Permit •
CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2013 -00181
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/10/2013
Parcel: 25101 DCO3800
• Jurisdiction: TIGARD
Site address: 7180 SW SANDBURG ST 400
Project: Spec Space Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: Cap (1) toilet, relocate (2) lays and (1) service sink.
Contractor: WESTERN PLUMBING Owner: MCCORMACK PROPERTIES LP
9460 SW TIGARD AVE SUITE 101 7190 SW SANDBURG ST
TIGARD, OR 97223 TIGARD, OR 97223
P
PHONE: 503 - 624 -4649
PHONE: 503 - 639 -5296
FAX: 503 - 684 -9015
FEES
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 06/10/2013 $25.02
Specifics: 1 ea Sink 06/10/2013 $25.02
2 ea Lavatories 06/10/2013 $50.04
Type of Use: COM 1 ea Water Closet 06/10/2013 $25.02
Class of Work: ALT 1 12% State Surcharge - 06/10/2013 $15.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $140.11
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
issuan - I w. ' suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification 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 d• ect questions to OUN . • callin• ! .232.1987 or 1.800.332.2344.
Iss ed By: / / Permittee S
Call 503.639.4175 by 7:00 a.m. for the next available ins • =ction 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.
06/06/2013 14:46 5036849015 rte., WESTERN PLUMBING INC PAGE 01/03
Plumbing Permit Application RE ��� V E D
Building Fixtures JUN 06 2013 FOR OFFICE USE ONLY
City of Tigard CITYOFTIGARD ew - PamitNo ' 3 -604/
I3125 SW Hall Blvd,, Tigard, OR / (� ��
' 2 : Phono; 503.639.4171 Pan: 5033 LDINGDNISI s Otha Permit No.: ti _�
T l Ci A K I) Inepeaion Line: 503.639 1 r dT
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Addition/aaoement ❑ Ot>acr. � - Desaip i I QtY• I Ea. I Total
lterstiom/ropl
�' do /• tir •a.- n � , New 1- 2-family dwellings (includes 100 ft. for each utility connection)
. „��! +� * `! "' Q A : a::.: _. 1 : F1t (1) bath '�' .<: ;•;i'` ' �r'''y • 5 .; S 312.70
0 and 2 - homily dwelling '�] Co.,.mercioVinclus�al. SFR (2) b�
'C 437.78
CI Accessory Multi building ulti family sFR ( bath 50032
0 master b u i l d e r Each additional bath /kitchen 25.02
`.' 4 "' ` j __Y ❑. �y� r [i<j,'�;f�_ Fire sprinlder (_•_ sq. R) Fag, 2
*!'. ? : :,r, : .. .: 1 i, 144 `r ' c : Sit uttRIA :
Job site a ddress , ` 1 , c j
�� � 1 � �Q �i,�0� �tf.�`'t�� Catch basin or area drain 18.76
City/Stat VP � c � ' a3
011 �°� l line, or trench drain 18.76
i Footing drain (no. line R; ) Page 2
Suite/bldg apt. no.: U Project name:
Manufacta ed homeublitiea 50.03
Cross stteet/directionsto job rite: . ..PE. C.- /i Merles '- 18.76
Rain drain co®ector 19.76
Sanitary sewer (no. linear S.: ) Page 2
' Storm sewer (ow. linear R: _) page 2
Subdivisitxi Water service (no. linear ft.: ) Page 2 I
n ' ( Lot no.: Future or Item:
Tax map/parccl no.: a 5 1 6 .1 D to ' 3 Co Baddlow pr eventer 31.27
" ,, . �,, ' ,: r , � ,., , .1tO ;^ ",t: .. ,: Bnakwalw valve 12.51
Clothes washer 25.02
�(� 25.02
' ' " ( I & l Drinking fb stain . 25.02
..:,' 4.,,,.,..� u,. ...au ,.ypyy�trjrj�jpp.� ...r
. ti :va'� . �r -:1; ,.,,., -r. �.,,.. sump 25.02
�,5 • y'. .., ._ jar..;:.: /- a,,. :��+5..`+ > „�`�•e..+;.. r . i ' ;'"`'� :C::; "ti Expannontxnk
'•'� � ., , -... , .. y };.�.. ,rr ,��'`,'r`.`ck;'';p.' ' -'' 12.51
Name: ' Fixture/sewer cap • / 25.02 A5',6 '/
A Floor drain/ftocr sink/hub 25.02
City/State/ZIP: • Garbage disposal 25.02
Hose bib 25.02
Phone: ( ) Fax (• )
• � n:,; r , .�,' �.. Y. >' Ion matter l2 51
°'�' " ?,•' .w.. -'`t: i . ,• :! . : "'` *#Y -g`.. '' ':..' M1r00ieW/&Zase"P 25 .02'
r ��,. r 5' :.' iite
.
