Permit CITY OF TIGARD PLUMBING PERMIT
1 I COMMUNITY DEVELOPMENT Permit#: PLM2015-00274
T f GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2015
Parcel: 2S112DA00800
Jurisdiction: TIGARD
Site address: 15055 SW SEQUOIA PKWY 140
Project: Spec Space Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Cap(1)laundry tub
Contractor: DEAN WARREN PLUMBING& REMODELING INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-236-4152
PHONE: 503-624-6300
FAX: 503-296-2218
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 08/19/2015 $25.02
Specifics: 1 12%State Surcharge- 08/19/2015 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 08/19/2015 $47.48
Class of Work: ALT
Plumbing
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 • - ' . •,• Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or• ect questions to .UNC b calling 503.232.1987 or 1.800.332.2344.
Issued By: �
- / � Per 2mittee Signature:
(/ Call 503.639.4175 by 7:00 a.m.for the next available insp ion 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 FOR OFFICE USE ONLY
City of Tigard Received Permit• 13125 SW Hall Blvd.,Tigard,OR 97223
Date/BY: C//7// ��"II) -'/L/c-�27�
MI Plan Review I Other permit No.:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
TI G A R D Inspeo Date ReadyBy: runs: ® See Page 2 for
Intern ctiet:n Line:www.tigard-or.gov 503.639.4175 Notified/Method: Supplemental Information
❑New construction 0.Demolition For special information use checklist
- Description 1 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 I 312.70
El 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
ry g ❑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: /7 D 5-›-5 w 5 7c„, d��.,y zvf/G
Catch basin or area drain 18.76
/ Drywell,leach line,or trench drain 18.76
City/State/ZIP: Footing drain(no.linear ft.: ) Page 2
Suite/b1dg./apt.no.: I Project name: %pc, 0/1 c Q 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.: // 2.,Z)/4"G)gOO Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
c ),C L-7 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
MAD PROPERTY OWNER 0 TENANT 1 Expansion tank 12.51
Fixture/sewer cap / 25.02 25-c2.
Name: /ode.i-rut l`
Floor drain/floor siric/hub 25.02
Address: S S „„i 4,
Garbage disposal 25.02
City/State/ZIP: 7'rl5'3,01 Gt,1- 712y Hose bib 25.02
Phone:(it-3 ) C;y-C 30,e/ Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON i, Interceptor/grease trap 25.02
e� �� Medical gas(value:$ ) Page 2
Business name: f c141,t-, (�,
ti
Medical
12.51
Contact name: j--E,R. Roof drain(commercial) 12.51
Address: /2 0//c./.4 /1717G/
Sink/basin/lavatory 25.02
City/State/ZIP: toy-A_ 02- 4 7r9 S Solar units(potable water) - 62.54
Phone:(s25 ) ''20.- Fo iy G I Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR. Water closet [ 25.02
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7,9:50
:5
j Plan review (25%of permit fee)
CCB Lic.: /5-1/9 l S '9 94/i 7 Plumbing Lic.no.:) -7?c,- State surcharge(12%of permit fee) g. T(?
Authorized signature: k� TOTAL PERMIT FEE 9g./ t
Print name: J / Date: --IS-�,�! This permit application expires if a permit is not obtained within 180 days
O 1 a e�J after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:\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-15'100' 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 V.,1, mermit F
Storm&Rain Drain-1st 100' 62.54
$1.00 to$5,000.00 Minimum be$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
1/11EPIERMIS tll' ees Q (Ea) Total 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*. : ; i �� t i
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
.,1Vork Performed: Capped 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 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"
3"
• Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the s ualifications above.
Garbage -Domestic non-food
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 I *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
Si Accumulative Sewer Tally
Tenant Name: Spec Space ***CRl DI'1'5*** SWR# N/:\
Site Address: 15055 SW Sequoia Pkwy#140 PLM# 2015-00274
Parcel#: 2S112DA00800
Fixture Value I'rcvious Previous Credits Capped Fixture Fixture New New
# value count capped#s vclue 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 ? 0 0 0 0 0
Drinking Fountain I 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3inch 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 (1 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:
-Iav/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 1 3 0 -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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1 3 0 0 -1 -3
Current Fixture Value -3 divided by 16= -0.188 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -3 divided by 16= -0.188 over (under) $ (969.00)
Enter EDU Change Here -0.190 *
*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: ***CREDITS***
Authorized Name/Signature: Debbie:\damski Date: 8/19/2015
Building Division
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.
r
1:\Building\Sewer Tally\SewerTallyShcet_5100_0701 15.xlsx