Permit n CITY OF TIGARD PLUMBING PERMIT
' s COMMUNITY DEVELOPMENT Pe rmit #: PLM2013 -00435
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/23/2013
TIGARD g Parcel: 2S 113AA00400
Jurisdiction: Tigard
Site address: 16200 SW 72ND AVE B2
Project: Spec Space Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: CAP (1) water closet and (1) urinal, ADD (1) break room sink, REPLACE (1) 2" floor drain, (1) laundry tray and (2)
lays. Fixture work results in an EDU credit of .63.
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 236 -4152 PHONE: 503 624 -6300
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
2 ea Fixture /Sewer Cap 12/23/2013 $50.04
Specifics: 1 ea Floor Drain/Floor Sink/Hub 12/23/2013 $25.02
1 ea Primer 12/23/2013 $12.51
Type of Use: COM 1 ea Sink 12/23/2013 $25.02
Class of Work: ALT 1 ea Laundry Tray 12/23/2013 $25.02
Type of Const: 2 ea Lavatories 12/23/2013 $50.04
Occupancy Grp: 2 ea Water Closet 12/23/2013 $50.04
Stories: 1 ea Water Heater 12/23/2013 $37.52
1 12% State Surcharge - 12/23/2013 $33.03
Plumbing
Total $308.24
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.
4 Issued By: v ''_ Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next availabl .Inspection date.
This permit card shall be kept in a conspicuous place on the job ite until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicatio
Building Fixtures ECEIVED
City of Tigard Received
By: /.2 . / 3 Permit No..A .< 0/ �. _
li ii
13125 SW Hall Blvd., Tigard,OR 97223 DEC 2 3 2013 Plan Review
Date/By: Review Other Permit No.:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 CITY OF TIGARD Date Read /B Juris: ® See Page 2 for
TI l; A K U Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: 77 Supplemental Information
TYPE OF WORK �+ FEE* SCHEDULE
ID New construction ID 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
ID 1- and 2- family dwelling 2 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.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / 6 )_ v C S w 7 2 '44-- Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP: r d 9 djl-. 1 22-1- y
5 ° Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: g G (,,,..,0..„..e „} Manufactured home utilities 50.03
Cross street/directions to job site: 1 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
S e c 7 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: a 7-7 y r- Fixture /sewer cap a' ,,Z, 25.02
D Floor drain/floor sink/hub t 25.02
Address: / S 3 gb S r+✓ S '
�' v a oa G
y Garbage disposal 25.02
City /State /ZIP: 7- ex- q 2 72-7 Hose bib 25.02
Phone: ( ) 62 y - 63 0 o Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
��a,„ Wi.,,,n , i nks d - fl +o 4 i
Primer I 12.51
Contact name: Q
Roof drain (commercial) 12.51
Address: f. Q , 4n / U 76 / Sink/basin/lavatory '-1 25.02
City/State /ZIP: Pe /Y A. 5 ) 2 2 y Solar units (potable water) 62.54
Phone: (>7.1, ) 7 bG - 5 y b G Fax: : (5. 3) 2 q .0 •-2 2-/ $ Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 2 - 25.02
CONTRACTOR
Water heater 1 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State /ZIP: Subtotal
P t ne: ( ) Fax: ( ) Minimum permit fee: $72.50
ry I CCB Lic.: 1 / 4 / 5 Plumbing Lic. no.: 2 6 - 7 3 6, °/,' Plan review (25% of permit fee)
1-"z
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: M R Date: 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- PermitApp.doc 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 - 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
I� 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
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall 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 f/ G}it..rrRy Val
Sink: - Lav/Bar non -food related S' / . �� LiF ✓S
- Bradley f�eA0-
- Com/Serv/Util food related izeto')
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filler 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 I 2 - plumbing permit can be issued.
Urinal
Other Fixtures:
I:\ Building \Permits\PLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
Tenant Name: Spec Space SWR # N/A
i �` �� Site Address: 16200 SW 72nd Ave., B2 PLM # 2013 -00435
Parcel #: 2S113AA00400
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
- 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 LIP) 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 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 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 1 6 0 -1 -6
Urinal 6 0 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 12 1 2 _ -1 -10
Current Fixture Value -10 divided by 16 = -0.625 Current EDU 1 EDU = $4,800.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -10 divided by 16 = -0.625 over (under) $ (3,024.00)
Enter EDU Change Here -0.630
Notes:
Authorized Name /Signature: Dianna I Iowsc Date: 12/23/2013
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 I'allySheet_4800._070113.xlsx
T1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: '001;0%3 -00435 '
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 - 4171x! @Ij� °�
Inspection Requests (24 Hrs.): (503) 639 -4175 !
INSPECTION WORKSHEET FOR DATE: % -a- aoV3 TIME: PAGE:
SITE ADDRESS: 163.00 S. (rJ • .1 CLASS OF WORK: vuk
SUBDIVISION: --n atck o., glaaq LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 1- � Pour Time:
Code # Inspection Description Confirm # Contact # Message
3os P Lv.3. u .c1u = t0.L
Corrections /Comments/ Instructions:
G Plu...L. i S 10,1- ( be — U �-
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Da h S • Date: la- 6- a o 13 Phone #: (503) 718-
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
16200 SW 72ND AVE B2, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
2014-02-06 00:00:00
PLM2013-00435
PASS - No C of O
Violation Summary:
Inspector Contractor