Business name: Medical gas (vitae: ) Page 2 •
Contact name: Primer 12.51
Address: Roof drain (commercial) 12
City/State/ZIP Sink/basiniavatory 28.02 ' Cl4
Solar units (potable water) 62.54
Phone: ( ) l Pax:: ( ) 71lb/shower/shower pan 12.51
Urinal • 25.02
:3hr :c..` ,'�d.}4F.. n ;F.i :- ' {f : p +r " `:' {C C. /-%M1. ra ,: - o'M 1e0S@t
.M9�<13i : :'� . ..16Vi� >r`.•.•3n ..� , °; v :2 - 1 ;.� : lr V . �- � •:.:7";17,..F, :- , ._,,(.; ., t',./ w � 25.02 '
; ,� ' . . .!•+y:f..' :t.J.. . ,N. 1 0 54.. `. !•� -
water gexter 37.52
Business name: Western Maudlin . Ina.
Wad pWgr€NWV 56.29
Address: 9460 SW Tigard Avenue Sudte 101 Other. 25.02
City/State/ZIP: Tigard, OR 97223 Subtotal /g S G i
■
Phone: (503) 639-5296 Fax (503) 684 -9015 hefinimum permit fee: $72.50 -'
n no.: 34 -29PB Plan review (25% of permit fee) �..
CCB Lic.: 2439 Plumbing Li
Authorized
signature: /��' PERMIT sSlam
surcharge TOTAL PERT PEE /6 e l
Print name: Dana Jensen / / •
J Date: b_1 � y; , permit errpircs It a permit 6 net obtained wtthla 180 days
attar It Ina been accepted as complete.
wu.. nvoOln,wnrra at ti., •trans....,, AarA:.,.. T...r...,.v c.,,,c.. w.-..t
06/06/2013 14:46 5036849015 WESTERN PLUMBING INC PAGE 02/03
j'Iumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:
., : 'S : ' +-. , •c •: ra - �.. . .. Residential Fire ression stems:
PP
..c ;f'::.:a :F_� , �t•_ - i ;: Wiz' < yt -•d y : s ;;- a 7 .,;,° ste Q f�;: ...
S e:.�. �?.,:lti { 7;i4 h i:i 1 t n EV.4t :fi ' . 1t t t c: l �. .,. .. ' r.. ;
Footing drain -1 100' _ 50.03 �:,_ ;; :..• x., ";,.;< [
0 to 2,000 j $1x1.90
Footing drain - each additional 100' 37.52 ,. 2,001 to 3,600 $169.69 '
• Sewer - 132100' 42.34 3,601 m 7,200 • $233.20
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 151 100' 62.54
-
Water Service - eaett additional Ito' 37.52 Medical Gas Systems:
Storm & ', ,, ;• , __ , -, ". ,,. �,.. on . < • . ,
Rain Drain -1st 100' 62.34 ` ', • R?1 ti!iV . ; : • '''; ''x"
Storm Rain Drain - eachadditiouel 100' 37 S
■ r � fee $72.50 ''
5100 to .00 Miptimom f
2 $5,001.00 to $10, 000.00 50 for the fast $5,000.00 and $1.52 for
10a±o;r. r'v yijk{ ;i f8s y each additional $100.00 or fraction thereof, to
':r.,:.. :;,.i.•.' l
and:incu
Inspection Clanging aging plumbing or for drag first $ .00.
