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Permit 1 �y ,, CITY OF TIGARD PLUMBING PERMIT 1111 8 . COMMUNITY DEVELOPMENT Permit: PLM2015-00196 T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/25/2015 Parcel: 2S101AB03000 Jurisdiction: TIGARD Site address: 7150 SW DARTMOUTH ST Project: Pediatric Associates Northwest Subdivision: 2012-009 PARTITION PLAT Lot: 2 Project Description: Interior plumbing,all new fixtures:(1)2'floor drain,(1)expansion tank,(1)ice maker,(1)primer, (22)sinks,(4) water closets,(1)water heater&(1)mop sink. Contractor: MCKINSTRY COMPANY LLC Owner: DF DEVELOPMENT LLC 16790 NE MASON ST., STE. 100 23077 SW NEWLAND RD PORTLAND, OR 97230 WILSONVILLE, OR 97070 PHONE: 503-331-0234 PHONE: FAX: 503-331-6907 FEES Quantity Description Date Amount 1 ea Expansion Tank 06/25/2015 $12.51 Specifics: 1 ea Floor Drain/Floor Sink/Hub 06/25/2015 $25.02 1 ea Ice Maker 06/25/2015 $12.51 Type of Use: COM 1 ea Primer 06/25/2015 $12.51 Class of Work: ALT 22 ea Sink 06/25/2015 $550.44 Type of Const: 4 ea Water Closet 06/25/2015 $100.08 Occupancy Grp: 1 ea Water Heater 06/25/2015 $37.52 Stories: 1 Plan Review 06/25/2015 $187.90 1 12%State Surcharge- 06/25/2015 $90.19 Plumbing 25 Misc Other Fee 06/25/2015 $25.02 0 Plan Review 06/25/2015 $6.00 0 12%State Surcharge- 06/25/2015 $2.88 Plumbing Total $1,062.58 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 ork is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to i/low the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0091/ You /' obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3 44. Issued By: . mittee Signature: 'NI 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 But,20 15 -Oo137 Building Fixtures I{ECEIVEP FOR OFFICE USE ONLY Received City of Tigard Permit No.:U / - 13125 SW Hall Blvd.,Ti ard,OR 9722 3 g 2 15 DateBy' g 5 �'I`�IJ ! ��5' /��g b Plan Review rip • Phone: 503.718.2439 Fax: 503.598.196 Date/By:6 23-(r Other Permit No.:6a (5-15661.0 Inspection Line: 503.639.4175 Date Read B ` l�� Juris ® See Page 2 for TIGARD y y ^', !�� g Internet: www.tigard-or.gov 1 1 d�*�� Notifted/Method: �O`� ( Supplemental Information TYPE OF 11'ORK 4121 FEE* SCHEDULE ®New construction ❑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 ❑ 1-and 2-family dwelling ®Commerciallindustrial SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 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:7150 SW Dartmouth Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard/Oregon/97223 . Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name:Tigard Pediatrics Manufactured home utilities 50.03 Cross street/directions to job site:SW Dartmouth&SW 72nd 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: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 -- - Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 I'lumbing-Drain,waste&vent;New domestic water piping Dishwasher 25.02 Drinking fountain 25.02 CG.)ettia-A-1) Ejectors/sump 25.02 ❑ PROPERTY OWN ❑ TENANT Expansion tank 1 12.51 12,s 1 Fixture/sewer cap 25.02 Name: Floor drain/floor sink/hu 2" 1 25.02 2s,QZ, Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker (t h►(l i robt. k'akA►4 1 12.51 12,E 1 ® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name:McKinstry Company Medical gas(value:$ ) Page 2 Primer / 12.51 4.67 Contact name:Adam Mueller Roof drain(commercial) 12.51 ,rte* u Address:16790 NE Mason Street Sink/basin/lavatory ,2 25.02 7 City/State/ZIP:Portland/Oregon/97230 Solar units(potable water) 62.54 Phone:(503)307-9151 Fax::(503)331-6906 Tub/shower/shower pan 12.51 E-mail:adammu a mckinstry.com Urinal 25.02 Water closet 4 25.02 100,E CONTR.-ACTOR Water heater 1 37.52 3'1 S Z Business name:McKinstry Company Water piping/DWV 56.29 Address: 16790 NE Mason Street Other:Mop Sink 1 25.02 15,0 2. City/State/ZIP:Portland/Oregon/97230 Irifkli Subtotal Phone:(503)307-9151 Fax:(503)331-6906 Minimum permit fee: 2.1,15- 77i.G id CCB Lic.: 1 2.is I Plumbing Lic.no.: 3� 2 08 Plan review (25%of permit fee) /9 3.90 / Stale surcharge(12%of permit fee) 9'�.C 7 Authorized signature: �^ - TOTAL PERMIT FEE //OGa.S 3 Print name:Adam Mueller / _ Date:6/11/15 1 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. l Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Accumulative Sewer Tally Tenant Name: Pediatric Associates of the Northwest SWR# 20015-00067 Site Address: 7150 SW Dartmouth Parcel#: 2S 101 AB030 PLM# 2015-00196 00 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 1 2 1 2 -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 I 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: -Lay/Bar-Non-Food Related 2 0 0 22 44 22 44 -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 4 24 4 24 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 0 28 73 28 73 Current Fixture Value 73 divided by 16= 4.563 Current EDU 1 EDU= $4,900.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 73 divided by 16= 4.563 over (under) $ 22,344.00 Enter EDU Change Here 4.560 Notes: Authorized Name/Signature: Debbie Adamski Date: 6/18/2015 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 I'allyShcet_4900._070114.xlss 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 7150 SW DARTMOUTH ST, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O November 12, 2015 at 8:42:03 AM PLM2015-00196 Don Sylvester 1. Corrections are complete. Violation Summary: Inspector Contractor