Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00113
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/16/2012
Parcel: 2S113BA00200
Jurisdiction: Tigard
Site address: 7800 SW DURHAM RD 500
Project: KOR Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Cap (10) fixtures and install (1) toilet, (1) shower and (2) sinks.
Contractor: K & C PLUMBING INC Owner: METZGER VENTURES, LLC
PO BOX 2124 PO BOX 400
OREGON CITY, OR 97045 SHERWOOD, OR 97140
PHONE: 503 - 518 -0234 PHONE:
FAX: 503 - 518 -1100
FEES
Quantity Description Date Amount
2 ea Sink 05/11/2012 $50.04
Specifics: 1 ea Tub /Shower /Shower Pan 05/11/2012 $12.51
1 ea Water Closet 05/11/2012 $25.02
Type of Use: COM 1 12% State Surcharge - 05/11/2012 $25.52
Class of Work: ALT Plumbing
Type of Const: 5 ea Fixture /Sewer Cap 05/11/2012 $125.10
•
Occupancy Grp: 5 ea Fixture /Sewer Cap 05/16/2012 $125.10
Stories: 0 12% State Surcharge - 05/16/2012 $15.01
Plumbing
Total $378.30
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 No' - '• 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 dir questions to S UNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed 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.
08 May 12 08:32a Russ 503- 518 -1100 p.2
Plumbing Permit ApplicationRECE!VED 61A.P600-000g3
Building Fixtures MAY - 8 2012
City of Tigard Received OF P /f .2 D its -DOl L3
11 ' Phone: 503.7!8 2434 Fax: 503.59. 2 1 ► TI^ /y �By:
[ D I Y Pamir No.:
13125 SW Hall Blvd., Tigard OR 97 CI i i Tti 1D Plan Review f)IQq?O4 SS
��ee ! Other Permit N
Inspection Line: 503.639.4175 ®I�`�7 DIVISION y.
�� /,_ ,� , (�
T 1 v A R IJ Internet: www.tigard- or.gov I Na�ed/Method: J� /a/ �1 v Supplemental Ed See Page t Information
� n lntormatioo
TYPE OF WORK (/ a) R15 FEE* SCHEDULE
❑ New construction I ❑ Demolition ��"!!""" For special information use checklist
Description I Qty. I Ea. I Total
XrAddition/alteration/replaoement ; ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCFION SFR (1) bath 312.70 11
❑ l- and 2 -family dwelling X Commercial/industrial SFR (2) bath 437.78 ; I
❑ Accessory building ❑ Multi- family 5FR (3) bath 500.32
es
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprurkltr( Sq.ftJ Paget
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 760Q S P L MAY-ha rn M i Catch basin or area drain 18.76
Diywell, leach line, or trench drain 18.76
City/State/ZIP: j ( fr L ei g
/ Footing drain (no. linear fl.: ) Page 2
Suite /bldg. /apt. no.: lO Project name: O le., Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
- Sanitary sewer (no. linear R: _) Page 2 •
Storm sewer (no. linear ft.: ) Page 2
,-
Water service (no. linear ft.: `) Page 2
Subdivision: GG i Lot no.: Fie tu re or item:
Tax map/parcel no.: /t d / /3 OO,9,0 0 Backflow prevent= 31.27
I DESCRIPTION OF WORK Backwater valve 12.51
• Clothes washer . 25.02
j h,5 () I +bl12- ` / S/1o[- ,�C�1 �ll Dishwasher 25.02
2 ) n- S' 1 OAP 5 4 x Taa-f s - Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank • 12.51
Name: Fixture/sewer cap / 0 V. 25.02 / /a
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State.21P Hose bib 25.02
Phone: ( I ) Fax: ( ) Ice maker 12.51
'❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Media! gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address:
S ink/basin/lavatory 25.02 50 , 6 µ
CityiState/ZlP: Solar units (potable water) 62.54
Phone: ( ) I Fax:: ( ) Tub/shower /shower pan r 12.51 / 2-.51
- E -mail: urinal 25.02
CONTRACTOR Water closet ( 25.02 .2S OZ
Water heater 37.52
Business name C P 1 ll h u b jury:/ ` 7 Water piping/DWV 56.29
Address: 1 . e, I Li p .5.70y-s-
Other: 25.02
jlstatcrLW: &'
one: (SO3) 78 j 7 17 / . I / Fax: ( S ` a3) 5 1 _ I / C Minimum permit fee: $72.50
CB Lie.: 1 (j (p I� ` 9 ✓ j \3 Plumbing Lie. no.: Plumbin ? . t3 Subtotal
5 Plan review (25% of permit fee)
'4 State surcharge (12% of permit fee) / A5'
Authorized si - / ' \ 1 TOTAL PERMIT FEE A
Print nam;' S ' ti t C a . Dater - - -- 1 Z. This permit application expires if a permit a not obtained within 18 11 days X h (
�� after it has been accepted as complete. 3 V
'Fee methodology se by Tri.Connty Building Industry Service Board
11 May 12 09:25a Russ 503 - 518 -1100 p.2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Tom 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 $23310
Sewer - 1st 100' 62.54 7 ,201 and greater $32754
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 S5,001.00 to 510,000.00 572.50 for the first S5,000.00 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 $154 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 550,000.00 $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 Relacak 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
- lacuzzi/Whirtpool 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 1 ❑ 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" (p Submit 2 sets of plans with any of the above.
- 3"
- 4" Isometric or Riser Diagram
Car Wash Drain
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
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:
11 Accumulative Sewer Tally
4
I T enant Name: Kor ** *CREDITS * ** SWR # N/A
• TIGARD Site Address: 7800 SW Durham Rd PI .M # 2012 -00113
Parcel #: 2S113BA00200
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 1 4 0 -1 -4
- 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 6 12 0 -6 -12
- 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 I-IP) 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 1 2 1 2
Sink:
- l..av /Bar - Non -Food Related 2 0 0 2 4 2 4
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 3 9 0 -3 -9
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 0
'TOTALS _ 0 0 10 25 4 12 -6 _ -13
Current Fixture Value -13 divided by 16 = -0.8 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -13 divided by 16 = -0.8 over (under) S (3,600.00)
Enter EDU Change Here -0.8
Notes: * * *C1j 1)rl'S * * **
Authorized Name /Signature: Debbie Adamski Date: 5/14/2012
Building Division
r 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 \Sewer fallySheet- 4500.xls 01/18/12