Permit I CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00091
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2012
T1G' - Parcel: 2S101AB01606
Jurisdiction: Tigard
Site address: 7357 SW BEVELAND RD 200 •
Project: Beveland Wellness Center Subdivision: HERMOSO PARK Lot: 17
Project Description: Cap (4) non -food related sinks and (1) clothes washer; Relocate (1) dishwasher and (1) non -food related sink; Add
(2) water closets.
5/4/12: REPRINT permit to add (1) ice maker and (1) sink.
Contractor: RD PLUMBING INC Owner: CLARKE, THOMAS C & SUSAN L
13900 NW SPRINGVILLE RD 12439 SW 22ND AVE
PORTLAND, OR 97229 LAKE OSWEGO, OR 97035
•
PHONE: 503 - 297 -7422 PHONE:
FAX: 503 - 297 -7344
•
FEES
Quantity Description Date Amount
•
1 ea Dishwasher 05/04/2012 $25.02
Specifics: 5 ea Fixture /Sewer Cap 05/04/2012 $125.10
1 ea Ice Maker 05/04/2012 $12.51
Type of Use: COM 1 ea Sink 05/04/2012 $25.02
Class of Work: ALT 1 ea Lavatories 05/04/2012 $25.02
Type of Const: 2 ea Water Closet 05/04/2012 $50.04
Occupancy Grp: 1 12% State Surcharge - 05/04/2012 $31.53
Stories: Plumbing
•
•
Total $294.24
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: ,� /
/ / ff"n/
U '4-j w "2
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.
M -I CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00091
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2012
Parcel: 2S101AB01606
Jurisdiction: Tigard
Site address: 7357 SW BEVELAND RD 200
Project: Beveland Wellness Center Subdivision: HERMOSO PARK Lot: 17
Project Description: Cap (4) non -food related sinks and (1) clothes washer; Relocate (1) dishwasher and (1) non -food related sink; Add
(2) water closets.
Contractor: RD PLUMBING INC Owner: CLARKE, THOMAS C & SUSAN L
13900 NW SPRINGVILLE RD 12439 SW 22ND AVE
PORTLAND, OR 97229 LAKE OSWEGO, OR 97035
PHONE: 503 - 297 -7422 PHONE:
FAX: 503- 297 -7344
•
FEES
Quantity Description Date Amount
1 ea Dishwasher 04/25/2012 $25.02
Specifics: 5 ea Fixture /Sewer Cap 04/25/2012 $125.10
1 ea Sink 04/25/2012 $25.02
Type of Use: COM 2 ea Water Closet 04/25/2012 $50.04
Class of Work: ALT 1 12% State Surcharge - 04/25/2012 $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: �/� / Pertnittee Signature: ` /)� e ���lll/// _ /
/( Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. g-/g-/oz./ e..--7 �
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.
04/14/2019 19:47 FAX 5032977344 RD PLUMBING IJ001 /002
Plumbing Permit Application
Building Fixtures ^ roR ol-ricl': l'SE °Nix
City of Tigard F � n ��eiv�d ty: 9 . I '
- n 13125 SW Hall Hlvd.. Tigard, OR 97211 Vrj+�� Y DI en / °2 y 42- Permit No'P[/1/4Q /a Oa 9ii
; ` Phone: 303.718.2439 Fax: 503.598.1 • 1 '� Hy Other Permit N
TIGARn Inspection Line: 503,639.4175 q Q 10 ?
V ila met: www.Ggard -or,gov - s ` • �� ` r D ate Ready/By: 1 • • S Set Page for 1
- �^ „� htl .. ,I na Notified/Method: _ Sup•lementallatermadon
;,r, 'i g 1 � ; f' i iiS 11 �,( 'I . , .,Ye♦rRM(I,:' -: ,:. , i„ �1 },i,, e;1• :I ul
:,> )� ". -1 lA• , : ;.; l.. .1 .. r . i ' 1• 1` I 'j 74 �+� l y .r,:
91...:'yRHS�llll:,: {,..�1 ',r.. •.. G; �: ',..`/,iis., i 1: i�'I,{,�' ��, ` , , .:•1. , P.: � ° t
• � _ '
❑ New construction ❑ n . :1'viiiirri�.. f,..:.:;*;:.:. a��e.4�1}+1„� f•. la�rl
..14- "ia 1, For special information use checklist
_� Addition/alteration/replacement [] pt'eY. Desen Lion I Qtr. I Ea. I Total
New 1- 2 -family dwellings (includes 100 iL fix each utility connection)
y+ h } qt y tly�, Ifs µ(IM�d'11 ,•' � •�' n :. .�, , ' SFR Y �ctiuta)
V1'I l'iV1.y;sa�:� M��h: Ili r /llry; '1 ` , o' ()
d:;I Its l ' Ira "i,y,. : "'•"S:` i ) bath 312.70
❑ I- and 2- family dwelling I' Commercial/industrial SFR (2) bath 437.78 .
D Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other.
:'J.QS'i ><f1 ! r eit �'s, t l �� . ,, w l ii'1 ";it R:, Ise, "r. ,,� „p lfi t� ; l;` r Fire sprinkler �_ sq. fl.) Page 2 1
411 l : ';;; 'i i7 .1,,,, .. ;v .,, It 1�.0 ,,�: 4 ' C':'..i i s Site utilities: 1
Job site address: 73 57 . Si ;J , LI 44.4/t/,D c. Catch basin or area drain I $.76
C ity/Suite/Z..I P. 7 , oR- Q 7 a• � 17rywell. le line, or trench drain 18.')
Footing drain (no. linear ft.: ) Page 2 •
1.e Suite /bldg. /apt. nu.: O Project name: a6l/EL.A'it/is k/ELLA/E Manufactured home utilities 50.03 •
Cross street/directions to job site: C E/V TER,. - Manholes 18.76
Rain drain connector I R.76
-
Sanitary sewer (no. linear R.: ,) _ Page 2
Storm sewer (no. linear R.: _,) Page 2 -
• Water service (no. linear ft.: _J Page 2
Subdivision:
��.//�� Loa no.: Fixture or clew: •
_lax map /parcel no.: aS /O /r /330 /040 , Backflowpreventer 31.27
EK TPTit � i , ., ' - 1•o ' •Ills •, ' Backwater valve 12.5
.. ...• , .- .:,:.,. . ai'r .,, a, .. •
,ii d "I� .,u r' , ..a -.
Clothes washer 25.02
Dishwasher .. I 25.02 ;5.c t/
__ Drinking fountain 25.02
Ejectors/sump 25.02
❑ PRUPBRTl t}> '.: t'; ;;: � ' q�� 1•'+ p , � ,,NiFlt 1 i 'yy •,...,1;.;:,: ; , . f tr ; • Pxpansion tank 1 2.51
i ; , } i...J ; : 1' '1Inewa� i i, il�i l5 I i'i itl!it.° t;l;l ilil':ti e � /
Name: Fixture/sewercap 25.02 1 ,75, /O
Floor drain/floor sink/hub 25.02
Address:
-
Garbage disposal 25.02
('ity /State / .IP:
_ - _- .-- - -,... Hose bib 25.02
Phone: ( ) Fax: ( )) Ice maker 12.51
• ❑ APPLI CANT ; ' a i l ' : ' 1 , 1• l �` i � .. , . , •` ',4i: - : v - ' Interceptor/grease trap 25.02
Business name: R.D. PI.Drrt 3,,.C ) ilk! , Medical gas (value: $ ) Page 2
Contract name: Primer 12,51
._ P/ a00 Ntii Roof drain (commercial) 12.51
Address: i "Ac)00 A). u7. Sf R//UCoviL.L.. Rb. _ Sink/basin/lavatory / ?5.02. ,2S,O 2 1 V
City /State/Z1 P: � AA , 0� . �1 7 2_1. 9 -- w Solar units (potable water) 62.54
Phone: (5 63 l rig 7 -7 eF 2I___ I 1F ax:: re3 );177 Tub/shower /shower pan _ 12.51
E-mail: RD Pi, v/n a / A..;& 6 T, ON &.r
Urinal
_ 25.00.
- - �l c closet �t�►
.;.. , .�4 A , Water h .a
..
y � y �,p� , 1 , ;-� 7 i , .z , ; ir " 1 1 � � 1 ,r � ry �� y ���
!l ( .,. , +l l''d"� ' `` ;:.iirllw:4:1' !.! ''i f 'J %'.. •..,n"i ""'4F! * 41 . Wat heater 37.5
Hn;iness name: • R D. PL_Um i3 t 1L36, F'J - 0 - Water piping/DW V - 56.29
•
Address: f $0 4j _
D ) //UCcgt /L Othe 25.02
City/State /ZIP: poR rLA /Lf ), Q , 9.72. y q
Subtotal ."x .5.1 isl
P one: (503 ) q7 A z 2- Fax: 303) ia 4 di Minimum permit fee: $72.51)
('(H Lk.: .ic.: 7 ej ! 3 25 Y Plumbing Lice no.; o ' 3 i
. . 7)aq Plan review (25 %of permit tee) -
- I I $tale surcharge (12 %of permit fee) L'? , 02
Authorized signature: ` / ' � _6t e• : �"' 'IY)'I'AL PERMIT FEE ,SA.2O
Print muite; $ 7 p�r./�},,I,a/, a )e'U /4S I Date: 4/74242,_ This paxm application expires If permit is not obtain
btain.ed within 180 drys
aaer It has been accepted as complete.
