Permit 17 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 -00162
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/30/2013
Parcel: 1S 136AD04000
Jurisdiction: Tigard
Site address: 11527 SW PACIFIC HWY
Project: Labor Works Subdivision: VILLA RIDGE Lot: 7
Project Description: Add (2) lays, (2) water closets and (1) water heater. EDU credits applied from PLM2010- 00290, leaving a EDU
balance due of .2 for this project (see SWR2013- 00118).
Contractor: K & C PLUMBING INC Owner: PACIFIC TERRACE COMMERCIAL LLC
PO BOX 2124 BY SMITH, EDITA M
OREGON CITY, OR 97045 833 NW 170TH DR
BEAVERTON, OR 97006
PHONE: 503 -518 -0234 PHONE:
FAX: 503 - 518 -1100
FEES
Quantity Description Date Amount
2 ea Lavatories 05/30/2013 $50.04
Specifics: 2 ea Water Closet 05/30/2013 $50.04
1 ea Water Heater 05/30/2013 $37.52
Type of Use: 1 12% State Surcharge - 05/30/2013 $16.51
Class of Work: Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $154.11
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: � Permittee Signature: nA7 /PZ..../ (.e7-77O j,
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.
29 May 13 09:22a Russ 503- 518 -1100 p.1
Plumbing Permit Application
Building Fixtures RECEIVED FOR 01 .: t SL 0y'1.1
City of Tigard RECEIVED =
is 131 SW Hall Blvd., Tigard, OR 9 9 n 3 Date/By: 3 d /' 7 ♦ a / 41 /to . -
Z . Phone: 503.718.2439 Fax: 503.5.'19'60 ` ` ` Plan Renew
Date/By: Olhtt Perrni[SedROSyy
a43 _ 1
Inspection Line: 503.639.4175 Date Ready/By: runs Ia See Pa 2 for
TIGARO )' 6e
Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: 77 Supplemental !aroma two
TYPE 01$441BRING DIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition
special Jafonnation 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 Ii?' Commercial /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.) i Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
' Catch basin or area drain 18.76
Job site address:
11 s,7 S L) t�A-- c► -2(C.. 44.4_ J
Ciq /StatelZ[P: ��,� / Drywell, leach line, or trench drain 18.76
/�
Footing dram (no. linear ft.: ) Page 2
Suite/bldgJapt. no.: Project name: EA. B p R. w 0 R
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 pre venter 31.27
DESCRIPTION OF WORK Backwater valve 12
f ►
I� L nn . .2 t 1 r �
Clothes
w a skier 25.02
7Z-a �C f � S' 'L �S Dishwasher 25.02 _
X N. e r j 4.2 C. f -E p f Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER %TENANT Expansion tank 12.51
Name: ( 4, 0 W ,, Fixture/sewercap 25.02
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
J. APPLICANT a CONTACT PERSON Interceptor /grease trap 25.02
L i
Business name: IS.. g 4 .1 b L rh C Medical gas (value: S ) Page 2
Contact name: R \ S Primer _ 12.51
� � I e � Roof drain (commercial) 12.51
Address: D C, p). G.J.�i 2._( ZC} Sink/basinllavatory `, _ 25.02 S'Q.O of
City /Stale/ZIP :.1p r DA L5 / 0 7 7 a45 Solar units (potable water) 62.54
Phone: (So)) 7 g 1 y 7 2 Fax :: ( -/ 8_, f e ,p ` Tub/shower /shower pan 12.51
E -mail: Lai k. Fn b .Z J'v►-C-c 1 . c O riA ___,
Wa 25.02
CO RACTOR Water closet - Z.- 25.02 5Q, OY
Water heater ( 37.52 37, 6 Z,
Business name: � 0 PLo wt. 67, t /tr. Water piping/DWV 56.29
Address: Fj, cg o.l . Z Z
p -421 Other: Other: 25.02
City/State/ZIP: i 1--xci o'er C c i O K, `l 70 < ,Tr Subtotal /37. /pv
Phone: (s 70 _J 7472 ax: ( S7 6. .1 ! p C - Minimum permit fee: $72.50
CCB Lic.: i ( Li 7 Plumbing Lic. no.: p 13 S Plan review (25% of permit fee)
Authorized sigma �� State surcharge (12 °/. of permit fee) ! (p, 5
TOTAL PERMIT FEE I sl+. `1 1,../
LPrint name: KLA,,Sc _ I( , Date: This permit application expires if a permit is sot obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
29 May 13 09:22a Russ 503 518 - 1100 p.2
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 O to 2.000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 5169.69
3,601 to 7,200 5233.20
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 S1,00 to 55,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 55.001.00 to $I0,000.00 572.50 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
pe and including $10,000.00.
Inspection of existing plumbing or for 510,001.00 to 525,000.00 5141.50 for the first 510.000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr ! each additional $100.00 or fraction thereof, to
(minimum charge - 112 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr S25,001.00 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 90.00Au 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
Quaoti y by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Rdocate
Please check all that apply.
Baptistry /Font ❑ Any new commercial building with water service 2" and
• Bath - Tub/Shower
Jacuzzi'Whulpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 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 0 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.
-3"
- 4- Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-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. /Re frig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station � _t
Shower -Gang r i 1.--.e et- r e De. C ✓r �l
-Stall
Sink/Lay - Non -food related 2- I pkg.-C." r ec [ [ j
- Bradley �
-Commercial -food related
- Service
Swimming Pool Filter *Note: li 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 2, fees assessed for the sewer increase must be paid before the
' U plumbing permit can be issued.
1 Other Fixtures: wtttcr kt -ete 1
IIIII - Accumulative Sewer Tally
v
Tenant Name: Labor Works SWR # 2013 -00118
TIEGARD Site Address: 11527 SW Pacific Hwy PLM # 2013 -00162
Parcel #: 1S136AD04000
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
-flinch 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 2 4 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 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0.8 12.8
TOTALS 0 0 0 0 4 16 4 3.2
Current Fixture Value 3.2 divided by 16 = 0.200 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 3.2 divided by 16 = 0.200 over (under) $ 933.00
Enter EDU Change Here 0.200
Notes: Applied EDU credits from PLM2010- 00290.
Authorized Name /Signature: Dianna Howse Date: 5/30/2013
Building Division
IN ote: 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 \ Sewer Tally \SewerTallySheet- 4665.xls 07/01/12