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Permit poi CITY TIGARD PLUMBING PERMIT P i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00466 ' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/19/2005 PARCEL: 1S134BC-00300 SITE ADDRESS: 12280 SW SCHOLLS FERRY RD ZONING: C -G SUBDIVISION: GREENWAY TOWN CENTER LOT: JURISDICTION: TIG Project Description: Relocating (2) lays, (2) water closets. New: (1) dishwasher, (1) sink. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: J SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: . TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 2 WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Owner: FEES VINNACOMBE CONSULTING Description Date Amount 12790 SE BLUFF RD SANDY, OR 97055 [PLUMB] Permit Fee 9/16/2005 $72.50 [TAX] 8% State Surchar1 9/16/2005 $5.80 Phone : 503 826 - 1726 - Total $78.30 Contractor: R A WARNER PLUMBING PO BOX 820785 REQUIRED ITEMS AND REPORTS VANCOUVER, WA 98682 Phone : 360 - 896 -0370 • Reg #: LIC 151329 PLM 37-521PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1-800- 332 -2344. Issued By: ' J ,i �� Permittee Signature: _ 'L f Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans ate required on the job site at the time of each inspection. r Building Fixtures Plumbing Permit A t) ';;,,,.T I Olt OFFICE Lisp: ()NIA City o Tigard Recemve ...A . 0 .5 -�� �2`11�?Ja 1(�� City Date/By. Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223nr - C 2 plan Review Phone: 503.639.4171 Fax: 503.598.1 U �i,,,. �� Other Permit No jAW/26 24- Hour Inspection Line: 503.639.4175 a L Date Ready/By: runs: 13 See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: /( Supplemental Information TghilLOEN SIGN FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use check list Description I Qty. I Ea. I Total Addition /alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 • ❑ I- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00 12 Accessory building 1:1 Multi-family SFR (3) bath 399.00 13 Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 1 2. z- 6o Catch basin or area drain 16.60 V O S w S t.(r.p l(C • l --ic.y City /State/ZIP: T7.A. , a r C Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: / I Project name: ®(L C Co........-- .° . (,t Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 • Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear R: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Back flow preventer Page 2 c.,rJ A-`e 2 TV l \. Backwater valve 16.60 ' ZJSS Les. l Clothes washer 16.60 - S I r..7 I( Dishwasher / 16.60 ❑ PROPERTY OWNER I 0 TENANT Drinking fountain 16.60 Ejectors sump 16.60 Name: Expansion tank 16.60 • Address: Fixture/sewer cap 16.60 City /State/ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State/ZIP: Roof drain (commercial) 16.60 Phone: ( ) I Fax: : ( ) �in as' t V � o j 16.60 Tub /shower/shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet (� 16.60 Business name: 2 4 wral...,_elL p ( \ (.- `o a Water heater 16.60 Address: N cl+ b%-/ ac.- Other: City / State/ZIP: t._) -►c f ir_ v.1.- ? 8 (o 5 2 Subtotal Minimum permit fee: $72.50 z vis Phone: ( 3(x(71 '7'7 ' -2 Lk C( () Fax: ( 3(,o) H Q , 0 3 7 d Residential backflow minimum permit fee: $36.25 2L - CCB Lic.: / S / 3 2 Plumbing Lic. no.: 37 s 11 l'(•3 Plan review (25% of permit fee) State surcharge (8% of permit fee) •,---1)16 Authorized signature: L., TOTAL PERMIT FEE 71'• ?d Print name: ` /� x Lit bsl,d_OQ t t/AA ,U-r'j Date: C7 - ( l- o 'C This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. is\ Building \Permiu\PI.MF- PelmhApp.doc 06105 4404616T(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' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater • $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Q ty. Fee (ea) Total additional $100.00 or fraction thereof to and Fixture or Item including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Back flow Prevention Device each additional $100.00 or fraction thereof to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof; to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Complex Structures Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. • accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quantity_by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service -Drive Thai facilities where new plumbing fixtures, including interceptors, Cuspidor/Water Aspirator are being installed for the food service area. Dishwasher - Commercial ❑ Any new residential building containing three (3) or more - Domestic / dwelling units. Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system. Eye Wash Floor Drain /sink 2" Submit 2 sets of plans with any of the above. -3" -4" Car Wash Drain Isometric or Riser Diagram Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal -Commercial three (3) or more stories in height. - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory 1 - Bradley - Commercial 1 - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this ermit results in an Water Extractor p Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. • is\ Building \Permits\PLM- PennitApp.doc 07/06/05 Accumulative Sewer Tally Parcel # 1 S134BC - 00300 Tenant Name: Oregon CommuNity Credit Union This SWR/ N/A Site Address: 12280 SW Scholls Ferry Rd This PLM# 2005 -00466 CREDITS Fixture Value Previous Previous Credits Capped Fixture Fixture ' New New # value capped off value added added total total count off #s count # value #s 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 1 2 1 2 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 1 0 0 0 - Car Wash D 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 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 - Bar /Lavatory 2 0 0 2 4 2 4 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 1 3 1 3 - Service 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 2 12 2 12 Urinal 6 0 0 • 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 14 224 TOTALS 0 0 0 0 6 21 6 -203 Current Fixture Value -203 divided by 16 = -12.7 Current EDU • 1 EDU = $ 2,600 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -203 divided by 16 = -12.7 over (under) $ (33,020.00) Enter EDU Change Here -12.7 Notes: Credits = 12.7 Authorized Name /Signature: Brian Blalock Date: 11/16/2005 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 \SewerTallyZewerTallySheet.xds 7/1/05 CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005 -00466 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/19/2005 Phone: (503) 639 -4171 � 4 6 Inspection Requests (24 Hrs.): (503) 639 -4175 • INSPECTION WORKSHEET FOR DATE: 10/26/2005 TIME: 7:07AM PAGE: 99 SITE ADDRESS: 12280 SW SCHOLLS FERRY RD CLASS OF WORK: SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE: PROJECT NAME: OREGON COMMUNITY CREDIT UN DESCRIPTION: Relocating (2) lays, (2) water closets. New: (1) dishwasher, (1) sink. OWNER: VINNACOMBE CONSULTING, PHONE #: 503 -826 -1726 CONTRACTOR: R A WARNER PLUMBING PHONE #: 360-896-0370 Inspection Request Scheduled For: Date: 10/26/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 019323 -01 360- 772 -2490 N Corrections /Comments/ Instructions: / -./ jp / 1 4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: iril Date: 1 6' 2 4/I' Phone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION , PERMIT #: pLM2005 -00466 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: �19/Z005 Phone: (503) 639 -4171 v y i i i Inspection Requests (24 Hrs.): (503) 639 -4175 —.. "__.. INSPECTION WORKSHEET FOR DATE: 9/28/2005 TIME: 7 :08AM PAGE: 60 SITE ADDRESS: CLASS OF WORK: SUBDIVISION: 12280 SW SCHOLLS FERRY RD LOT #: TYPE OF USE: PROJECT NAME: GREENWAY TOWN CENTER DESCRIPTION: OREGON COMMUNITY CREDIT UN Relocating (2) lays, (2) water closets. New: (1) dishwasher, (1) sink. OWNER: PHONE #: CONTRACTOR: VINNACOMBE CONSULTING PHONE #: 503 -826 -1726 R A WARNER PLUMBING 360-896-0370 Inspection Request Scheduled For: Date: 9/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 016838 -01 360-601-7928 N • Corrections /Comments /Instructions: f . / F/ PASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 7 Phone #: (503) 718 - Y TIGARD OF GARD BUILDING DIVISION r } " PERMIT #: PLM2005-00466 ' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/18/2005 Phone: (503) 639 -4171 • � 0s ` rv ° 4 W iii Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9/21/2005 TIME: 7 :03AM PAGE: 83 SITE ADDRESS: 12280 SW SCHOLLS FERRY RD CLASS OF WORK: SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE: PROJECT NAME: OREGON COMMUNITY CREDIT UN DESCRIPTION: Relocating (2) lays, (2) water closets. New: (1) dishwasher, (1) sink. OWNER: VINNACOMBE CONSULTING, PHONE # : 503- 826 -1726 CONTRACTOR: R A WARNER PLUMBING PHONE # : 360-896-0370 Inspection Request Scheduled For: Date: 9/21 /2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 305 Plumbing underslab 016233 -01 360-601-7928 N Corrections/Comments/Instructions: / ',/ , /iP k (0,C 7, .,, _ e(,, . e, r i,„4, ) PASS El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED I Inspector: / 7 ) 1.7 11 Date: Phone #: (503) 718 - -V