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Permit
• • V CITY OF TIGARD IrtS PLUMBING PERMIT COMMUNITY DEVELOPMENT "5 Permit #: PLM2012 -00349 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/29/2012 Parcel: 2S 110AB00200 Jurisdiction: Tigard Site address: 14345 SW PACIFIC HWY Project: Desserts of Distinction Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1 -4 Project Description: cap (8) 3" floor drains. "1/8/13, REPRINTED for revision, per owner & insoector. reducing number of capped floor drains to (5). Contractor: OWNER Owner: KOLVE, G C 14389 SW PACIFIC HWY TIGARD, OR 97224 PHONE: PHONE: 503 - 620 -8087 FAX: FEES Quantity Description Date Amount 8 ea Fixture /Sewer Cap 11/29/2012 $200.16 Specifics: 1 12% State Surcharge - 11/29/2012 $24.02 Plumbing Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $224.18 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, • ' • , is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utilit , otification Cente . Those es are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may o btain a copy of the rules or '.erect questions to OUNC by - ing 543. 32.1987 or 1.800.332.2344. I- sued By: Permittee Signat re: 4 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. 1 v CITY OF TIGA Elf iSE® PLUMBING PERMIT 1/ 8 ' COMMUNITY DEVELOPMENT Permit PLM2012 -00349 �� 3 r � - Date Issued: 11/29/2012 T [CARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Parcel: 2S110A600200 Jurisdiction: Tigard Site address: 14345 SW PACIFIC HWY Project: Desserts of Distinction Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1 -4 Project Description: cap (8) 3" floor drains Contractor: OWNER Owner: KOLVE, G C 14389 SW PACIFIC HWY TIGARD, OR 97224 PHONE PHONE. 503 - 620 -8087 FAX FEES Quantity Description Date Amount 8 ea Fixture /Sewer Cap 11/29/2012 $200 16 Specifics: 1 12% State Surcharge - 11/29/2012 $24 02 Plumbing Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $224 18 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 questions to OUNC by calling 503 232 1987 or 1 800 332 2344 Issued By: "'AV -L Permittee Signature: A n n 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. l n CITY OF TIGARD PLUMBING PERMIT q• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00349 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/29/2012 Parcel: 2S 110AB00200 Jurisdiction: Tigard Site address: 14345 SW PACIFIC HWY Project: Bakery Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1 -4 Project Description: cap (8) 3" floor drains Contractor: OWNER Owner: KOLVE, G C 14389 SW PACIFIC HWY TIGARD, OR 97224 PHONE PHONE: 503 - 620 -8087 FAX: FEES Quantity Description Date Amount 8 ea Fixture /Sewer Cap 11/29/2012 $200.16 Specifics: 1 12% State Surcharge - 11/29/2012 $24.02 Plumbing Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: • Total $224.18 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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ��A ( Permittee Signature: 00 �I 0V ,I1 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 ApnlicationREcElvE 1 Building Fixtures t1 vv FOR OFFICE USE °NIA City of Tigard NOV 2 9 2012 Received Date/By: II (�p ; c I Permit No.:PLC./ do A," QD 3 q 11 n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.1 se1TY (* TIGARD Date /B Other Permit No.: T I G A R U Inspection Line: 503.639 B H L G �IS� Date Ready/By: lu "1 t s y Su : Is See pplemental Page 2 for Internet: www.tigard- or.gov atJl Notified/Method: �J TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total erAelditi n/alteration/1re lacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 1:1 �: 1- and 2- family dwelling Cemmercial/industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ 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: j 4 3 4.7 Poietp tai Catch basin or area drain 18.76 City /State /ZIP: 1G J}20 ©R_ -1 7 0 a b Footing drain line, or trench drain 18.76 Page Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: B Manufactured home utilities 50.03 Cross street/directions to job site: 1 4 3 L{S SW {? LC 4 w Manholes 18.76 C -kgrC Z AZU ( U ( € Rain drain connector 18.76 5 ,1 A pn i w e o, C E .- ( � - Sanitary sewer (no. linear ft.: ) Page 2 [� NI Iv t 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 II )4 A ^ 0cA -pit ( 3 LOO R jnn,t3 Clothes washer I I 25.02 /T1�1/ 'uT Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 IgsPROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: r�l` ©Lt/ ( IF - Fixture /sewer cap 8 25.02 an < I LI 3 9 Q U PO l � l � Floor disposal sink/hub 25.02 Address: W Garbage ge dispsposal 25.02 City /State /ZIP: T N.Q CZ a q 7 o LP Hose bib 25.02 Phone: (503 G� � "7 Fax: (503 6$q 5 1 t Ice maker 12.51 ❑ APPLICANT j,. CONTACT PERSON Interceptor /grease trap 25.02 Business name: .1 f� Medical gas (value: $ ) Page 2 Contact name: Primer 12.51 Roof drain (commercial) 12.51 Address: l y 3 8 q a� Pi i TL C W v Sink/basin/lavatory 25.02 City /State /ZIP: t / 1D o R- 4'7 � 1 Solar units (potable water) 62.54 Phone: ( b3 Fax:: � 36531- 1 ( Se 1 1 Tub /shower /shower pan 12.51 E -mail: C # J I W CZ Cn� l E, A-Hto t al m zel Urinal 25.02 Y Water closet 25.02 CONTACTOR 'J Water heater 37.52 Business name: el KoI.�V Water piping/DWV 56.29 Address: l 9 St) t Ac, F qt,� 1 Other: 25.02 City /State /ZIP: j l(', c! A Q., Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 &OD,I, CCB Lic.: umbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) ...W .CI Authorized signatur : TOTAL PERMIT FEE 'Ati, Ig Print name: A.„..1 �'-1 5 D ate :' L ,/ 1 Z Th is permit application expires if a permit is not obtained within 180 days P after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1:\ Building \ Permits \PLMU- PermiiApp.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" 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 - I st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - I st 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 Re inspection 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 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" 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: - Lav/Bar 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 Accumulative Sewer Tally N ..4 Tenant Name: Desserts of Distinction***CREDI'T'S*** �E g S\\'12 # N/:1 Site Address: 14345 SW Pacific I-Iwy kQ ex e_ 10.4.,24)tet�pl,\I # 2012-00349 TIGARD T Parcel#: 2S110AB00200 0.oLP)V-4 -r - 0 U1 LS 6�sty Fixture Value Previous Previous Credits Capped v Fixture Fixture New New # value count capped#5 value count added# added value total#5 total values Baptisery/Font 4 0 0 0 0 0 Bath: -'l'ub/Shower 4 0 0 , 0 _ 0 0 -Jacuzzi/Whirlpool 4 0 0 0 _ 0 0 Car Wash: - IZach 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 I 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 8 40 0 -8 -40 -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 I-IP) 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: -lay/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 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 FIDU Credit 0 'I'O"I'AI,S 0 0 8 40 0 _ 0 -8 , -40 Current Fixture Value -40 divided by 16= -2.500 Current EDU 1 EDU= $4,665.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change -40 divided by 16= -2.500 over (under) S (11,662.50) Enter EDU Change Here; -2.500 Notes: ***CREDI'T'S*** Authorized Name/Signature: Debbie Adamski Date:' 11/29/2012 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\Scwcr Tally\Sewer I'allvSheei-4665.xls 07/01/12