Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2014-00403
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/06/2015
Parcel: 1 S136AD06507
Jurisdiction: Tigard
Site address: 11460 SW PACIFIC HWY
Project: Quality Inn Subdivision: WAY LEE Lot: 3
Project Description: Capping(4)tub/showers,(4)lays&(4)water closets. Adding(1)sink.
Contractor: DIRECT PLUMBING LLC Owner: AISLING CREATION LLC
PO BOX 4247 PO BOX 1120
TUALATIN, OR 97062 BEAVERTON, OR 97075
PHONE: 503-548-3448 PHONE:
FAX:
FEES
Quantity Description Date Amount
12 ea Fixture/Sewer Cap 01/06/2015 $300.24
Specifics: 1 ea Sink 01/06/2015 $25.02
1 12%State Surcharge- 01/06/2015 $39.03
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $364.29
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. may •. -in • cop • he rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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.
Plumbing Permit Application
Building Fixtures r ���,
City of Tigard 14,∎ Received 1, permit No.:
13125 SW Hall Blvd.,Tigazd,OR°97223 DateBy: l �3 /y / 7W ,C)
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960-, A %`i,,v- Other Permit No.:
\ } Date/By:
Inspection Line: 503.639.4175 Date Ready/By: luris Ed Page 2 for
I !GAR I) oil Y: g
Internet: www.tigard-or.gov 01:ry‘CIN1_ _ Notified/Method: Supplemental Information
TYPE OF WO t •■IN 1, S1O FEE* SCHEDULE
❑New construction 1i1�■1:y N t` P For special information use checklist.
Description I Qty. I Ea. I Total
IR Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling t 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: \\4000) S�.J ' c���L Catch basin or area drain 1 8.76
City/State/ZIP: TA� v�� �L Drywell,leach line,or trench drain 18.76
'r � v t Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/diredions to job site: gs b k l IJ Manholes 18.76
GJ ,fit ` , - Rain drain connector 18.76
�x 1 "`-"'\) 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
1P12-- �.iv�-0h ADO 1 v ti viv..-- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap ‘2__ 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
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: 54/nL, ell �y
Medical gas(value:$ ) Page 2
( / Primer 12.51
Contact name: y t , Roof drain(commercial) 12.51
Address: I l t 1 (t Sink/basin/lavatory \ 25.02 25 &-A-
.
City/State/ZIP: • e/1 r�-1 r� t Solar units(potable water) 62.54
Phone:( ) Fax: :( ) 'r /s., Tub/shower/shower pan 12.51
D\ i�V �� Urinal 25.02
E-mail: \Vlt`CNE � T c�j�.
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: ,"" \ k'c- e . l Water piping/DW V 56.29
Address: ' _ - in- - Other: 25.02
City/State/ZIP:"C- N �� C:41").0(LP - Subtotal ,3257-14
Phone: -�'-�����, � j Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: n�'zz7 Plumbing Lic.no.: ` State surcharge(12%of permit fee) V.
Authorized signature: AdigigiAMPIIIIIIIIIIIIIIIIIIIP. �/---- TOTAL PERMIT FEE .fir
Print name: ,� l . Date: This permit application expires if a permit is not obtained within 180 days
` `ts-� t r0 . �s, , ►_ �Z after it has been accepted as complete. 4L
*Fee methodology set by Tri-County Building Industry Service Board. b
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
P 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: ('apped 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"1'hru - as defined in OAR918-780-0040.
Cuspidor/Water Aspirator
El Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial El 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"
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: -LavBar non-food related �^
-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 aid before the
Water Extractor p
Water Closet-Toilet �. plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Debbie Adamski
From: Debbie Adamski
Sent: Monday, December 22, 2014 8:55 AM
To: 'direct.plumbing @comcast.net'
Subject: Quality Inn, Tigard, OR, PLM2014-00403
Anthony,
This permit is ready to be issued. The fees due are$364.29. You can pay these fees online. Please let me know once
the fees have been paid so I can issue the permit. Once I issue it, I will email a copy of the permit and the sewer tally
credit voucher. The credit voucher will need to be given to the property owner so they can present it to us the next time
they have any plumbing work done. Thanks!
Debbie Adamski
Senior Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd., Tigard, OR 97223
503-718-2450
1
Debbie Adamski
From: Debbie Adamski
Sent: Monday, January 05, 2015 8:49 AM
To: direct.plumbing @comcast.net
Cc: #Building Permit Technicians
Subject: Quality Inn, PLM2014-00403
Anthony,
This is just a reminder that this permit is ready to be issued. The permit fees due are $364.29. You can pay these fees
online if you like or you can come in to the office to make the payment. Our office hours for payments are Monday
through Thursday, from 8:00 am to 4:30 pm. If you pay them online please let us know so we can go ahead and issue
the permit. Let me know if you have any questions regarding this matter.
Debbie Adamski
Senior Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
1
gi Accumulative Sewer Tally
Tenant Name: Quality Inn***CR1.D1'I'S*** SWR# N/A
PLM#
Site Address: 11460 SAC'Pacific I Iwc
Parcel#: 1S 136AD06507
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total value:
Baptisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 4 16 0 -4 -16
-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 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/Bar-Non-Food Related 2 0 4 8 1 2 -3 -6
-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 4 24 0 -4 -24
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 12 48 1 2 -11 -46
Current Fixture Value -46 divided by 16= -2.875 Current Iilll_' 1 EDU = $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -46 divided by 16= -2.875 over (under) $ (14,112.00)
Enter EDU Change Here -2.880
Notes: ***CREDITS***
Authorized Name/Signature: Debbie Adamski Date: 12/22/2014
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:\Buil ding\Sewer Tally\SewerTally Sheet_4900._070114.xlsx