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Permit
CITY OF TIGARD PLUMBING PERMIT 114 2 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00085 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/17/2012 Parcel: 25101 DA00104 Jurisdiction: TIGARD Site address: 13333 SW 68TH PKWY Project: Clear Channel Radio Subdivision: VARNS ACRES Lot: 9 Project Description: TI: 3rd and 4th floor offices and radio broadcast facilities. Capping 15 fixtures, relocating (1) drinking fountain, (2) floor drains, (3) lav /sinks, and (2) toilets. Adding (1) ice maker drain. Contractor: MARXMEN PLUMBING & CONSTRUCTION INC Owner: TRIANGLE POINTE LLC 9665 SW 163RD AVE 901 NE GLISAN ST, #100 BEAVERTON, OR 97007 PORTLAND, OR 97232 PHONE: 503 - 579 -2200 PHONE: FAX: FEES Quantity Description Date Amount 15 ea Fixture /Sewer Cap 04/17/2012 $375.30 Specifics: 1 ea Floor Drain/Floor Sink/Hub 04/17/2012 $25.02 1 ea Ice Maker 04/17/2012 $12.51 Type of Use: COM 1 ea Sink 04/17/2012 $25.02 Class of Work: ALT 2 ea Lavatories 04/17/2012 $50.04 Type of Const: 2 ea Water Closet 04/17/2012 $50.04 Occupancy Grp: 4 ea Water Heater 04 /17/2012 $150.08 Stories: 1 12% State Surcharge - 04/17/2012 $82.56 Plumbing Total $770.57 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 ' I started within 180 days of issuance or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the r es adopted by the Oregon Utili otificatio enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 1090. i may obtain a copy of the rules or rect questions to ■ N . • . Ili. ! 503.232.1987 or 1.800.332.2344. I I I Iss ed By: i , Permittee Signature: ' I _ 1 Call 503.639.4175 by 7:00 a.m. for the next available inspectio date. This permit card shall be kept in a conspicuous place on the job site until comp , tio • the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application n 1 Building Fixtures { -it r"i� � \. 4 FOR OFFICE t.iSL ONLY .l ii- �.i7t.._,, Cit of Tigard 17 Received ' A. �1 Permit No.: 4 �/e ,62..�( g�� 1. a 13125 SW Hall Blvd., Tigard, OR ¢Oj 11 7 2012 Date/By: 4 / / 4"LL�J .i /G►[/` 2 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: a Other Permit No.: C �+ �p, f F :0 , f , ; , I I G n R Internet: www.ti ard or. ov Inspection Line: 503.639.4175 lL E n� °" ,' '® Date Ready/By: runs: El See Page 2 for g g r°" ,: r t aor+ r,1C1,::+eh�pt Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For specaal information use checklist Description I Qty. I Ea. I Total [el 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 [ m Comercial/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: 1 ,9 V "r) p A Q K W Gh Catch basin or area drain I I 18.76 City/State/ZIP: y Drywell, leach line, or trench drain 18.76 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Clegg Ciiu v neL" T/X 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.: , 5 kJ/ DA DO /6 . Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 �t Clothes washer _ 25.02 I Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER IA TENANT Expansion tank 12.51 Name: C,‘ -e a, M C A pt y'y\-t Fixture/sewer cap / 5 25.02 37 S - Floor drain/floor sink/hub E 25.02 ‘ 7.5-42 Address: ? Q VM1 Garbage disposal 25.02 City/State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker / 12.51 0.,,57 al APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Contact name: Primer 12.51 Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 3 I 25.021 7s City /State/ZIP: Solar units (potable water) i 62.54 ___ Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 - Water closet !L 25.02 �.Of' CONTRACTOR 9 l Water heater / S'b• e 37.52 Business name: M g Rx,me IN cptu.nmp11J� t C, ous4" eNG Waterpiping/DWV 56.29 Address: q (D(Q 6 'uU i 63 k Other: 25.02 City/State /ZIP: ve_Vrt 1 Subtotal 64 AO/ • Phone: ( 661) d C►.Z'Z ©Q Fax: ( 56) 5-q -z zpI Minimum permit fee: $72.50 CCB Lic.: 1 OZ�4�Z PI bing Lic. no.: 34..E b/ Pe Plan review (25% of permit fee) State surcharge (12% of permit fee) ga • 5 Authorized signature: 6' TOTAL PERMIT FEE 77 6,9 7 7 Print name: ,411_ GN Date: I-.✓] 1 g 4,112... This permit application expires if a permit is not obtained within 180 days ii after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \PermitAPLMU- PrnnitApp.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 and including $$0,000.00. 100.00 r fraction thereof, to 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 Thru ❑ 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 1 I ❑ Any complex structure as defined in OAR918- 780 -0040. Eye Wash Floor Drain/sink - 2" 2 / Submit 2 sets of plans with any of the above. -3" Car Wash Drain Isometric or Riser Diagram 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./Refrig. Drains 1 Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink/Lav - Non -food related '1 't; - Bradley - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes p 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 1 plumbing permit can be issued. Other Fixtures: C:\ Users\ markhp \Downloads\PLMF- PermitApp.doc 2 c) III Accumulative Sewer Tally a Tenant Name: Clear Channel Radio ** *CREDITS * ** SWR # N/A TIGARD Site Address: 13333 SW 68th Parkway 1 # 2012 -00085 Parcel #: 2S101 DA00104 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 1 1 1 1 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain /Sink: - 2 inch 2 0 2 4 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 1 1 1 1 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: - Lav /Bar - Non -Food Related 2 0 4 8 3 6 -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 6 36 2 12 4 -24 Urinal 6 0 2 12 0 -2 -12 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 15 61 8 _ 22 -7 -39 Current Fixture Value -39 divided by 16 = -2.4 Current EDU 1 EDU = $4,500.00 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -39 divided by 16 = -2.4 over (under) $ (10,800.00) Enter EDU Change Here -2.4 Notes: Additional creditsalso available from PLM2009 -00059 & PLM2010 -00297 Authorized Name /Signature: Debbie Adamski Date: 4/17/2012 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 'I'igard Building Division to redeem credits towards future system development charges. I: \Building \ Sewer Tally \Sewer I'allyShcct- 4500.x18 01/18/12