Permit CITY OF TIGARD PLUMBING PERMIT
' - C COMMUNITY DEVELOPMENT Permit# PLM2012 -00268
Date Issued 09/17/2012
T I G AFLD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S101 DA01700
Jurisdiction Tigard
Site address 7130 SW FIR LP
Project FTDI Chip Subdivision 72ND BUSINESS CENTER Lot 7
Project Description Capping (1) lay, (1) toilet, & (1) laundry tray
Contractor ADDISON PLUMBING LLC Owner FTDI LTD
27425 S BEAVERCREEK RD 7235 NW EVERGREEN PKWY STE 620
MULINO, OR 97042 HILLSBORO, OR 97124
PHONE 503-740-8116 PHONE 503 - 547 -0988
FAX 503 - 632 -1168
FEES
Quantity Description Date Amount
1 ea Laundry Tray 09/17/2012 $25 02
Specifics: 1 ea Lavatories 09/17/2012 $25 02
1 ea Water Closet 09/17/2012 $25 02 ,
Type of Use COM 1 12% State Surcharge - 09/17/2012 $9 01
Class of Work ALT Plumbing
Type of Const
Occupancy Grp
Stories
Total $84 07
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 ques C by callm• 503 232 1987 or 1 800 332 2344
Issued B de e `/ 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
Plumbing Permit Application
Building Fixtures RECEIVED
IN City of Tigard Dat Received eB y /7 Permit No (,}/�p /a. ` C0 - jg
a 13125 SW Hall Blvd , Tigard, OR 97223 S Cr: 17 .. `, 7 Plan Review
C . Phone 503 718 2439 Fax 503 598 1960 Date/By Other Permit No
T l G n K D Inspection Line 503 639 4175 CITY OFTIGARD Date Ready/By Juns ® See Page 2 for
Internet www tigard -or gov BUILDING DIVISION Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special Information use clreckltsL
� ,,1 Description I Qty I Ea I Total
IA Addition/alteration /replacement ❑ Other New 1 - 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312 70
ID 1- and 2- family dwelling 14 Commercial /industnal SFR (2) bath 437 78
building SFR (3) bath 500 32
❑ Accessory g ❑ 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 7 / 3 O 5 Id r►r O m Catch basin or area drain 18 76
Cif /State /ZIP q Drywell, leach line, or trench drain 18 76
y r r el f t6 it. ` Z3 Footing drain (no linear ft Page 2
Suite/bldg /apt no II Protect name 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 Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12 51
Clothes washer 25 02
! 12 i !A/AN 6 ( 1 14 (9 I to. 1 1 Dishwasher 25 02
Drinking fountain 25 02
Ejectors /sump 25 02
PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
L� Fixture /sewer cap 25 02
Name
/::: jp r 6 it i p
/ Floor drain/floor sink/hub 25 02
Address 3 5.-- Ai I ,'R-P4, 71i149µ6 S -1Y &sD Garbage disposal 25 02
City /State /ZIP i i //S �B'c ) ore— G/ t /2 1 Q Hose bib 25 02
Phone (55'03) .5 7 . _ D (r £! g Fax (5 5V4. � c7 g 4- Ice maker 12 51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
Business name Lk r u'S s )L . LL
J L Medical gas (value $ ) Page 2
7)
Contact name c/ Primer 12 51
`��'� / �� a/j�l�(s > J Roof drain (commercial) 12 51
Address S b• 3 tp j IL&.& C r b--Q Sink/basin/lavatory 02
City /State /ZIP G 4 kte ? 0 - i Q R a3 5 Solar units (potable water) 62 54
Phone (y O) 3 4,? () r(, B / — Fax ($ )‘ 2- ti-6 ` ' le Tub /shower /shower pan 12 51
E -mail !. fg Vle/ dm. r 46 //e.... - 4, a) Urinal 25 02
Water closet / 25 02
CONTRACTOR
Water heater 37 52
Business name Ada/, j0 i Y 1 vow k.,,`sj L (._ Water piping/DWV 56 29
Address Z7 t S (3r�, ."r --,e.V v'a Other 25 02
City /State /ZIP , J. 1 `v.... ; O le. 47d 4-z- Subtotal
Phone (.SaS) 6.Z —A6S7 Fax ($a3 ) OZ. _ /flog
Minimum permit fee $72 50 75,a(p
Plan review (25% of permit fee) '-----.
CCB Lie ( S - - - g ] .N -c f . Plumbing Lic no 3 Le-41 e6 State surcharge (12% of permit fee) 9 0l
Authonzed signature S.-eci TOTAL PERMIT FEE gy, 67
Print name ,' o, ` ,ur v—s I Date 1 ..t Z . x. This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set by Tn- County Buildinglndustry Service Board
I \Buildmg\Permits'PLMU- PermitApp doc 10 /01/09 440- 4616T(10 /O2ICOM/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 each additional $100 00 or fraction thereof, to
h 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 $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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following
Fixture Type for Replace/ Please check all that apply
Work Performed: Capped Added Relocate
Baptistry/Font El Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath -Iub /Shower
- Jacuzzi/Whirlpool engineer
Car Wash Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918- 780 -0040
El Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities
Dishwasher Commercial CI Any multipurpose fire sprinkler system
Domestic El Any complex structure as defined in OAR918- 780 -0040
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink - 2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
- Car Wash Drain
Garbage Domestic non - food that meet the qualifications above
Disposal - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach /Refrig Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec Vehicle Dump Station
Shower -Gang
-Stall
Sink La Bar non -food related i
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet Toilet 1 plumbing permit can be issued.
Urinal
Other Fixtures Loa awd•.^t ' on I
I \Building\Permits\PLMF- PermitApp doc 08/04/2011 2
I lhl Accumulative Sewer Tally
4
p
t enant Name I'1 DI Chip * * *CRLDI l'S ** SWR # N/A
TIGARD Site Address 7130 SW Fir Loop PI Al # 2012 -00268
Parcel # 2S101DA01700
Fixture Value Previous Previous Credits Capped Fixture Fixture Ncw New
# value count capped #s value count added # added value total #s total values
Baptistry /•ont 4 0 0 0 0 0
Bath - 1 ub /Shower 4 0 0 0 0 0
- Jacui i /Whirlpool 4 0 0 0 0 0
Car Wash - Lath Stall 6 0 0 0 0 0
- Drtvc 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
Ik.yc 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 I IP) 16 0 0 0 0 0
- Commercial (to 5 I IP) 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
Rcc 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 2 4 0 -2 -4
- Bradley 5 0 0 0 0 0
- Com /Scrv/Uul - 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 I•xtractor 6 0 0 0 0 0
Water Closet - I oilet 6 0 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous LDU Count 0 0
Capped I•.DU Credit 0
10] A I S 0 0 3 10 0 0 _ -3 -10
Current Fixture Value -10 divided by 16 = -0 625 Current 1. DU 1 EDU = $4,665 00
Previous Fixture Value 0 divided by 16 = 0000 Previous 1. DU
Change -10 divided by 16 = -0 625 over (under) S (2,938 95)
Enter EDU Change Here -0 630
Notes ** *CREDITS * **
Authorized Name /Signature: Debbie Adamski Date:
Building Division
ote 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 1 ally \ Sewer 1 allyShect -4665 sls 07/01/12