Permit 111CITY OF TIGARD PLUMBING PERMIT
� COMMUNITY DEVELOPMENT Permit PLM2015-00361
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2015
Parcel: 2S110AB00200
Jurisdiction: Tigard
Site address: 14411 SW PACIFIC HWY
Project: Oregon Beverage Recycling Subdivision: CANTERBURY PLACE,AMENDED Lot: PTS 1-4
Project Description: Cap(13)fixtures and add(1)floor drain and(3)sinks.
Contractor: JUDSONS INC Owner: BULL MOUNTAIN INVESTMENTS LLC
PO BOX 12669 ATTN JERRY KOLVE
SALEM,OR 97309 14389 SW PACIFIC HWY
TIGARD, OR 97224
PHONE: 503-363-4141 PHONE:
FAX: 503-399-8760
FEES
Quantity Description Date Amount
13 ea Fixture/Sewer Cap 10/21/2015 $325.26
Specifics: 1 ea Floor Drain/Floor Sink/Hub 10/21/2015 $25.02
3 ea Sink 10/21/2015 $75.06
Type of Use: COM 1 12%State Surcharge- 10/21/2015 $51.04
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $476.38
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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: 7 Permittee Signature: _ /
if
ph/ �7°i°c.ieT��
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.
Ac muive Sewer Tally
Tenant Name: Oregon Beverage Rcuecycling lat SWR# N/A
TI G ARD Site Address: 14411 SW Pacific Hwy PLM# 201 5-00361
Parcel#: 2S 110AB00200
Fixture A'alue 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 1 4 0 -1 -4
-Domestic 2 0 II 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 4 20 0 -4 -20
-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:
-Lay/Bar-Non-Food Related 2 0 2 4 1 2 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Scrv/Util-Food Related 3 0 6 18 2 6 -4 -12
Swimming Pool Filter 1 0 0 0 11 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 _ 13 46 4 10 -9 -36
Current Fixture Value -36 divided by 16= -2.250 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -36 divided by 16= -2.250 over (under) $ (11,4 5.00)
Enter EDU Change Here -2.250 *
*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: Dianna Howse Date: 10/20/2015
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.
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10/15/2015 14:18 5033998760 JUDSONS INC PAGE 01
Plumbing Permit Applica T°CEIVEP
Building Fixtures rrlk ()rrlcr. t Sl•: ONIA PWIAIM
City of Tigard C nnte/B /0 Zd >' i�1 Permit NVa4 e 4/ -e036
1111 . 13125 SW Hall Blvd.,Tigard,OR 3: 1 b 2015 Plan Review
X Phone: 503.718.2439 Fax: 503.598.1':60 Date/By; other Permit No.:
T f( H I) Inspection Line: 503.639.4175 v r A i' Dntc Rta,dylBy: Juris 6J Sec Page 2 for
www tigard-or gov �I 1 �1F�t lgI�ntp�4 fq ' yg Notified/Method: Suppkmtn Information
L1r °'J 4' ,"''i
Internet:N, ; t d'r� ';11 7:5, '� 4rT ..'. 278 .e„/ ,A,I, ,7r•74,r A..�, �4yr o �,•,r' ..Ak.,. lr ii ,„,.,,
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��. Pwiir�^ P` I t �,1• 1 '1! -i�,�a L � enrxw,:rz ar, ' ,v � „y;'3wwi
❑New construction ❑i lemol ition _ For special information use eh¢cklis4
Dcscrip2n I tom. 1 Ea. I Total
'A ddition/alteration/replacemcnt ❑('ther: New 1-2-Family dwellings(includes 100 ft.for each utility connection)
its "� �xm � a gxt4;7 rY� 1)74''''' r .! ^ii ' e..if'E c t: �'?�5 SFR(I)bath 312.70
SFR(2)bath 437.78
❑ 1-and 2-family dwelling :I t'ommercial/industrial
SFR(3)both 500.32
❑Accessory building 1=I 1lulti-family
_ Each additional bath/kitchcn 25.02
❑Master builder l I Aber: Fire sprinkler(i sq.ft.) - Page 2
uJt ll ,rr o' I4u Fi e .4ti. :Y/ ° G1 4a:,, '� Al 1fdY ,r>'''4 •0 i"° ae Atia 1- Site utilities:
Tpl•,site address:S .. ww �' �,.�..1'diir,.�
i r f 5 F C-1 ( C „ .' Catch basin or area drain
{ �i V" Drywell,leach lint,or trench drain 18.76
City/State/ZIP: .-1-7 TVA / ON- el 7 v'1--I" Footing drain(no.linear R.: ) Page 2
Suite/bldg•/apt.no.: Project name: c',,,an Qpt pc a 1c1c(a nil Manufactured home utilities 50,03
Cross street/directions to Job site: J Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear R.: ) Page 2
Storm sewer(no.linear 8.: ) Page 2
Water service(no,linear ft.!,.•_) Page 2
Subdivision: I Lot no.: Fixture or item:
! Dackflow preventer 31.27
Tax map/parcel no.:
12.51
. . w W ialj i,µ,i{L roid r ^ I Backwaer valve
1 � S
Clothes Wtfiher 25.02
i, r ` .e J. i^ P vJ� i^
Dishwasher 25.02
' >+, ..'1n I 1 1-.e l 11td
wk./ i ►*j( Drinking fountain 25.02
rA (/ t f7Mn. S•S-. , Ejectors/sump 25.02_