which no fee is specifically indicated 90.00/hr
$10,001.00 to 52,5,000.00 $14.30 for the first $10,000.00 and $1.54 for
(minimum charge -1/2 barer) each additional $100.00 or fraction thong to
Inspections outside of normal business 90.00/ and i tclUding $25,000.00.
hours ( charge 2 hours) $25,001.00 tD $50, 000.00 $379.50 for the first $25,000.00 and $l .45 for
Retrffipectian Fees 90.009a minimum
each additional $100.00 or fraction thereof to
and including $50,000.00.
Additional plan review ih r revisions 90 p0/br $50.001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge -1/2 hoar) each additional $100.00 re fraction thereof •
Subtotal:
•
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", ' iiT t ` F rt , ,r y :,�,; ,
please indicate work performed by ire. Failure m Y'', ( 4 � rk ! l
Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees Please check all that arcly.
`a:,= - ''3,".a ° =,€ ;;:..Y:i ;� :•� !9ig:' ;_• < ' ...�•?.; '�'� ` *1� 0 Any new commercial building with voter acrvice 2" and
�� r, :n ;.. -r.. v lCur . ; �: ` ;; 5 •st; greater, except systems destgo°d and stamped by licensed
134213 41113/Shower 0 New exterior plumbing site trti lies for any complex structure
Jactusimb rtpool as defined is OAR9 i 8- 980.0040.
Car wash - Each Mall D Medical gas and vacutuir systems for health care facilities.
-Drive Thro D Any multipurpose fire sprinkler system.
Cuspidor/Water Aseitator
0 Any complex structure as defined in OAR918 780-0040.
Dishwasher - Commercial '
- Domestic • Submit a sets of plans with any of the above. • • ••• . : Fountain
Eve Wash _, :. <'
Floor Drain/siok - 2° e ' .. ti_;.,w `
Isometric or riser diagram is required for new buildings
- 4" that meet the qualifications above..
Car Wash Drain
' Garbage - Domestic
Disposal - Commercial
- Indnetrial Comments regarding :fixture work:
Ice Macb../Refri . Drains _
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang •
.Stall
Sink - &¢/Lavatory 1-
-Bradley -
-Commercial ' "Note: If the fixture work ender this permit results in an
-Service increase of sewer EIRT asewer
Swimming Pool Filter - a , � s, permit will be issued and
Washer = Clothe, fees assessed for the sewer. increase must be paid before the
Water Faaraaar plumbing permit can be lined.
water Closet - Toilet j l
Urinal .
Other Fixtures:
•
Accumul Sewer Tally
1 ,11
v
p Tenant Name:,Spec Space' ' *CRFl)l'I'S' ' S\WR # N/A .
TI G n K D Site Address: 7180 SW Sandburg Suite 400 PLM # , 2013 -00181
Parcel #: 2S 101 DCO3800
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptistry/Pont 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 I-IP) 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:
- l.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 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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped 13DU Credit 0
TOTALS 0 0 1 6 0 _ 0 -1 -6
Current Fixture Value -6 divided by 16 = -0.375 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -6 divided by 16 = -0.375 over (under) S (1,772.70)
Enter EDU Change Here -0.380
Notes: * * *CRFDTTS * **
Authorized Name /Signature:, Debbie Adamski Date:, 6/11/2013
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 of Tigard Building Division to redeem credits towards future system development charges.
•I: \Building \Sewer Tally \Sewer l'allvShect- 4665.xIs 07/01/12