Permit CITY OF TIGARD PLUMBING PERMIT
' • COMMUNITY DEVELOPMENT Permit#: PLM2015-00148
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ` Date Issued: 05/12/2015
Parcel: Tigard
01300
i' Jurisdiction: Tigard
Site address: 10830 SW GREENBURG RD
Project: Washington Square Hotel Subdivision: MEADOW VIEW Lot: 8
Project Description: Interior Plumbing:Capping(19)sinks and(19)water closets. 5/19/15: Reprinted permit to change contractor from
Alpha plumbing to Alpha Omega Plumbing.
Contractor: ALPHA OMEGA PLUMBING LLC Owner: SCHAEFER, ROBERT M&SALLY J&
201 ARDUS DR MILLER, GERALD V
NEWBERG, OR 97132 BY SHILO INN-WASHINGTON SQUARE
11600 SW SHILO LN
PORTLAND, OR 97225
PHONE: 503-538-7848 PHONE:
FAX:
FEES
Quantity Description Date Amount
38 ea Fixture/Sewer Cap 05/12/2015 $950.76
Specifics: 1 12%State Surcharge- 05/12/2015 $114.09
Plumbing
Type of Use: COM 45 Misc Administration Fee 05/19/2015 $45.00'
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $1,109.85
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 std wit • 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules ado. • •y the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may ob a ••py of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800
Issued By: •ermittee 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.
1111 n CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2015 00148
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/12/2015
Parcel: 1S135BD01300
Jurisdiction: Tigard
Site address: 10830 SW GREENBURG RD
Project: Washington Square Hotel Subdivision: MEADOW VIEW Lot: 8
Project Description: Interior Plumbing:Capping(19)sinks and(19)water closets.
Contractor: ALPHA PLUMBING Owner: SCHAEFER, ROBERT M&SALLY J&
21713 S BEAVERCREEK RD MILLER, GERALD V
OREGON CITY,OR 97045 BY SHILO INN-WASHINGTON SQUARE
11600 SW SHILO LN
PORTLAND,OR 97225
PHONE: 503-869-6095 PHONE:
FAX:
FEES
Quantity Description Date Amount
38 ea Fixture/Sewer Cap 05/12/2015 $950.76
Specifics: 1 12%State Surcharge- 05/12/2015 $114.09
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $1,064.85
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 mayf,obtain py 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.
Plumbing Permit Application I l . S 0 cO
Building Fixtures v,�Q FOR OFFICE USE ONLY
City of Tigard G�` Rece By: permit No.:
1L ,�5 DaterBy �iJ f[ 4i 77-
�Ma7015- /K,
1, • 13125 SW Hall Blvd.,Tigard,OR 971%, Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 1��1 1 �Q Other Permit No.: / p
Inspection Line: 503.639.4175 Mtn` QQ Date/By. v � '��
T I G A R D r„,P`` to Ready/By: Suns: B See Page 2 for
Internet: www.tigard-or.gov \1\-"' 1, tified/Method: Su emental Information
❑instruction ❑ dim
For special information use checklist
Description I Qty. I Ea. Total
ddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
❑ I-and 2-family dwelling i ercial/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
Site utilities:
Job site address: l 0 8 3 a S W G Rd"Q N aKi 4 c le-cA Catch basin or area drain 18.76
City/State/ZIP: •---1-% G A R es a t C =2 3 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: L f Mt ut-re A NASN.Sy 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
DESCRIPTION OF WORK - Backwater valve 12.51
Clothes washer 25.02
-fit(++• 4riKcs-ONaDic C-o.4Ne4.aSrs.., OE
Dishwasher 25.02
"--r•.I • Q a OA 3 -r • -s"" CC n .T eC Drinking fountain 25.02
-CI)A•.r L..•987 a P a r.tit. ' r Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT zi Expansion tank 12.51
Fixture/sewer cap 3r 25.02 6 Name: -T H ti- OA T t G f'A' (Lc-
Floor
, .7(O
drain/floor sink/hub 25.02
Address: t % 01-4. S d 12 t'^ CT Garbage disposal 25.02
City/State/ZIP: '1 h ify V/A ea.6 Y Cr& °t'7 • 8 d" Hose bib 25.02
Phone:K-03) gi-7 5 9'4 6 o Fax:(S 03) 62 a S 2 77 Ice maker 12.51
13"APPLICA ❑ CONTACT PERSON Interceptor/grease trap I I 25.02
Business name: 3 A M / s Medical gas(value:$ ) Page 2
A Primer 12.51
AContact name: R. d '../ < Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
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
CONTRACT')
Water heater 37.52
Business name: A (.- '114 L u M 9>r' " Water piping/DWV 56.29
Address: 7 .3 Icie;ere Reg Other: 25.02
City/State/ZIP: iv"CoCiAl C 970 i.t 5- Subtotal qsz '740
Phone:(sC4 S) /3-6-i4( - Ccrt S ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: i�U�7 7/g/1, Plumbing Lic.no.: - 705-p0 Plan review (25%of permit fee)
v � -r}-.� State surcharge(12%of permit fee)i/fit.ei
Authorized signature: .7/i/1/ TOTAL PERMIT FEE?
Print name: e (/ Pr rt Date: E l / 1< - This permit application expires if a permit is not obtained withinrle
/0 Q .days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pennia\PLMU-PermitApp.doc 10/01/09 440-9616T(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-I st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52
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
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
CI Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
1:1 CCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Taro as defined in OAR918-780-0040.
CI Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial E.1 Any multipurpose fire sprinkler system.
Domestic CI 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"
95 1A041et.de..01.-RitinDiN
❑ 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./Refnrig Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station _
Shower: -Gang
-Stall
Sink: -LavBar non-food related 1 G1
-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
WaterCloset-Toilet t 1 ' plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
11 Accumulative Sewer Tally
s . Tenant Name: LA QUINTA SWR# N/A
Site Address: 10830 SW GRF.ENBURG RD PLM# 2015-00148
Parcel#: 1S1 35BD01300
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 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 19 38 0 -19 -38
-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 19 114 0 -19 -114
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 _ 38 152 0 0 -38 -152
Current Fixture Value -152 divided by 16= -9.500 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -152 divided by 16= -9.500 over (under) $ (46,550.00)
Enter EDU Change Here -9.500
Notes:***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 5/12/2015
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\Sewer 1'allySheet_4900._070114.xlsx