Change Here -0.1 Notes: ** *CREDITS * ** Authorized Name /Signature: Debbie Adamski Date: 1/20/2012 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 01/18/12