Permit CITY OF TIGARD PLUMBING PERMIT
2 ; COMMUNITY DEVELOPMENT Permit #: PLM2013 -00116
T EGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/29/2013
Parcel: 2S110DCO2400
Jurisdiction: Tigard
Site address: 11565 SW DURHAM RD 100
Project: Dr Auzins Subdivision: 1998 -128 PARTITION PLAT Lot: 2
Project Description: cap (2) sinks, relocate med gas at four chairs.
Contractor: VENNE PLUMBING LLC Owner: DRT PROPERTIES LLC
15145 SW DIVISION ST 9805 SW CHOCTAW ST
SHERWOOD, OR 97140 TUALATIN, OR 97062
PHONE: 503 - 624 -9309 PHONE:
FAX: 503 - 684 -0940
FEES
Quantity Description Date Amount
2 ea Fixture /Sewer Cap 04/29/2013 $50.04
Specifics: 5000 ea Medical Gas 04/29/2013 $72.50
1 Plan Review 04/29/2013 $30.64
Type of Use: COM 2 ea Info Process /Archiving - Sm 04/29/2013 $1.00
Class of Work: ALT $0.50 (up to 11x17)
Type of Const: 1 12% State Surcharge - 04/29/2013 $14.70
Plumbing
Occupancy Grp:
Stories:
Total $168.88
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: 1 `" Permittee Signature:
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 ApplicapCEI` ED
Building Fixtures �� tIlL.r.VV ��ll LLJJ FOR OFFICE USE ONLY
IIII City of Tigard APR 0 8 2013 eB p � Permit No.: e f3-
k l7
_
13125 SW Hall Blvd., Tigard, OR � /
Date/By: �
Phone: 503.718.2439 Fax: 503 901= TIGARD Plan Review � � -
Other Permit No.:
{�� DIVISION TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: ions: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. ( Ea. I Total
® Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 437.78 r
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family J'
Each additional bath/kitchen 25.02 ,
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 C,,
JOB SITE INFORMATION AND LOCATION Site utilities: C
Job site address: 11565 sw durham rd Catch basin or area drain 18.76 ai
Drywell, leach line, or trench drain 18.76 --D
City/State/ZIP: Tigard, OR 97224 BLDG F Suite 100 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Dr. Anzio 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.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Capping two sinks and relocated air vac nitrous, oxygen at four chairs. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 2 25.02 50.04
Floor drain/floor sink/hub 25.02
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
Business name: Venne Plumbing, LLC Medical gas (value: $ 5000) Page 2 72.50
Primer 12.51
Contact name: Ryan Venne
Roof drain (commercial) 12.51
Address: 15145 SW Division St. Sink/basin/lavatory 25.02
City/State/ZIP: Sherwood, OR 97140 Solar units (potable water) 62.54
Phone: (503) 624 -9309 Fax: : (503) 684 -0940 Tub /shower /shower pan 12.51
E -mail: Ryan @venneplumbing.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Venne Plumbing, LLC Water piping/DWV 56.29
Address: 15145 SW Divison St. Other: 25.02
City/State/ZIP: Sherwood, OR 97140 Subtotal 122.54
Phone: (503) 624 -9309 Fax: (503) 6840940 Minimum permit fee: $72.50
CCB Lic.: ),9214 1 , ' -.: � Plumbing Lic. no.: pb956 Plan review (25% of permit fee)
State surcharge
I y q rge (12% of permit fee)
Authorized tsi4ria'tt>yf TOTAL PERMIT FEE
Print name: Lindsay Venne Date: 04 /4/13 This permit application 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. \ nuilding \Permits\PLMU- PermitApp. doe 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 - 1s 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 - 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
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
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of following.
the follin
Work Performed: Capped Added Relocate q g'
Baptistry/Font Please check all that apply.
Bath - Tub /Shower ❑ Any new commercial building with water service 2" and
Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
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 ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic - non - food g q g
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related I
- Bradley
- Commercial -food related
- Service
Swimming 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:
http://www.tigard-or.gov/city_hal I /departments /cd/docs/PLMF -Petry i tApedoc
Accumulative Sewer Tally
1 1 1 1 Tenant Name: Dr. Auzins SWR # N/A
Site Address: 11565 SW Durham, Tigard, OR 97224 PLM # 2013 -00116
TIGARD
Parcel #: 2S 110DCO2400
Fixture A .11 t n I'reviills Previous Credits Capped Fixture Fixture New New
# \ alue count capped #s value count added # added value total #s total values
Baptistry/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 Dra ill 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 ? 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 (I 0
Capped EDU Credit 0
TOTALS 0 0 2 4 0 0 - -4
Current Fixture Value - divided by 16 = -0.250 Current EDU 1 EI)I = $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: * *CREDIT **
Authorized Name /Signature: Shirley Treat Date: 04/25/2013
Building Division
Note: The property owner shall retain the ORIGIN.11, 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 1: \ Building \Sewer Tally \SewerTallySheet- 4665.xls 07 /01/12
1
FOR OFFICE USE ONLY — SITE ADDRESS:
This form is recognized by most building departments in the Tri- County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
114 ■ Transmittal Letter
I i , ; ,\ F: i > 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: DAT ED
DEPT: BUILDING DIVISION 4V
APR 1 5 2013
FROM: CITY OF TIGARD
COMPANY: V O. P(L) C 7 BUILDING DIVISION
PHONE: 5 7 (0 - By:
RE: .I \ 2Ci3
(Site Address) (P t umber)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: _ Description: Copies: I Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain):
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Description: Amount Due:
$
$
$
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes I ❑ No ❑ Done
Applicant Notified: Date: Initials:
1:1Building\ Fors \TransmittalLetter - Revisions.doc 05/25/2012