Permit i !.
y n CITY OF TIGARD PLUMBING PERMIT
11111 ' 13 .... COMMUNITY DEVELOPMENT Permit #: PLM2012 -00327
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/07/2012 . : '.,,, iii,:
Parcel: 1 S 135DC00200
Jurisdiction: Tigard
•
Site address: 11825 SW GREENBURG RD
Project: Greenburg Business Park Subdivision: TIGARDVILLE PARK Lot: 8
Project Description: Capping (4) bathrooms and relocating (2) bathrooms in common areas on 1st and 2nd floors.
Contractor: LIVESAY PLUMBING Owner: TWO G'S REAL ESTATE LLC
175 NE 5TH AVE 18395 WOOD THRUSH LLC
CANBY, OR 97013 LAKE OSWEGO, OR 97035
PHONE: 503 - 619 -7594 PHONE: 503 684 -0550
FAX:
FEES
Quantity Description Date Amount
' 2 ea Sink 11/07/2012 $50.04
Specifics: 4 ea Lavatories 11/07/2012 $100.08
4 ea Water Closet 11/07/2012 $100.08
Type of Use: COM 1 ea Water Heater 11/07/2012 $37.52
Class of Work: ALT 1 12% State Surcharge - 11/07/2012 $34.53
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $322.25
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 th- rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -00sI. You ay o. in a copy of the rules
or direct qu- ••ns to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued : y: I
dif 1 . I / r Permittee Signature: Ind Call 503.639.4175 by 7:00 a.m. for the next available inspecti • �, I r . ,
..
This permit card shall be kept in a conspicuous place 1 lace on the site until coy • --f the project.
r
N.;
oject.
Approved plans are required on the job site at the time of each in : - • n.
liAll Accumulative Sewer Tally 1
p . T enant Name: [ rccnburg Business ark CREDI'rs 1 SWR # jN /A
T I G A R D Site Address:111825 SW G reenburg Rd 1 PLM #12012-00327
Parcel #:11 S 135DC00200
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
- 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 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:
- Lav /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 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 2 12 0 -2 -12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0 •
Capped EDU Credit 0
TOTALS 0 0 6 20 0 0 -6 -20
Current Fixture Value -20 divided by 16 = -1.250 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -20 divided by 16 = -1.250 over (under) $ (5,831.25)
Enter EDU Change Here 4 -1.250 1
Notes: ** *CREDITS * **
Authorized Name /Signature: !Debbie Adamski j Date:; 11/7/2012
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. •
L: \Bull ding \Sewer Tally \SewerTallySheet- 4665.xls 07/01/12
Plumbing Permit Application 11
Building Fixtures RECEIVED FOR OFFICE USE ONE)
City of Tigard Received
a 13125 SW Hall Blvd., Tigard,OR 972�V
Date/By: ///7 // 9...(-3...43 Permit No.: tr102o�� -093,27
i l li q
0 Phone: 503.718.2439 Fax: 503.598.1960 0 7 2012 Plan Review Other Permit No.:
Inspection Line: 503.639.4175 �'�/ TI � G/ ��p�
Date/By: Ready/By: I G A R D CITY 1 I IuP1f1f./ Date Ready/By: tuns: El See Page 2 for
Internet: www.tigard- or.gov
APING rnv�S�O� Notified/Method: Supplemental Information
TYPE OF v FEE* SCHEDULE
❑ New construction El Demolition For special information use checklist
Description I Qty. I Ea. I Total
A Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- and 2- family dwelling . Comercial/industrial SFR (2) bath 437.78
- m
❑ Accessory building Multi-family
SFR (3) bath 500.32
❑ Multi -famil
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: 1 \4's2 �t,L�g�y� Catch basin or area drain 1 8.76
City/State/ZIP:-T<„,06,04 � Drywell, leach line, or trench drain 18.76
(3.c. �j -77 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project 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:
G
Tax map /parcel no.: / 5 /35 Cco}G'c Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
"4 �- 4 1 .'•- - C-- levvcr o\ �{L�Q. Dishwasher 25.02
4� a A ms / e Drinking fountain 25.02
e Ejectors /sump 25.02
IQ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name�(�,, to G, .. c R��L �- ` A�� L` Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Nre.,t1g weab 17, wS IA
Garbage disposal 25.02
City /State /ZIP: („A �� � ,. Da_.. Hose bib 25.02
Phone: c(943)e1 osS a Fax: (54 ) /..,'2o 5 523 Ice maker 12.51
gI APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:e v.- Medical gas (value: $ ) Page 2
/1 po ��_� �� Roof 12.51
AS A
Contact name:
Roof drain (commercial) 12.51
Address: 1 /-
1� �(70� )��.v,5� Sink/basin/lavatory 4 4 25.02 �,�j0
City /State /ZIP: 1.4,,,N 1..., 4:2)3,,,,, ) b(Z Solar units (potable water) 62.54
Phone: ( %,03)x'$ ''o$ S d Fax: : ;4a 42o- $3 Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet if 25.02 gO.0 7
Water heater / 37.52 37.6x'
Business name: L,vm s ,„,, y V 14. +��� tw1 y Water piping/DWV 1 56.29
Address: \''Le it,. It 5 'aY•Q Other: 25.02
City /State /ZIP:['q Nx , 4•>, 0 -67__ - QC .7 O ) "5 Subtotal Z ?.72.
Phone:6,3) tool ---/ 1 )^ Fax: „1-3, Minimum permit fee: $72.50 ,...-1
CCB Lic.: \€ 7 Z:7 , robing Lic. no.: �t 94:4 94:4 Plan review (25% of permit fee)
State surcharge (12% of permit fee) 5
Authorized signature • TOTAL PERMIT FEE, 2'
Print name
• Vs.cr5 ,1 Date: L( ■ 7 i This permit application expires if a permit is not obtained within 180 days
a ft e r it has been accepted as complete
*Fee methodology set by Tri -County Building Industry Service Board.
11Building\ Permits \PLMU- PermitApp.doc 10/01/09 440- 4616T(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 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
P 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
❑ 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 MachiRefrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non -food related kit L,
- 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 a„ plumbing permit can be issued.
Urinal
Other Fixtures:
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