Permit •
•
CITY OF TIGARD PLUMBING. PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2012- 00316 • .
T LGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/14/2012 ,
Parcel: 1 S136CD01500
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Jurisdiction: Tigard
Site address: 11660 SW PACIFIC HWY
Project: Tigard Bowl Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: Relocating concession stand.
Contractor: WESTERN PLUMBING Owner: POWERS PEARL LLC
9460 SW TIGARD AVE SUITE 101 11660 SW PACIFIC HWY
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 639 -5296 PHONE:
FAX: 503 - 684 -9015
• FEES
Quantity Description Date Amount
• 1 ea Backflow Preventer 11/14/2012 $31.27
Specifics: 1 ea Dishwasher 11/14/2012 $25.02
2 ea Floor DrainiFloor Sink/Hub 11/14/2012 $50.04
Type of Use: COM 2 ea Primer 11/14/2012 $25.02
Class of Work: ALT 1 ea Sink 11/14/2012 $25.02
Type of Const: 1 ea Lavatories 11/14/2012 $25.02
Occupancy Grp: 1 12% State Surcharge - 11/14/2012 $21.77
Stories: Plumbing
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Total $203.16 •
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 direc estions • • UNC by calling 503.232.1987 or 1.800.332.2344.
Issu By: Permittee Slgnatu e:
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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.
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III Accumulative Sewer Tally
4
p ' Ten ant Name: Tigard Bowl SWR # 2012 -00218
-. Site Address: 11660 Pacific Hwy PLM # 2012 -00316
T I:G 1.1
Parcel #: 1S136CD01500
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 1 2 1 2
- 3 inch 5 0 0 1 5 1 5
- 4inch 6 0 0 0 0 0
- Car Wash 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:
- Lav /Bar - Non -Food Related 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 1 3 1 3
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 EDU Credit 0
TOTALS 0 0 0 0 3 10 3 10
Current Fixture Value 10 divided by 16 = 0.625 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 10 divided by 16 = 0.625 over (under) $ 2,938.95
Enter EDU Change Here 0.630
Notes:
Authorized Name /Signature: Debbie Adamski Date: 10/29/2012
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 I'allyShect- 4665.xls 07/01/12
Plumbing Permit Application \ ,
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received No.: Pt a /Q1(X 8�G 3/4
-
q 13125 SW Hall Blvd., Tigard, OR 97223 \` Plan Review
lC f�9 ��
111
Plan Review
Phone: 503.639.4171 Fax: 503. 598.1960 Date/By: Other Permit Supplemental �/ �1 -
Inspection Line: 503.639.4175 Date Re B Q� nail: 0 See P o �
TI G A R D /M
Internet: www.tigard or.gov Notified/Met od / / 0W , J ent 2 for
ents I Information
TYPE OF WORK (p" L ie,)/ FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. I Ea. Total
'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 gCommercialindustrial 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:
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Job site address: 11660 J'r„/ /9 /L44i Catch basin or area drain 18.76
City/State/ZIP: - 7 - 7644 , � 9707x3
Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: -176 la, ,z_ • 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 R: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: /S / 3 4 r O / 5Cb Backflow preventer / 31.27 31 °7
DESCRIPTION OF WORK Backwater valve 12.51
//� ,,y/)��►/� �/� / Clothes washer 25.02
_/14 /L"„ "'� _ " �OV��� Ce7 �fSi1,, Dishwasher / 25.02 0
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub p4 25.02 .5D 'n
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
1- Business name: 6/9, ,(0/4//-- Medical gas (value: $ ) Page 2
� / / Primer a 12.51 O[ S
Contact name: (
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory a 25.02 S0,
City/State/ZIP: Solar units (potable water) 62.54
Phone: 0 6,39 -a 'O/ I Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Western Plumbing, Inc
Water P P� t m W V 56.29
Address: 9460 SW Tigard Avenue Suite 101 Other: 25.02
City/State/ZIP: Tigard, OR 97223 Subtotal Jgr . 3 7
Phone: (503) 639 -5296 Fax: (503) 684-9015 Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: 2439 Plumbing Lic. no.: 34 State surcharge (12% of permit fee) a� 7
_
Authorized signature: /./ TOTAL PERMIT FEE A03.14
Print name: Dana Jensen Date: �Q / ?G // Z This permit application expires if a permit is not obtained within 180 days
• after it has been accepted as complete.
•F..a m,fh.vinlnnv cot by Tri-rn „nw R, InAnc,n. C•nnr. Raoul
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Tot Square Footage: Permit Fee:'
Footing drain - I 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
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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
each additional $100.00 or fraction thereof, to
Other Inspections or Fees Qty. Fee (ea) Total 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 ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing
engineer.
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower as defined in OAR918- 780 -0040.
- Jacanii /Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator El Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain /sink - 2" I ❑ Isometric or riser diagram is required for new buildings
3" that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal -Commercial
- Industrial Comments regarding fixture work:
Ice Mach /Ref ig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory 1
- Bradley
- Commercial I *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be aid before the
Washer - Clothes p
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
Car-7 J 5004' " Pe 3 3