*Fee methrxhdngy set by Td-County Building: Industry Servrce 1/11;
d<0.4616T(1W03lCOM/WBB)
I',Buildirg1Non sTLMU- Pcrmirnpp.dnc 10/01/09
04/18/2019 20:28 FAX 5032977344 RD PLUMBING 6001 /001
Eti D, F4 u■r7 8 /4)6, � N d_
Plumbing. Permit Application - City V g t;'3 J g fe- 94-0
Page 2 - Supplemental Information
APR 2 4 2012 i4ro) t21i1A
Fee Schedule: Fire Sur ression Systems:
?...: ' „r;... ;y:.f,.7I� Z .i•4!il�1i�41f0.1 TIG ,; ,7 ji i 1 n :rig:.i. a m•' • i. .
Site Utiilpt��es .. , �, •;. ,' 1 . ; ;� : • „ o. a1 :• r
Footing drain - l" 100' 3 - . 1 t o 2 ,00 0 $121.90
Footing drain - each additional 1 00' 37.52 2.001 to 3,600 $169.69 -
Sewer - 1st 100' 62.54 3,601 to 7 $233.20 -.. • . ... •
7,201 and greater $327.54
-- eee•er - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas S stems:
water Service - each additional 100' 37.52
? j.., rlj,ifj�j a . . , .. Ir.N. ^..,;:..:. •
Sturm & Rain Drain - 1st 100' 62,54 ,) ''',, ; •, l.,.•';' i;tyj 1i: o . bl ,. "'« :
it r.M.nr ., Fa.. ,. r • ... .... ���
SI.00 to $5,000.00 •
Minimum ice $72.50
Storm S _
Ruin 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
nthGr 61Specnone tip'° - j "" '� j' each additional $100.00 CT fr action thereof. to .
A,., ' A G' r I� 'f a N"u it Ii, and including $10,000.00.
h lion sting plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.5'1 for
which
wchic no fee e is is s pecifically 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 t o $50,000.00 $379.50 for the f rst $25,000.00 aural b 1 .45 for
hours (minimum charge - 2 hours) each additional $100.00 of fraction thereof. iu
Reinspectiun fees 90.00/hr
and including $50,000.00.
Additional p lan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 lint
(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 *.
'at it ll !131 ?frtiirak eT! pdj" $ L n5 llations
Mixture -1)1x for nm>.pt r ;,a1!pa;C!u . •.. !i aea � • .:,w1n :�,►3Je . Olp4, a .,, 1 � ,`::�'.. $:..
�:'ti > > a + Plan review is required for any of the following
Work Performed: • '.. •:; •: •;:•. ,::;::•;. , i;1:••t::;i6, Il r, l Please chcck all that apply.
Baptistry/Font
Bath -rub /Shower ❑ Any new commercial building with wuler service 2" rind
- Jacucci/Whirlpool greater, except systems designed and stamped by licensed
w
Car Wash -Each Stall engineer.
-(hive Thru ❑ New exterior plumbing site utilities for any complex struc.turc
Cu tip Wm/Water Aspirator as defined in OAR918 -780- 0040. •
17izlneaslter -Commercial / ✓ ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure its defined in OA R9 I 8-780-0040.
Rye Wash
Hour Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
(iarhage - Domestic non -food
Disposal - Domestic -food related - that meet the qualifications above.
-Commercial- food rclatcd
- Industrial-food related _
(cc Mach. /gel 'nig. Drains
oil Separator Was Station) ' Comments regarding fixture work:
Rec. Vehicle Dumtation
Shower -Gang
-Stall t / / . /
Sink /l.av -Nun-food related ✓ V — - -
- Bradley -
- Commercial -food related __ ,
•Scivicc
Swimming Pool Filter / ✓ *Note: If the fixture work under this permit results in an
Watshcr - Clothes
Water Exlractur increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet ✓ fees assessed fur the sewer increase must be paid before the
r 'U r i na l - a ' plumbing permit can he issued.
