Permit CITY OF TIGARD PLUMBING PERMIT
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• • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00346
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/27/2012
Parcel: 1 S134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 250
Project: Spec Space Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: B
Project Description: Cap (2) breakroom sinks
Contractor: JAMES ROOD PLUMBING INC Owner: ROBINSON, CONSTANCE A
125 S 1ST AVE #542 BY KILLIAN PACIFIC LLC
HILLSBORO, OR 97123 500 EAST BROADWAY, STE 110
VANCOUVER, WA 98660
PHONE: 503 - 648 -3907 PHONE:
FAX: 503 - 681 -2196
FEES
Quantity Description Date Amount
2 ea Sink 11/27/2012 $50.04
Specifics: 1 12% State Surcharge - 11/27/2012 $8.70
Plumbing
Type of Use: COM 22 ea Minimum Fee Adjustment - 11/27/2012 $22.46
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N i cation Cen - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir questions to OUNC • -- ' •!3.232.1987 or 1.800.332.2344.
I ued By: 1 i A Permittee Signature: y
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures � FOR OFFICE 1SF. ONLY
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City of Tigard RECEIVED "-'D Date/Bey: // at 6 i01 / Permit No.: / 4/�a2o /I e9 >5' - 6
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
% c Phone: 503.71$.2439 Fax: 503.598.1 v 2 6 V 2012 Other Permit No.: DacdByl �✓ /f'
Inspection Line: 503.639.4175 Date Ready/By; tutu: 1Z1 See Page far
TIC .4 N 1] Internet: www.tigard- or.gov Su emental Information
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❑ Demolition Fat special information use checklist
❑ New construction Description 0 . Ea. Total
E' Addition/altered-km/replacement ❑ Other: New I - 2- family dwelli 1: (includes 100 ft. for each utility connection)
�g} i lip. �'+ r Ftr. , ' no.Tp. :Ar'C r v.rti ltimuisici 1� 7t . �r;y �1� ,ruslot�l}�ni , F ' 1 r i +'te SFR (1) bath 312.70
t.. „ 'ta 1 > rt + 1 n'ilkcd.r ti'��14�.., '� ,t' 1 ' u .iti 7.,41:".'_ , .!.v � ' it :i.: m •t r �e .. :'N... �� L 4i0 . . ` • :,,S, .!I
'L.� Commercialfmdustrial
SFR (2) bath 437.78
❑ 1 -and 2-family dwelling SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 •
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, 'i , • ' . s � �, 4 , c �"^n ' I " y �.i7. f ,� 3)"91 S�e n.... l;u•4'..- " , {� 1 Si IC utilities: .
Eg ragg 1'liir
ai. ,+ ?, r< slyl cfi1eL9L L- "tiall'ig4l4l�l:1- r...� -.
' -..':r ..i f.wx. :33.7... +- ..n,4.ttS;Zn:4:..,..,: --(>J thtll.l.{.r :. Catch basin or area drain 18.76
Job site address: p j ? S $ W i. wl clr'-
Drywell, leach line, or trench drain 18.76
City /State/ZIP: ( c_k 01. Footing drain (no. linear ft: ) Page 2
ildgJapt. no.: 5O Project name: S tat.w Ot 0156 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: Lot 00.: - Fixture or item:
Tax map /parcel no.: /3// de 4477 ?e o ) ackflow preventer 3127
n ri t iD, , , , ��; „ x° � ^A- � ct �t��'^ •',�•'��' � ��!4 t y�� r { - Backwater valve 1 2.51
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y 4 c o Hn 7�w LAIi r.-r #.�11 r�, t1�3 .v.,r, , r. ]vir, . r�, l '
lf? 7 t ,:; I f 1 , , r Clothes washer 25.02 ill
•
C. - it ree.i.de: ' A £4 - i ik Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
nt Srt r x �t1-7 f 1 e, a { + 1,�I ! I , 1�S �}p'r� a 1 C i �w { i ig Ex ansion tank 12.51 •
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r hi� ile/ . ` r ' , 'art n, . built 1:411,.1.1% 4:'Hbia7a'i rxfr i cb„t Jsi(ta,:l'- i'-'4. ;ll. p •
�sii alt t<i
Fixture/sewer cap 25.02
Name: Floor drain /floor sink /hub 25.02
Address: • Garbage disposal 25,02
City /State /ZIP: Hose bib 25.02
Phone: ( ) [�7 Fax: ( ) Ice maker 12.51
. � '.ltl ° Il 1 ¢1 f r CCLt �1 rlr n� �� k r t �• " a!i p rAf a t t ' u re I S.lili 177 �trj� Interceptor /grease trap 25.02
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ilti is xh lvr1C,K.�..1 ., c Pi. . II ate +, ca 3� .sa :,� .rm. ill5.1?n h�... 4 :1; 2 ...._
Business name: . Medical gas (value: $ ) Page 2 .
Primer 12.51
Contact name: Roof drain (commercial) ` 12:51
Address: Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water) 62.54
Fax: ( ) Tub/shower/shbwer pan 12,51
Phone: ( ) Urinal 25.02 •
E -mail } ii �r Water closet 25.02
v 5:75 5 1; 9 J S.c1 �f i�L �T c, , '3', f � I. Ti - 14 4 . 111 x . y , u `�
r { efr.ill,. , bill,, ' - 1 i i !,� d �;I :islr :t tt'ii,I :1 ..4 :iti ila
n.i 3irt� Sfili i; li 1a Water heater 37.52
Water piping/DWV 56.29 -
Address: 62_ 5 S. /S & It # 5.92 Other: 25.02 .
