Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00250
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/03/2015
Parcel: 2S113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 165
Project: American Lung Association Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: Add(1)break room sink
Contractor: GRIDLINE PLUMBING Owner: OREGON STATE BAR,THE
14844 SW 109TH AVE 16037 SW UPPER BOONES FERRY RD
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 971-275-6167 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 08/03/2015 $25.02
Specifics: 1 12%State Surcharge- 08/03/2015 $8.70
Plumbing
Typo of Use: COM 47 ea Minimum Fee Adjustment- 08/03/2015 $47.48
Plumbing
Class of Work: ALT
Typo 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. You may •stain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. •
Issued By: / Permittee Signature: ':Ova 1
—Soo t \
Call 503.639.4175 by 7:00 a.m.for the next available inspectii .ate.
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� Received FOR OFFICE USE O\l.1
City of Tigard ,RECEIVE a' 1(1( > PennuNo.. j �i �G/5-00).5.0
13125 SW Hall Blvd.,Tigard,O 97223 Plan Review
( sL
3 2015 Plan Review All'5-'406�,�
Phone: 503.718.2439 Fax: 503.598.M Date/By: Other Permit No.: �
Inspection Line: 503.639.4175 Date R B runs:
T I G A R D Internet: www.ti ardor. ov y' la See Page 2 for
S g Notified/Method: Sup lemental Information
TYPE'OF
❑New construction ❑Demolition For special information use checklist
is- Description Qty. Ea. I Total
'tion/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility comection)
SFR(1)bath 312.70
❑ 1-and 2-family dwelling ercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 N.
❑Master builder `t
❑Other: Fire sprinkler( sq.ft.) Page 2
,1 LOCATION ` Site utilities:
Job site address: r /i,� �I�� �, Catch basin or area drain 18.76
1 9 ' Drywell,leach line,or trench drain 18.76 V
ity/State/ZIP: / �' / N" 6 2Z ,�,1
s Footing drain(no.linear ft.: ) Page 2
V ite/bldg./apt.no.: /1p 5' Project name: Apogee/0 GiT Manufactured home utilities 50.03
q Cross street/directions to job site: Manholes 18.76
�� eg CScrT i Rain drain connector 18.76 Y
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.: ;2'5//alit-5: 0 Backflow preventer 31.27
-' -°-- . Backwater valve 12.51
DESCRIPTION OF WORK
1"11/11r/3-} H� Clothes washer 25.02
� ,44.--,"---k- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Ar ❑ PROPERTY OWNE , ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
N Phone:( ) Fax:( 1 Ice maker 12.51
❑ APPLICA ❑ 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/basin/lavatory X ( 25.02 (72502,,
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) I Fax: :( ) Tub/shower/shower pan 12.51
E-mail: ' / Urinal 25.02
1 C �. .,•L1.4 O '-�-+� Water closet 25.02
CONTRALTO'
Water heater 37.52
Business name: �r-� 7) "i2e. U S�i Water piping/DWV 56.29
Address: ��f( 2 y Yt Other: 25.02„Al
City/State/ZIP: 77 fp ak-ai 1 )y 97,V4/ Subtotal _ �
Phone:(9J /) 275‘,/Z.:77 Fax:( ) Minimum permit fee: $72.50 �a
t / -/�`p Plan review (25%of permit fee)
CCB Lic.: N40.5/ Plumbing Lic.no.:a6 7,l�
ll State surcharge(12%of permit fee) 5.70
Authorized signature: i`iA\ TOTAL PERMIT FEE f/.XO
Print name: '� , _ _ This permit application expires if a permit is not obtained within 180 days
������ m LL Dam' I after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Building\Permits\PLMU-PennitApp.doc 10/01/09 440-4616T(l0ro2/convWEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Al 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
Storm&Rain Drain-1st 100' 62.54 Yahuilium MnI It
$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
er nspecfio 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 Plumbin )C�`stallations
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/Mont ❑ 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 tall 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"
4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the •ualifications 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 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 p
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: American Lung Association SWR# 2015-00097
Site Address: 16037 SW Upper Booties fern Rd #165 PL,M# 2015-00250
TIGnRt) Parccl#: 2S113AB00300
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptistry/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 I 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
-4inch 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 Extractor 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
w 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 = $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 2 divided by 16= 0.125 over (under) $ 663.00
Enter EDU Change Here 0.130 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: Debbie Adamski Date: 8/3/2015
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_5100_070115.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
16037 SW UPPER BOONES FERRY RD 165,
TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00250
George Heimos
Violation Summary:
Inspector Contractor