Permit •
CITY OF TIGARD WOW PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2012-00058
T i G A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2012
Parcel: 1 S136DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST 120
Project: Shell Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Interior plumbing.5/11/12,reprinted to change project name to SHELL.
Contractor: ATLAS PLUMBING CONTRACTORS Owner: AMERICAN INDUSTRIES INC
P.O. BOX 1352 1750 NW NAITO PARKWAY
RIDGEFIELD,WA 98642 PORTLAND, OR 97209
P
PHONE: 503-478-6603
PHONE: 360-887-8054
FAX: 360-887-8504
•
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 03/15/2012 $25.02
Specifics: 4 ea Sink 03/15/2012 $100.08
1 ea Water Closet 03/15/2012 $25.02
Type of Use: COM 1 12%State Surcharge- 03/15/2012 $22.52
Class of Work: ALT Plumbing
Type of Const: 1 ea Water Heater 03/15/2012 $37.52
Occupancy Grp:
Stories:
Total $210.16
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.
•
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00058
Date Issued: 03/15/2012
TI C A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S136 DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST 120
Project: Great Clips Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Interior plumbing.
Contractor: ATLAS PLUMBING CONTRACTORS Owner: AMERICAN INDUSTRIES INC
P.O. BOX 1352 1750 NW NAITO PARKWAY
RIDGEFIELD, WA 98642 PORTLAND, OR 97209
PHONE: 360 - 887 -8054 PHONE: 503-478-6603
FAX: 360 - 887 -8504
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 03/15/2012 $25.02
Specifics: 4 ea Sink 03/15/2012 $100.08
1 ea Water Closet 03/15/2012 $25.02
Type of Use: COM 1 12% State Surcharge - 03/15/2012 $22.52
Class of Work: ALT Plumbing
Type of Const: 1 ea Water Heater 03/15/2012 $37.52
Occupancy Grp:
Stories:
Total $210.16
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.
� I Issued By: � • • mittee Signature: /
Amu //
• 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.
Mar 1412 03:02p Atlas Plumbing Contractor 360 - 887 -8504 p.2
Plumbing Permit Application
<c.ISI . .
Site Utilities 1 =C)l: (►rrlc l: 1 S1.: <)�l.l
City of Tigard
+
13125 SW Hell Blvd., Tigard, OR 9 2 � � Q O i•� "+= +?�� ®' �.1� rte
Phone: 503.7182439 Fax: 503.598.1960 VP O G U Review
`` Date/8y:
T i G .11 n Other Permit No.: ...L. .
Inspection Line: 503.639 Q Date Ready/By:
Internet: www.tigard- or.gov . 45 1 See age 2 fog
0„q. \v Notified/method: Supplemental Information
TYPE OF WORK ��' FEE* •
❑ New construction
❑ Demolition F or spec information use checklist
® Addition/alterationlreplat�nlent ❑ Other: Description I Qty. I Ea i Total
New 1- 2- family dwellings (includes 100 ft for each utility cmmection)
CATEGORY OF CONSTRUCTION SFR(1) bath ' 312.70
❑ 1- and 2 -family dwelling ® Commercial/industrial SFR (2) bath 437.78
❑ Accessory building 0 Multi- family SFR (3) bath 500.32
❑ Master builder ❑ Other: Each additional bat /kitchen 25.02
Fire sprinkler( sq. ft) Page 2
'JOB SITE INFORMATION AND LOCATION' Site utilities:
Job site address: 7275 SW Dartmouth St Catch basin or area drain 18.76
City/State/ZIP: Tigard, OR 97223 Drywell. leach ling trench tcch drain 18.76
Suite/Mg/apt. no.: 120 I Project name: Great Clips Footing drain (no. linear R: ____) Page 2
Manufactured home utilities 50.03
Cross street/directions to job site r Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _) 1 Page 2
Water service (no. linear ft: Page 2
Subdivision: [ Lot no.: Fixture or item:
Tax map /parcel no.: 1S136DCO2504 Backflow pm-venter 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
Install plumbing fixtures for new tenant Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tart 12.51
Name: American Industries roc Fixture/sewer cap 25.02
Address: 1750 NW Front Ave Ste 106 Floor drain/floor sink/hub 1 25.02 25.02
Garbage disposal 25.02
City/ State/ZIP: Portland, OR 97209
Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
® APPLICANT . ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Atlas Plumbing Contractors Medical gas (value: $ ) Page 2
Contact name: Travis Zea Primer 12.51
Address: P.O. Box 1352
Roof drain (commercial)
Sink/basin/lavatory 4 25.02 100.08
City /State2II':12idgefield, WA 98642 Solar units (potable water) I 62.54
Phone: (360 ) 430 -5765 I Fax : (360) 887-8504 Tub/shower /shower pan 12.51
E-mail: travis @atlasplumbingcontrectors.com Urinal 25.02
CONTRACTOR Water closet 1 25.02 25.02
Business name: Atlas Plumbing Contractors Water heater 1 37.52 37.52
Water piping/DW V 5629
Address: PO Box 1352
Other
25.02
City/State/ZIP: Ridgefield, WA 98642 Subtotal 187.64
Phone: (360) 887 -8054 I Fax: (360) 887 -8504 Minimum permit fee: $72.50 ---
CCa Lic.: 165718 Plumbing Lic. no.: PB149 Plan review (25 % of permit fee)
Authorized signature: -
� State surcharge (12% of permit fee) , S'
'� - TOTAL PERMIT FEE al 4) i i`
Print name: Travis lea I Date: 3/14/2012 I T u permit application expires if a permit is not obtained " in 180 days
a fter it
has bee a as complete.