City / State/ZIP: , ;46 , o trro O■ 4 ') / 2.- 1 - Subtotal 0 . Q
Phone: ('563 ) 6ct, 349 p1 - Fax: (Sb f) C11- .2> 04 Minimum permit fee: $72.50 .6()
Plan review (25% of permit fee) MEM
CCB Lie.: f .2 f Plumbing Luc, no.: ea $.51 Stare surcharge (12% of permit fee) Q, 70
Authorized signature: ` TOTAL PERMIT FEE .2.0
This permit application expires if a permit B not obtained within 180 days
Print name: ,- 4) co Date: I� after it has been accepted as complete. �'�J
*Fee methodology set by Tri- County Building Industry Service Boa d."-) '
l: Nauilding \emuitelnl.Mli- permmuudoc 10/01/09 440 er(10/0220M/wee)
Plumbing Permit Application, - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: txt 7 �7y ^s Residential Fire Su • s r S stems:
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' 1 1 , in .;<%! %:, iVa l' ai 1 N •J,�r x�oln:, .ut. Y.- � #• wrw;,11 � e1..1;� xJA,hrf,,11-1. �'' : (itrt.t .:�t'y } „1„ hd :hs ,S, .u����'�f -.nip r,,..- :..,. u. 16.,un.. r �nnS� �;..ler.n lAr �.n'I'.l'1 n lllllllfi +l:
Footing drain -1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,061 to 3 > 600 $169.69
3,601 to 7200 $23320
Sewer - 1st 100' 62.54 X 201 and greater $3
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas S stems:
Water Service • each additional 100' 37 ,52 'R^ - 4?ri r i F A,K `t{{2�q ' i.y 1 , r , L r ' E F u,� >,/
.z4U 4.,c ^' 4 tgla ..:�`' ll� ....i:41.l P ^r:l. .1 6d�; .1 4 - .._� ' i
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
11 7 . iti ?ftl r i=1Jy k.4 ii: ` l' ;1 � " s 4 ", r r°i_ each additional $100.00 or fraction thereof, to
ii. m4xs1: .1 ;w 4,/ 7, r , ;; ` ;: . .:: i .. !If .,i' ,,,..„,.4.11 �` 6 • . tu.'iri t`i- 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 hour) each additional $100.00 or fraction thereof, to
M 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
accuratel re ' ort fixtures could result in increased sewer fees * .
- a w n a „ , +�t`- ,��+ xtl r ?! 11914�
�, irl: >:, wr. rr i IN ii' ., $rl ,.41� t. 9 , r 1 . a ■ ¢ ' i a k "' tf,1
«I; jl��i � 1��7 t, 1Ard . 6 � NA l�lkt In ,11 "\i:! "�F p1 3 i 1 4�i� r l i�a t ,k n:
t y � > . ?dtd �,�'� 1 i . �! a .a ; � . �...q _ � ( , ,� r„ z,..... 1 : ,.k..:yv 5.t, 3, +,n .,,,,...1!Cvl['
v t ii'o� , ` vga i�s " � ,r 1 11 4i"1fu' i'r �1 l" I' 3 g w td m i;_ review -
?ilbrrFY? ll-' "" N� 1 � 11y �.L�.�.__ j d Plan review is required for any of the following-
s aa:l- ...,,. #, ,+,�,,,�� ;'n;t'S� ..4r_,.. _ .,.:..; , _�- i17•'..KG Please check all that apply.
Bapbstry/Font ❑ My new commercial building with water service 2" and
Bath - Tub /Shower greater, except systems designed and stamped by licensed
- - Jacuzzi/whirlpool
Car wash -Each Stall engineer.
- Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918 780 - 0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic • ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ My complex structure as defined in OAR918- 780.0040.
Eye wash
Floor Drain /sink - 2' - Submit 2 sets of plans with any of the above.
- 3 „ •
i �p .1 1 . � }'.7'ri I'r 1 1 iI i r1 :: ii ✓1<r r { ti k, € ,.
Car Wash Drain Li ��r.:i.,�.,>.,.�;.�, ,i l.. sZ? n[1.t,f : , a +.. ,l...,,, K .... •,,: 1, -.;. ..t.1.._..
Garbage - Domesiio non food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic - food related _ that meet the qualifications above-
- Commercial -food related
- Industrial -food related
Ice Mach./R,efrig. Drains •
_ Oil Separator (Gas Station) Comments regarding fixture work:
Rec. vehicle Dump Station • re- f hot; f w
`
Shower -Gang V
-Stall
Sink/Lav - Non -food related a►.
. - Bradley '
- Commercial -food related -
- Service
sr nC Pool Filter *Note: If the fixture work under this permit results in an
Washer Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal • plumbing permit can be issued. .
Other Fixtures:
C :\ Users\ jim1AppData \Local\Temp1PLMF- PcrmitApp.doc 2
I II Accumulative Sewer Tally
0 T enant Name: Spec Space * *CREDITS ** SWR # N/A
Site Address: 10115 SW Nimbus #250 PLM # 2012 -00346
TIGARD Parcel #: 1S134AA01900
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 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 2 4 0 -2 -4
- 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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 4 0 0 -2 -4
Current Fixture Value -4 divided by 16 = -0.250 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -4 divided by 16 = -0.250 over (under) $ (1,166.25)
Enter EDU Change Here -0.250
Notes: ** *CREDITS * **
Authorized Name /Signature: Debbie Adamski Date: 11/27/2012
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 \SewerTallySheet- 4665.xls 07/01/12