Permit 1 111111 q CITY OF TIG�4RD PLUMBING PERMIT
� 2 COMMUNITY DEVELOPMENT Per #: PLM2012 00299
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/17/2012
Parcel: 25101 DA001
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 310
Project: Cascade Management Subdivision: VARNS ACRES Lot: 9
Project Description: Add (1) breakroom sink, (1) water heater, (1) 2" hub drain, (1) domestic dishwasher and (1) primer. .
Contractor: GRIDLINE PLUMBING Owner: GK TRIANGLE CORPORATE PARK III L
4343 SE 37TH BY THOMSON REUTERS INC
PORTLAND, OR 97202 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 503 - 771 -8790 PHONE:
FAX:
FEES
Quantity . Description - . Date Amount
1 ea , Dishwasher 10/16/2012 $25.02
Specifics: 1 ea Floor Drain /Floor Sink/Hub 10/16/2012 $25.02
1 ea Primer 10/16/2012 $12.51
Type of Use: COM 1 ea Sink •10/16/2012 $25.02
Class of Work: ALT 1 ea Water Heater 10/16/2012 $37.52
Type of Const: 1 12% State Surcharge - 10/16/2012 $15.01
Occupancy Grp: Plumbing
Stories:
•
Total $140.10
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 y`,
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 • - ru es a• • •ted by the Oregon
Utility Notification_ Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. ou may obtain a copy of the rules
or dire estions to ■ NC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: Permittee Signature: j
Call 503.639.4175 by 7:00 a.m. for the next available ins • n e.
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 OCT 16 ^ R eceived FOR OFFICE USE ONLY g
City of Ti and Permit No.'
n 131 SW Hall Blvd., Tigazd,OR 97223 p� �a Date/Bv (//6,.//1.2.. A/7„ o a , 4`�9 -
a Phone: 503.718.2439 Fax: 503.598.1960%6'U i I O` 111 Plan Revie Other Permit F ,4/�ad/ no�/
Date/B � 0
Inspection Line: 503.639.4175 BIJILDINGDIVISI i' ` ' ,at e Read /B mn : ®See Pa e 2 for
TIGARD Ready /By:
Internet: www.tigard - or.gov Notified/Method: T.r� Supplemental g Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
dition/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 Clnmercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory, building ❑ Multi - family
• Each additional bath/kitchen 25.02 KI
❑ Master builder ❑Other: Fire'sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 4Q Catch basin or area drain 18.76
/�A�/ i Drywell, leach line, or trench drain 18.76
City /State /ZIP: / �ce r7' 3 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt..no.: l 9 I Project name: 8 ' "'L' 7 Manufactured home utilities 50.03 •
' Cross street/directions to job site: ' ' Manholes 18.76
771::-/e2-441 Rain drain connector 18.76
[[[
4/
Sanitary sewer (no. linear ft.: ) Page 2
. Storm sewer (no. linear ft.: ) Page 2
Wate/ -(no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/ t n
Clothes washer 25.02
fr Aal as■ tS c / /�--+ Dishwasher ■ / 25.02 a .5 0c2
- /`7 `ea / Drinking fountain 25.02
/ v� / 1/Q /' ,r7 Ejectors /sump 25.02
❑ PROPERTY OWNER T�Ii 1VANT Expansion tank 12.51
Name: Fixture /sewer cap . d 25.02.
. Floor drain/floor si ub a- t/ > / 25.02 a 0.-„,
. Address:
Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
• Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer x / 12.51 /Z. 6/
Contact name:
Roof drain (commercial) 12.51
- Address: Sink/basin/lavatory ✓ x / 25.02 02S.0z
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
/ Water heater x / 37.52 37, 52, Business name:G t v 6 / ,, b�`n Water 1 to WV 56.29
y' Address: 3 7 T'�"' P�P� �
Other: 25.02
City/State /ZIP: .97 Subtotal /25, 0q
one: 4 7 7/ g"�r'e / Fax: L. 77 /_....A0/3 Minimum permit fee: $72.50
AJ �� !! I ✓ Plan review (25% of permit fee)
4 Lic.: 71.-/ac/ Plumbing Lic. no.: p�p +19,„
-
State surcharge (12% of permit fee) /s, 0/
Authorized signature: "/ ; ,ow,..- TOTAL PERMIT FEE' No /p
Print name: \/ Date: /(p /a_ This permit application expires if a permit is not obtained within 180 days
/ j� �� after it has been accepted as complete. s e •
L \ P I D
*Fee methodology set by Tri - County Building Industry Service Board: P
\ BuildingWermits LMU- PermitApp.doc 10/01/09 440 -4616T(10 /02/COM/WEB) I
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
l� 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
❑ Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
engineer.
Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
- Domestic ❑ 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
4 " ❑ 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: -LavBar non -food related
- 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
WaterCloset - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF - PermitApp.doc 08/04/2011 2
71 . A ccum ulative Sewer Tally
4
Tenant Name: Cascade Manag SWIt # SWR2012 -00299
Site Address: 13221 SW 68th Pkwy, Ste 310 PI Al # P1.M2012 -00299
TIGARD
Parcel #: 2S101 DA00102
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #5 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 1 2 1 2
Drinking Fountain 1 0 0 0 0 0
1 ,ye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 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 1 IP) 16 0 0 0 0 0
- Commercial (to 5 11P) 32 0 0 0 0 0
- Industrial (over 5 1 -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:
- l.av /Bar - Non -Food Related 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Com /Sery /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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped E Credit 0
T'O'TALS 0 0 0 0 3 6 3 6
Current Fixture Value 6 divided by 16 = 0.375 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 6 divided by 16 = 0.375 over (under) S 1,772.70
Enter EDU Change Here 0.380
Notes:
Authorized Name /Signature: Dianna Howse Date: 10/16/2012
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 \SewerI'allyShcct- 4665.xls 07/01 /12