Permit CITY OF TIGARD PLUMBING PERMIT
11111 ' COMMUNITY DEVELOPMENT Permit #: PLM2013 -00431
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2013
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 410
Project: NWCUA Subdivision: VARNS ACRES Lot: 9
Project Description: Add (1) sink, (1) dishwasher, (1) expansion tank, (1) floor drain, (1) primer and (1) water heater.
Contractor: GRIDLINE PLUMBING Owner: GK TRIANGLE CORPORATE PARK III L
4343 SE 37TH BY THOMSON REUTERS INC
PORTLAND, OR 97202 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 503 - 771 -8790 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 12/16/2013 $25.02
Specifics: 1 ea Expansion Tank 12/16/2013 $12 51
1 ea Floor Drain /Floor Sink/Hub 12/16/2013 $25.02
Type of Use: COM 1 ea Primer 12/16/2013 $12.51
Class of Work: ALT 1 ea Water Heater 12/16/2013 $37.52
Type of Const: 1 12% State Surcharge - 12/16/2013 $16.51
Occupancy Grp: Plumbing
Stories: 1 ea Sink 12/16/2013 $25.02
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 . ...pted by the Oregon
Utility Noti • Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. Y• • may obtain . copy of the rules
or dire questions t UNC - ailing 503.232.1987 or 1.800.332.2344.
Iss d By: Permittee Signature: 00:0" all
Call 503.639.4175 by 7:00 a.m. for the next available inspec e. /
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.
Plumbine Permit Application
Building Fixtures FOR OFFICE USE ONLY
C EIVE D 14 C ity of Tigard Received Perini' No
s� 13125 SW Hall Blvd., Tigard,OR 7
Date/By: / ie, /5 (,; � r / LiI /5 -
Phone: 503.718.2439 Fax: 503.598.1�p 6 Plan Review
II Phone: Permit No.:
Inspection Line: 503.639.4175 C 6 2013 Date/By: TIGARD Internet: www.ti ard - or. ov Date Ready/By: luris la See Page 2 for
g g TVOFTIGARD Notified/Method: Supplemental Information
TYPE OF W DH'i, tritstow FEE* SCHEDULE
❑ New construction Demolition For special information use checklist -
Description I Qty. I 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 w
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32 C
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02 7.3
❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) Page 2 OiN
VI
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / 3 ? �. / ii 4, /'r -- -# 4 / 0 Catch basin or area drain 18.76
City /State /ZIP: �; / Drywell, leach line, or trench drain 18.76
/ r L / n Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: /v � 6. l U a_, Manufactured home utilities 50.03
Cross street/directions to job s Manholes 18.76
�� /' t e b (// / CJ Rain drain connector 18.76
1j PjCea / r J , ��f Sanitary sewer (no. linear ft.: ) Page 2
( �[ $z / Storm sewer (no. linear ft.: ) Page 2
T- ✓` -C /// 4/ 0 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
�� Dishwasher x [ 25.02 5 p
1 - , • -e / _ Drinking fountain 25.02
/ - r� - /71-44/(// l 7 LI, Dat / n � 1ij c et✓ Ejectors /sump 25.02
!/ 0 PROP ERTY OWNER ❑ TENANT Expansion tank / 1 12.51 /a, 5
Name: Fixture /sewer cap 25.02
Address: Floor drain/floor sink/hub X / 25.02 , 5 /9 7
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: Medical gas (value: $ ) Page 2
Contact name: Primer x / 12.51 4,7, 57
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory X l 25.02 0 7,,,5 -- .4 o e
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRALTO Water heater / 37.52 3 S�
Business name:
/'l D // nf � , � /fig > Waterpiping/DWV 56.29
Address: -• CA
3 i Other: 25.02 / 37, CP 0
City/State /ZIP: l-":)0,--- aix- - / o 97,„? Subtotal 7a, 56
Phone: ( 3) 77/ - 879;0 Fax: (*) 77/ /p 6/ 3 Minimum permit fee: $72.50
CCB Lic.: 11-M5 Plumbing Lic. no.: / CJ fwd Plan review (25% of permit fee)
/ �� // ! State surcharge (12% of permit fee) / , • Si
Authorized signature: 4 r / TOTAL PERMIT FEE / 5 (i .11
Print name: , L r / n / Date: /i,/ , ! 3 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: \ Building \Permits\PLMU- PennitApp.doe 10/01/19 440- 4616T(10/02/C01WWEB)
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 - 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 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
El Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918- 780 -0040.
Cuspidor/Water ❑ Medical gas and vacuum systems for health care facilities.
Cus Water Aspirator
Dishwasher: As -Commercial al ❑ Any multipurpose fire sprinkler system. •
Commeic ❑ 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" 1
3" 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 f
- 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
1 Accumulative Sewer Tally
= Tenant Name: NWCUA * * *CRI'sll1'I'S * ** SWR # N/A
TIGARD Site Address: 13221 SW 68th Pkwv #410 PLM # 2013 -00431
Parcel #: 2 S 101 DA00102
Fixture \ .ilu, Previous Previous Credits Capped Fixture Fixture New N. ew
# t, .due count rappel #!, value count added # added value total #s total value
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 1 2 1 2
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 1 2 1 2
- 3inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash 6 0 1) 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
Living Unit 16 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 I) 0 0 0
Shower. - Gang (per head) 1 0 (1 0 0 0
- Stall 2 0 0 0 0 0
Sink
- Lav /Bar - Non -Food Related 2 0 0 1 2 1 2
- 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 EDU Credit 0.8 12.8
TOTALS 0 0 0 0 3 6 _ 3 _ -6.8
Current Fixture Value - 6.8 divided by 16 = -0.425 Current EDU 1 EDU = $4,800.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -6.8 divided by 16 = -0.425 over (under) $ (2,064.00)
Enter EDU Change Here -0.430
Notes: ** *Credits from PLM2010 -00333 applied to this permit***
Authorized Name /Signature: Debbie Adamski Date: 12/16/2013
Building Division
r ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \Building \Sewer Tally\ SewerTallySheet _48(N)._070113.xlsx
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13221 SW 68TH PKWY 410, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
2014-01-23 00:00:00
PLM2013-00431
PASS - No C of O
Rough inspection pass.
Violation Summary:
Inspector Contractor