"Fee methodology sat byTri- County Building Industry Service Board.
1 : 1 HwldiaglPerminaLWl1- PamitApp.doc 1010I49 440- 4616t(10002/COM/WFB)
Mar 1512 08:52a Atlas Plumbing Contractor 360- 887 -8504 p.5
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qt. Fee (ea) Total Square Footage: • Permit Fee: .
50.03 0 to 2,000 $121.90
Footing drain - 1° 100' 2,001 to 3,600 $169.69
Footing drain - each additional 100' 37.52 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 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52 I Valuation: • Permit Fee:
Storm & Rain Drain - lst 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
, each additional $100.00 or fraction thereof, to
Other Inspections or Fees Qty. _ and including S10,000.00.
Inspection of existing plumbing or for $10,001.00 to S25,000.00 $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 hoar) 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.
$50,001.00 and up $74200 for the first $50,000.00 and $1.20 for
Add l plan review for revisions 90 each additional $100.00 or fraction thereof.
(minimum charge -1/2 hour)
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 * .
()candy by Fixture TYPe Plan Review for Plumbing Installations
Fixture Type for c Added Repind Plan review is required fo any of the following
Work Performed: Please check all that apply.
Baptistry;Fom ❑ Any new commercial building with water service 2" and
Bath -Tub/Shower greater, except systems designed and stamped by licensed
,IacuzzilWh _ g
engineer.
Car s Wash -Each
Driv Stall ❑ New exterior plumbing site utilities for any complex structure
Drive o as defined in OAR918- 780 -0040.
w aWeter Aspirator
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
0 Any multipurpose fire sprinkler system.
- Domestic ❑ Any complex structure as defined in OAR918 780
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor I)raia'sink - 2" 1
-3" .
_ 4 •= Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic- non -food that meet the qualifications above.
Disposal -Domestic-food related
- Commercial -food related ,
- Industrial -food related
• Ice Mach./Refrig. X115 Comments regarding fixture work:
Rec. Separator Dump Station) just adding $ new.
Shower -Gang
-Stall
Sink/Lay -Non-food related 3
- Bradley
- Commercial - food related
-Service 1
Swimming Pool Filter - *Note: If the fixture work under this permit results in an
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water
Extractor increase
fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Urinal nal
Other Fixtures: (La ti r r i'it'.t' -- I
http: / /www.tigard- or.gov /city hall/departments /cdldocs/PLMU-Perm'tApadoc
5111 . cive Sewer Tally
n
Tenant Name: Shell Building * *CREDIT t « *p SWR # N/A
TtGARi3 Site Address: 7275 SW Dartmouth St PLM # 2012 -00056
Parcel #: 1S136DCO2504
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptistry /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
Eve 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 11P) 16 0 0 0 0 0
- Commercial (to 5 I IP) 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 0 0 0 0 0
Shower: - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink:
- Iav /Bar - Non -Food Related 2 0 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Com /Serv/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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous F:DU Count 0 0
Capped I - ' :DU Credit 0
TOTALS 0 0 3 11 0 0 -3 -11
Current Fixture Value -11 divided by 16 = -0.7 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous I:DU
Change -1 I divided by 16 = -0.7 over (under) S (3,150.00)
Enter EDU Change Here -0.7
Notes: - "'CRI ?DI'1'Sk "" Capping all existing fixtures in building
Authorized Name /Signature: Debbie Adamski Date: 3/14/2011
Building Division
Note: The property owner shall retain the ORIGINAL. sewer tally record. I f 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'allvShect- 4500.xls 01/18/12
III Accumulative Sewer Tally
a T enant Name: GREAT' CLIPS SWR # SWR2012 -00051
TIGARD Site Address: 7275 SW DARTMOUTH ST PL,M # PLM2012 -00058
Parcel #: 1S136DCO2504
Fixture Value Previous Previous Credits Capped Fixture Fixture New Ncw
# value count capped #s value count added # added value total #s total values
Baptistry/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 1 2 1 2
- 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 Scp (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 3 6 . 3 6
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 1 3 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 0 0 5 11 5 11
Current Fixture Value 11 divided by 16 = 0.7 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 11 divided by 16 = 0.7 over (under) S 3,150.00
Enter EDU Change Here 0.7
Notes: .7 EDU CREDITS FROM PLM2012 -00056 APPLIED TO THIS PERMrI'. ZERO BALANCE AS OF 3/15/2012 B.T.
Authorized Name /Signature: BRANDEN TAGGART Date: 3/15/2012
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 \Se vcr'I'allyShcet- 4500.xls 01/18/12