Permit CITY OF TIGARD PLUMBING PERMIT
-• COMMUNITY DEVELOPMENT Permit #: PLM2013 00080
T[G'tIRD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2013
Parcel: 2S 112 DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 100
Project: Language Line Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Add (1) mop sink
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 236 -4152 PHONE:
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Sink 03/13/2013 $25.02
Specifics: 47 ea Minimum Fee Adjustment - 03/13/2013 $47.48
Plumbing
Type of Use: COM 1 12% State Surcharge - 03/13/2013 $8.70
Class of Work: ALT
Plumbing
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 k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No' ation Cente . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire questions to OUNC . - = 'ng 503.232.1987 or 1.800.332.2344.
•
Issue By: , / Permittee Signatur �--
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.
Plumbin Permit A licat•
Building Fixtures CEIVED FOR OFFICE USE ONLY
City of Tigard Received 'i 3 ! � 90, permit No. alo?D /j? Ben
7111 n 13125 SW Hall Blvd., Tigard,OR 97M €R 1 3 2013 DateBy:
C . P hone: 503.718.2439 Fax: 503.598.1960 D a t e B `yew Other Permit No.: 5w(2_ 24/ 3 _ doct J
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For speci a! information use checklist
Description I Qty. I Ea. I Total 9J
rj^ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) 0
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 vJ
❑ 1- and 2- family dwelling El Commercial/industrial
SFR (2) bath 437.78 I
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 Ut
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 4- /5 //- 5<,../ S p 9 v �� /
a � lY Catch basin or area drain I I 18.76
[ Drywell, leach line, or trench drain 18.76
City/State/ZIP:
V---t, g , J ail 9 5 ly Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Ar i3 k L OS. 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:
Tax map /parcel no.: I b A- do 30 O Backflow preventer I 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/� / / / Clothes washer 25.02
/'/ r�! cJ G.,./2 S ` `' Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name:
r'C 744, sr
1- .5,3 .5 .5 5 W s ey Q, . � way Floor drain floor sink/hub 25.02
Address:
A r/ Garbage disposal 25.02
City /State /ZIP: T /• 5 ai S 7i ( Hose bib 25.02
Phone: (y > ) (, y_ c. a a Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
/� /,„ Medical gas (value: $ ) Page 2
Business name: n
w --/ 5 4,4 ci4
Primer 12.51
Contact name: ..5�•- p
Roof drain (commercial) 12.51
Address: c h /y.--,c1 Sink/basin/lavatory / 25.02
City /State /ZIP: A coa 9 > .7_, Solar units (potable water) 62.54
Phone: (em) ) "r" 5 - p - ,› y k Fax: ( ) , ...1 t- -2.. Tub/shower/shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7i .$O
CCB Lic.: r sL/ '7/ 51 Plumbing Lic. no.: 2 C - -06,..6 Plan review (25% of permit fee) 7�
State surcharge (12% of permit fee) D
Authorized signature: 2 ..ce j.L, TOTAL PERMIT FEE g/.210
Print name: a J'6 I Date: - 3 - 4 - 3 --0 This permit a expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\Building\Permits\PLMU- PermitApp.doc 10/01/09 440 -4616T(I0 /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 - 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
Valuation: Permit Fee:
Storm & Rain Drain - I st 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
Baptistry/Font ❑ Any new commercial building with water service 2" and
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 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
Water Closet Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
UPI Accumulative Sewer Tally
v
C , Tenant Name: Language Line SWR # 201 3 -0005 5
Site Address: 15115 SW Sequoia Pkwy #100 PI.N1 # 2013 -00080
TIGARD
Parcel #: 2S112DA00800
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #5 value count added # added value total #s total values
Baptisers /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: - Bach 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
[ye 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 I 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 I - 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:
- I_av /Bar - Non -Food Related 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Com /Sery /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 Lxtractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous [?DU Count 0 0
Capped [DU Credit 0
TOTALS 0 0 0 0 1 3 1 3
Current Fixture Value 3 divided by 16 = 0.188 Current [DU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous I.DU
Change 3 divided by 16 = 0.188 over (under) S 886.35
Enter EDU Change Here 0.190
Notes:
Authorized Name /Signature: Debbie Adamski Date: 3/13/2013
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 ofTigard Building Division to redeem credits towards future system development charges.
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