Permit Dec. 20. 2013 11:39AM Mo ern Plumbing 3 -6?- No. 2995 P. 1
D
Plumbing Permit Applicati CEIVE / I
Building Fixtures Ell H)12 (11 I It l t'st 0\1.1 2
71 City of Tigard DEC 2 Received / : �r 7j y j , PcrmitMo.: °C11.2415-e0 7�
'I 13125 SW Hall Blvd., Tigard, OR. 97223 3 2013 Dare/By: 7 k J
Plan Review `��'
o Phone; 503.718.2439 Fav: 503 e 59�-,r.460 Other Permit No.: > >l3 "' t•� 3
� l [t 1, j� Dale/By:
O
TIi;ARD Inspection Line 503.639.4175 OFT1GARD DateRerdyBy: / di � El See Page 2 for
Internet: w�ww.tigard- or.gov BUIL i ■ I a . Notified/Method: •r � � / 3 Su ,lemental Information
TYPE OF WORK • - /' ' 144 ' I r FEE* SCHEDULE
❑ New construelion ❑ Demolition rspednl information use checklist.
Description I Qty. ( Ea. I Total
N I - Addition/alteration/replacement ❑ Other: Ncty 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 '.S
ID I I. and 2- family dwelling SFR (2) bath 437.78 .�
■
SFR (3) bath . 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02 _ n
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 7
JOB SITE INFORMATION AND LOCATION Site utilities:
Job Site Address; �7 6(� Catch basin or area drain 18.76 OeN
City /Stale /2IP: t /� J . � Drywell, leach line, or trench drain 18.76 1�
11 &. ( L0 'f ` ' Footing drain (no. linear R.: ) Page 2
Suite/bldg. /apt. no.; Project name: L ' b itti u f ri wS Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
1„ �� -ter r t U �L l <2 - ( 3 / Rain drain connector 18.76
r 4) /' C� Sanitary sewer (no. linear fl.: �) Page 2
Storm sewer (no. linear R.: ) Page 2
Water service (no. linear fl.: _l Page 2
Subdivision: I Lot no.: Fixture or ilcm:
Tax map /parcel no.: / / ,, tp C -:A e 5t t/ Backflow preventer 31.27
- DESCRCPT11.ON OF WORK Backwater valve 12.51
Clothes washer 25.02
64.G�.14, /ry�, Lt�
JUpyart„�
Dishwasher 25.02
/V.4-4) .4JA - A L .-v tti J
,,. Hkt'e )A)l`l'i1 Drinking fountain ) 25.02 �)SO)-
L S a rd c C.er -h L. _ 4 Ejectors/sump 25.02
❑ - PROPERTY' OWNER I I ' ?1 I Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 9' _ 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ..:' D CONTACT PERSON. Interceptor /grease trap 25.02
Business name: Medical gas (value: $ _) Page 2
Primer 12.51
Contact name;
Roof drain (commercial) 12.51
Address: Sink strtJavatory /14,4 -44 3 ` 25.02 7 0/,
City /Stale/ZIP; Solar units (potable water) 7 62.54
Phone: ( ) I Fax: ; ( ) Tub/shower /shower pan 12.51
E-mail: Urinal 25.02
CONTRAcro ': : <s .
Water closet a-- 25.02 £
. . Water heater r ash 7 - 37.52 -7 S'd y
Business name: hi / 1 V /Li/ L4 .!t. / .., Waterpiping/DWV 56.29
Address: // J,. o S 1 ,3 T u s j. rw( CO q .3 Other: 25.02
City/State/21P: 2 .--- u ! ' (9 g OA Subtotal \ sj tp
II / /^ r / Minimum pent* fee: $72.50
Phone: (13) f07 ( 6O 1 (0 `Q Tax: ( t, q I 6 7 7 / _
CCB Lie.: p r] q 0 b Plumbing Lic. no.: 3 if .),s-0 p Plan review (25 ".0 of perit fee
State surcharge (12% of perm
fee) ? e
Authorized si nature: � k �' � �y� ` 'TOTALPERMITFEE a5)1
me J t.�l Jl r 1 J .S / / r� v D a l e; / d .. .0 This permit application expires It permit is not obtained within ISO days
Print na
y r^ after iI has been accepted as complete.
Y "Fee methodology set by Tri•Counly Building Indus Service Board.
t \ DuildingTermiwi'LFN 0,'
- PcrmiiAPp doe 10 109 440 1616T( i(W02/COM/WEB) L. ,3 7/ 3
I I Accumulative Sewer Tally
• `Tenant Name: Lumber Liquid SWR # 2013 -00213
Site Address: 7301 SW Dartmouth PLM # 2013 -00434
TIGARD
Parcel #: 1S136DCO2504
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 1 1 1 1
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 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 /Bat - 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 1 3 1 3
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
TOTALS 0 0 0 0 6 20 6 20
Current Fixture Value 20 divided by 16 = 1.250 Current EDU 1 EDU = $4,800.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 20 divided by 16 = 1.250 over (under) $ 6,000.00
Enter EDU Change Here 1.250
Notes:
Authorized Name /Signature: Debbie Adamski Date: 12/23/2013
Building Division
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.
r
1: \ Building \ Sewer Tally \ SewerTallyShect_4800._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
7301 SW DARTMOUTH ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
2014-01-23 00:00:00
PLM2013-00434
PASS - No C of O
Violation Summary:
Inspector Contractor