Other Fi xtures: ,
l i tip: //w w w. t i Bard -or. gov /e i ty_ hall /dcpartme n ls/ed /docs/t' LM1"" -Perini tApldoe
. Accumulative Sewer Tally
n
Tenant Name: Beveland Wellness Center SWR # N/A
TIGARI) Site Address: 7357. SW Beveland St. PLM # PLM2012 -00091
Parcel #: 2S101AB01606
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
- 3inch 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 -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:
- Lay/Bar - Non -Food Related 2 0 4 8 0 -4 -8
- 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 1 6 0 -1 -6
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 5 14 2 12 -3 -2
Current Fixture Value -2 divided by 16 = -0.1 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -2 divided by 16 = -0.1 over (under) $ (450.00)
Enter EDU Change Here -0.1
Notes: •
EDU credits = .1
Authorized Name /Signature: Dianna Howse Date: 4/25/2012
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
04/14/2019 19:47 FAX 5032977344 RD PLUMBING _ 0001/002
Plumbing Permit Application /9-2s.61 �70���' /-7/ x �
Building Fixtures ^ Ft1R O1Ticl•: USE. ()NUN' �V neceived '
City of Tigard
- t 312 SW Hall Hlvd.. Tigard, OR 972 C 1
mien* y /a'Y �� - p No.P(/ ja BOO }
4 !I
I
Phone: 503.718.2439 Fax: 503.598. Flan Review
Ti G A R tl Inspection Line: 503.639 p Q 2,01
Datanty: Other Petard N
Internet: www.tigurdsr.gov L D R ` r Date Ready/By: 1 ' dice Page l fnr
1 r t Netified/Mahod: •. Sup. mentallntermanon
.. • _ .1(;��:•••'• .. (5 ;. li :` q i u•r i . ; ;. ,._.,�
•... . _.• i, � 4 �' '` a �,;;••,�,�' ��`,; •F'+ 7a�d;irr G� � ;, �; yI'i � :; ;;,h� �i : ��r .,, -. ,vim
.....!ilW + - ..,..,.: � ,�a ;'1•: :14•::'i : i. , . r ( � l ; - :,. • .r,i tm .1,� la, n ;.:: ^'=
_ O New cunslruct(oll 0 n : IL 'l For special inform:lion use checklist.
• Descri • tion I Qty. [ Ea I Touil
A Addition / /replacement ❑ O er. Nrw 2•ftlolil dwellings Includes 100 IL
._ r iu Y B ( each ulilit a connection)
C
ycv�tl'1 r�. •r"„ Y
1 A Tjtuott „Q . " ^ - J ' 'cm •1:, P1.. t... "• SFR (1) bath 312.70
❑ - and 2- family dwelling l'. Commercial/industrial SFR (2) bath 437.7$
•
❑ Accessory building ❑ Multi family SFR (3) bath 500.32
• Each additional buthhitchen 25.02
C) Muslcr builder ❑ Other •
" , rFy , r .•,.,. rt,a;rnrr, Fite sprinkler ( __ ft) Page 2
1 n i' i;
':J.D8.'9 � ceu °'� r u•1��1"•',''i1�'S•�t!'���::.r / I'la �; • i- �d::aa�l�t. +.•(t a'�e�l�u;ldfr�.uC..IZI :•+:, r• ,7.!) tl' ��. ���: ? ��t!';T�!��i9�+�!��(:i: $Ih Utllhha 1
_nub site address: f , 5 Catch basin or area drain 18.76
City /Stuteal P: - t n/Q_ Q 7 a.. Drywall. leach line, or trench drain 18.76
Fnotiog drain (no. linear R,: p 2
Suite/bldg./apt. uu.:.o Project name: /�c
agl %D k/ 4c., vr_C : Manufactured home utilities 50.03 _
Cross streeVdiruetions to job site: C EIS/TER. Manholes 18.76
Rain drain connector 1 R.76 -
Sanitary sewer (no. linear R.: _....) Page 2
• -- Storm sewer (no. linear ft.: �) Page 2 -
• Water service (no. linear ft.: ,J Page 2
Subdivision: J Lot no.: _ Fixture or Item:
'Fax map /parcel no.: S'/0//960/bO Backtlow venter 31.27
washer � {.02
:. • .1434#111/K:":4 4 w p .' , : Cloth
+: +1r[ .. ; _, l':;,. r , Backwater valve _ 12.51 -
