Permit CITY OF TIGARD PLUMBING PERMIT
` 'F> C OMMUNITY DEVELOPMENT Permit #: PLM2012 -00025
Date Issued: 2012
02/08/
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 02/ 2S102CB03200
Jurisdiction: Tigard
Site address: 9975 SW FREWING ST 140
Project: Adeo Home Care Subdivision: FREWING'S ORCHARD TRACTS Lot: 21
Project Description: Install (1) lay, (1) water closet & (1) water heater. Credits from PLM2011 -00380 applied to this permit. 1.2 EDU
credits still available.
Contractor: ALL PRO PLUMBING SERVICES LLC Owner: BY PICOCO
2210 SE CELEBRATION CT MASSIH LLC
HILLSBORO, OR 97123 4343 VON KARMAN AVE 3RD FL
NEWPORT BEACH, CA 92660
PHONE: 503 - 579 -5555 PHONE:
FAX: 503 - 259 -2555
FEES
Quantity Description Date Amount
1 ea Lavatories 02/08/2012 $25.02
Specifics: 1 ea Water Closet 02/08/2012 $25.02
1 ea Water Heater 02/08/2012 $37.52
Type of Use: COM 1 12% State Surcharge - 02/08/2012 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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 ByL /. f . j Permittee Signature:
POW
Call 503.639.4175 by 7:00 a.m. for the next available inspection d
This permit card shall be kept in a conspicuous place on the job site until corn. -tion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures • ECEED FOR OFFICE USE ONLY
ill City of Tigard _ �, Date/By: - p_ A� 4 ....... 4 . 03 Permit No.: 4° U-4,106 . 1 __ .2 S
'I 13125 SW Hall Blvd., Tigard,OR 97223 2 ?012 �1
Plan Re view 9
Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Other Permit No.: BliPp�p /2- t:'bd/
Inspection Line: 503.639.4175
T I G A RD CITY OF TIGARD Date Ready/By: Suds: RI See Page 2 for
Internet: www.tigard - or.gov I TD
Dygg IAI t� ( rI v l7 itivyco !. x (fir Notified/Method: Supplemental Information
- �L:J
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
ddition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
El 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: CM •15 S W F2 E, W I iV i „ S ( Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: `��
T l {� 0 �L 7 Z Z Footing drain (no. linear ft.: ) Page 2 ,
Suite/bldg. /apt. no.: / Li() I Project name: OA of (71 i Manufactured home utilities 50.03
Cross street/directions to job site: ,rt2E W iNC f q ' 1' 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
f Clothes washer 25.02
7C f
l X 4i/Vle I YI S +A,1 1 Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02 •
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name: P1etrr ya.(fwa l t ►
Floor drain/floor sink/hub 25.02
Address: a 13 eck.c+
Garbage disposal 25.02
City /State /ZIP: La, O SWry., A at . 170 5C Hose bib 25.02
Phone: (563 ) 702/ LaZ L 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 j 25.02 2,S 07.
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet i 25.02 a ,02
CONTRACTOR Water heater 1 37.52 37, 5-47
Business name: c 4 a , P2'o p UM/3<N G, Sr ,C✓ /( r S fit Water piping/DWV 56.29
Address: a-/I a SF eF to , •4 . -1 ;�,- , (4 Other: 25.02
City/State /ZIP: tic 1140.10 101 g 7l ) ; Subtotal 8 7.5(0
Phone: (TO ) 5 7 J � 5 Fax: (S63) 279
Minimum permit fee: $72.50
� °F .? PlumbingLic. no.: pt3 77Z Plan review (25 %of permit fee)
CCB Lic.: j
State surcharge (12% of permit fee) /e.67
Authorized signature: l� //� id t TOTAL PERMIT FEE 9g. 0 7
Print name: r Date: This permit application expires if a permit is not obtained within 180 days
��� C et) /2i al Z� I 1 - ' after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ 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 - V' 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 Plan 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 Thni ❑ 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.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
- 3"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic-non -food s
g q g
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
- 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 plumbing permit can be issued.
Other Fixtures:
I: \Building\Permits\PLMF- PermitApp.doc 02/24/2011 2
lig : Accumulative Sewer Tally
a
Tenant Name: Adeao 1 Iome Care SWR # N/A
TIGARD Site Address: 9975 SW Frewing St #140 PLM # 2012 -00025
Parcel #: 2S 102CB03200
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 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 -IF) 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 1 2 1 2
- Bradley 5 0 0 0 0 0
- Com /Sere /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 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 1.7 27.2
TOTALS 0 0 0 0 2 8 2 -19.2
Current Fixture Value -19.2 divided by 16 = -1.2 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -19.2 divided by 16 = -1.2 over (under) S (5,400.00)
Enter EDU Change Here -1.2
Notes: ** *CREDITS ** *Credits from PLM2011 -00380 applied to this permit.
Authorized Name /Signature: Debbie Adamski Date: 2/2/2012
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: A Building \Sewer Tally \Sewer fallyShcet- 45011.xls 01 /18/12