Permit CITY OF TIGARD PLUMBING PERMIT
3 COMMUNITY DEVELOPMENT Permit#: PLM2015-00085
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/19/2015
Parcel: 2S 112 DD00400
Jurisdiction: Tigard
Site address: 15912 SW 72ND AVE B17
Project: PacTrust Subdivision: 1994-006 PARTITION PLAT Lot: 2
Project Description: Replacing existing backflow preventer.
Contractor: DEAN WARREN PLUMBING&REMODELING INC Owner: PACIFIC REALTY ASSOCIATES L P
PO BOX 14701 15350 SW SEQUOIA PKWY#300-WMI
PORTLAND, OR 97293 PORTLAND, OR 97224
PHONE: 503-236-4152 PHONE:
FAX: 503-296-2218
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/19/2015 $31.27
Specifics: 1 12%State Surcharge- 03/19/2015 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 03/19/2015 $41.23
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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. ou may obtain a copy of the 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.
Plumbine Permit Application �i
Building Fixtures FOR OFFICE USE ONLY
City of Tigard G"` 0'��j R`�"ed 3 Permit No.. /�
r� Date/By: �3� I�, ,�5-
.11111 • 13125 SW Hall Blvd.,Tigard,OR 9722 1� L /� V/! /� `�WO
• Phone: 503.718.2439 Fax: 503.598.1960 •lan Review
MP ! �a,`By: Other Permit No.:et Inspection Line: 503.639.4175 'c�GP
I WARD 01-1%\-40- ,1‘S .•to Ready/By:
d/Meth : Juris Supplemental See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
-TYPE OF WORK op,...- FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
R 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 [ -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: AI f (4..._ r..1.. 71 Catch basin or area drain I 18.76
/State/ZIP: _ Drywell,leach line,or trench drain 18.76
City/State/ZIP: °S S ) Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 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 a/. 7
DESCRIPTION OF WORK Backwater valve 12.51
pp �� [ Clothes washer 25.02
/"QJ1e7 e`er °0{,b�+ C b ' -�'L 5 f Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: v0�L t-7•,.S Fixture/sewer cap 25.02
Address: / c /l Floor drain/floor sin /hub 25.02
r 5 c 5 9 L G 1d v -4 u"e."4 Garbage disposal 25.02
City/State/ZIP: TrS J-r'4- criz, .3 7 2-)'( Hose bib 25.02
Phone:(5-G)) t ._1(- 3 ov Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: /� '4,415 ,- el / Medical gas(value:$ ) Page 2
r � ��
°� ' Primer 12.51
Contact name: r�
n n Roof drain(commercial) 12.51
Address: ! C /S /t1 7. /
Sink/basin/lavatory 25.02
City/State/ZIP: t f. G vi, 4 72-SJ Solar units(potable water) 62.54
-
Phone:( ) 'go- 9u G Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: (S /- ' G) bout` Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 3/,97
Phone:( ) Fax:( )
Minimum permit fee: $72.50 7/50
CCB Lic.: / Plumbing Lic.no.: 3 Plan review (2125°4%of permit fee) -�
5y9/ g �6 7 c
' State surchazge of permit fee) •70
Authorized signatur : /2.42___ TOTAL PERMIT FEE lg./.Print name: C Date:�� ,/� This permit application expires if a permit is not obtained with180 days
��P Las after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board. �j
I:\Building\Permits\PLMU-Perm /itApp.doe 10/01/09 440-4616T(10/02/COM/WEB) i T•k v,
7 •y 0
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1 n 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: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall 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
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filer 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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
Tenant Name: REAL ASSET SWR# 2015-00031
Site Address: 15350 SW SEQUOIA PKWY PLM# 2015-00084
r t C;n tt t7 Parcel#: 2S112DA01400
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count coed#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 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 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 1:xtractor 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
TOTALS 0 0 0 0 1 _ 2 1 2
Current Fixture Value 2 divided by 16= 0.125 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 2 divided by 16= 0.125 over (under) $ 637.00
Enter EDU Change Here 0.130
Notes:
Authorized Name/Signature: BRANDEN TAGGART Date: 3/19/2015
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\SewerTallySheet_4900._070114.xlsx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15912 SW 72ND AVE B17, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00085
George Heimos
Lawn irrigation valve. 2" Watts model LF007M1, serial number 013175
Violation Summary:
Inspector Contractor