,kwe..('4�1 'l. n @ '''.1:(571Z, 6 4.1r 7 in.:4;g4,r � mr Evit t{� A� ��ii? h . Expansion tank 12,51 1
f `, pixture/sewcr cap 1, 13 25.02 13 .5:249'
Name: y` , . e c64:: 'Z'7-' f
�� + �-� �-��` Floor drain/floor sink/hub I 25.02 „75,09-
Address: G[,� . 0 t✓Q Garbage disposal 25.02 1
City/State/ZIP: ,1.f, 7IQ ',1 Hose bib- 25.02
Phone:(1• 3 )542 14.2(, Pa ( ) Ice maker 12.51
fle nn a j k �r� ._ r1 k rnw � } x.,' a ! l , nM
Interceptorlgrcasctrap 25.02
R
Medical l gas(value:5 ) P
Business name: 7.72 ,Sov‘S VI. �„ Primer 12.51
Contact name: ` t kv W Q- Rof d rain(commercial)
12.51
Address: \3. � ` Y~ '�n" _ Sink/basin/lavatory A FCCL/% J 3 25.02 10j,0�
I City/State/Z1.P: J R t,2 M 0 P-' A -i 3 0 I Solar units(potable water) 56/". 62.54
Phone:(5
vJL5 1 / ' r Fa ::(503 ) 3q 1j 16-1 C'0 Tub/shower/showcr pan 12,51
) 1 Jt+ a t0
c 5 U OM Urinal 25.02
E-mail: pMIL� �� 50.5 S 2
;i��i i� , ii, li l `°M1�u(n .,i ° titbit, tr71 1�6^� } ` t, 'i�Ar' ti. Water CIOBCt 2 .11
r ".1.r`'!4Ci lr'IrN� '`t r ,,,.•�...,n-,, ,,,, t b 'e:^.; 71IVe . � O'
.. � �w ;y,��, �- "...'�. �.��"'�d`` Water heater 37,52
Business name: 5 f>�-1v>,, A•�&k: CA/-Q- Water piping/DWV 56.29
Address: ‘` t ' Other: 25.02
I City/Statc/ZTP: •• ‘, I / Subtotal LA.-5. 3"
[ (5a 3 �� -�
Phone: Minimum permit fee. 572.50
(5a3 ) 3�'Zj `T k 44( Fa
Plan review (25%of permit ice)
CCB i,ie.: 0 ie lc, 0 Pli robing Lie.no.: _7,a
' r State surcharge(12%of permit fee) • 51,D
Authorized signature: C ">),/I/L +� '`� 7 f f 7 T TOTAL PERMIT FeC) '.,
Print name: ,, ci a Date: P / I Thls permit nppficntinn tzpires Ira permlt is not nhtnincd within.180 days
■ tJ �j t/�l�Pi alter tt her been accepted as complete.
✓J
•Fee methodology set by Tri•County Building Industry Scrwicc Board.
I:\Building\vrrmltr\PLMU•PermitApp dac 10/01/09 440.4016T(10/02/COM/w13II)
10/15/2015 14:18 5033998760 JUDSONS INC PAGE 02
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule:
Residential Fire
Systems:s
y . 7 i i i
V
p ,,{ yn . t :1, ` r �.� .I^ ,,"AAr J�I I ,;
Footing drain-1"100' 50.03 1111. 0 to 2,000 5121,90
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 5327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 6254 Medical Gas Systems:
Water Service•each additional 100' 37.52 Vil $5,000.00 Minimum.w „ w r' ayrw`e y1iu m
Storm&Rain Drain-1st 100' 62.54 nimum fee$72.50
Storm&Rain Drain•each additional 100' 37,52 1M $5,001.00 to$10,000.00 $72.50 for the first$5,000,00 and$1.52 for
.-7,- t:r rte�}},�p4 I 3. ,, each additional 5100.00 or fraction thereof,to
. c tul,'': .. - ' .''..a,..)l- :, ; .;. - : ,,c, 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 fcc is specifically indicated 90.00/hr 1111 each additional S100.00 or fraction thereof,to
(minimum charge-1/2 hour) and includinj$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 chs gc-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 il creased sewer fees*.
, , tatlnki f *.rixturc Ype I; nita k 1 following.8
liiii v
xO4tipifbr
N cii6 6.hil !.:: 0 a'.., #44a: :,: ItOo li Plan review required for any of the
FSapt;otry/inns: Please check all that apply.
Bath -Tub/Shower - El Any now commercial building with water service 2"and
-Jacuzzi/Whirlpool ,, -_ greater,except.systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru E New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator -.. as defined in OAR918-780-0040.
17ishwaahcr -Commercial _/L:--:. ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink :�° , Submit 2 sets of plans with I y above.
an of the ehov
❑ Isometric or riser diagram is required fws r
Car Wash Drain � �� � 1� �
Garbage -Domcstio-non-food buildings
Disposal -Domestic-food related - that meet the qualifications above.
-Commercial—fluid related
-industrial-food rclatcd
-
ice Mach,/Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.vehicle Dump Station -
Shower -Gang
-Stall
-
Sink/Lav •Non•food related f -
-Bradley b ,,
-Commercial-fond related
-Service i - -
Swimming Pool Filter
Washer-Clothes - Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal _ plumbing permit can be issued.
Other Fixtures; ,
C:\Users\MSUNGhi-1\AppData\Local lTemp1PL''i F PermitApp.doc 2
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
14411 SW PACIFIC HWY, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00361
Chip Barnett
Violation Summary:
Inspector Contractor