5/ es l X.. (P /CE H*A•/t eliC <) 4i,Jk Dishwasher _ t/ 25.02 2,5;02. I/ -6 ... aeotPt a6 w�K _ Drinking fountain 25.02 -
L•jectors/sw np - . 23.02 .-
. ..t >w��•r'$' !. jaTJci'I; e' r'ia:. -.pri ;, ^: ", •' 'Kt FixturrJsewerc
. '' - • INJ:; Expansion tank / 12.51
• Name: cop . - .'� ...• 21.02 1a5, /O '•/'''
Floor drain /floor sink/hub 25.03
Address:
Garbage disposal _ 25.0.E
City /State/7.1 P: Hose bib 25.02
Phone: ( ) -- - - -- Fax: ( ) Ice maker r . 12.51
.4,�, n 1 li;u.;lrp ut� +, �•:mre �,. fr ki
4RRLIG.tf�4T. :' ::•�.•.. :. :' '....:, i<ti� t� °�� I� +; a .' rr I cr Intttcc "P 23.02
Business name: A IN, pi...0 An irt-) (7i J ilk! Medical gas (value: S _) v Page 2
Contact name; Primer 4, 12.51 I
._ T>� pMst.0 J� T>E.utii s Roof drain (commercial) ties t� 12.51 5 ((
Address: i 7 A i.!). SPRiA)/ 01,./., ia. __.... Sink/busin/Iavatory r- x2„. 75.07. = V
City /State/•Lll': poAr, 4qtin 2 O/e O.Q. , 7 2- 2. C I _ units (potable water) - 62.54
Phone' (5,3 )A9 -74 tax' : 6.1.3 )277- 14 Tub/shower /shower pan 12.51
1
1 -moil: Oh- 0Al sa A:G &MP/YKIA.5 T. Ai E.7- Urinal 25.02
i Water closet ,q 25.02 , 56,09r '/
tl!r�:l�'.tt!`� b';r11:�!
97 i^�° :i •i' Re= d AN Water heater )7.52
linaness name: • AD, p, pi,_u m (3 t iLI G i //id.. r Water piping/D W V 36.29
Address: i W__Q itJ[c> . AQ/�Gt/i[.Lt / Other. 250
City /State/ZIP: eTLA n1Q, 40A Q • 9'722.? - 9 _.• . •
Subtotal
Pa
F es (� �) a 97f 7 3 4 �/ Minimum permit fee: $72.50
P one: (. ) 7 7# 2- � - Plan review (25% of permit fee) _
( ' Ct. I.ie.: 3 9 13 11,. 5):" 1 Plumbing Lie. no.: A.h - i3 P
� � I �,,.. ,� f - State surcharge (12% of permit fcc) .�tt
Authorized signature: ;> .. ,.. �`� - .+4� ..e fU'1'AL PERMIT (Cl": ✓
Prim mane; $1 A'AJt.Y Q 4�/UN / -
•Fe
I Date: /1/7, J nth ire i ne thn ppti'A ahrr n ail lth Tdi b een a d nda os c umplela ed within Imo days
e metiiduh f by �ounty Banna Industry tierme Mimi
1". Dulldin�V 'mmiulPLMt1- Ppmlrnpp.dos 10/01/09 eao.ieidmaius#co wea)
Accumulative Sewer Tally
v
i p Tenant Name: Beveland Wellness Center * *REVISED 5/4/12 ** SWR # 2012 -00074
TIGARI) Site Address: 7357 SW Beveland St. LM2012 -00091
Parcel #: 2S101AB01606
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: - rub /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 UP) 16 0 0 0 0 0
- Commercial (to 5 1 -IP) 32 0 0 0 0 0
- Industrial (over 5 1 -IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 1 1 1 1
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 4 8 1 2 ' -3 -6
- Bradley 5 0 0 0 0 0
- Com /Scrv/Util - Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 1 6 0 -1 -6
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count - - 0 - 0
Capped EDU Credit 0
TOTALS 0 0 _ 5 14 4 15 -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:
EDU credits = .1 Revised 5/4/12, to add (1) ice maker & (1) sink. Exceeded EDU credit amount. Dadamski
Authorized Name /Signature: Dianna Howse/Debbie Adamski Date: 4/25/2012- 5/4/12
Building Division
u ote: The property owner shall retain the ORIGINAL, sewer tally record. If credits exist, this document will serve as a voucher which must be
bmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \Building \Sewer Tally \Scwcr TallyShect- 4500.xls 01/18/12