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Permit (177) CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2016-00030 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/27/2016 Parcel: 2S112DC00701 Jurisdiction: Tigard Site address: 15957 SW 72ND AVE Project: TAP Plastics Subdivision: FANNO CREEK ACRE TRACTS Lot: 39 Project Description: Cap(3)lays,(4)floor drains,(3)water closets,(3)showers,(2)clothes washers,(1)laundry tub,(1)hub drain. Relocate(1)primer&(1)water heater. Add(1)break room sink. Contractor: DEAN WARREN PLUMBING& REMODELING INC Owner: PACIFIC REALTY ASSOCIATES PO BOX 14701 ATTN: N PIVEN PORTLAND, OR 97293 15350 SE SEQUOIA PKWY#300 PORTLAND, OR 97224 PHONE: 503-236-4152 PHONE: FAX: 503-296-2218 FEES Quantity Description Date Amount 17 ea Fixture/Sewer Cap 01/27/2016 $425.34 Specifics: 1 ea Primer 01/27/2016 $12.51 1 ea Sink 01/27/2016 $25.02 Type of Use: COM 1 ea Water Heater 01/27/2016 $37.52 Class of work: ALT 1 12%State Surcharge- 01/27/2016 $60.05 Type of Const: Plumbing Occupancy Grp: Stories: Total $560.44 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 direc s i o OUNC by calling 503.232.1987 or 1.800.332.2344. Issu d 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 Building Fixtures Cit of Tigard Received permit No. // 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: ",17 �t/tp�� = Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No.:Date/By: Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information ❑New construction El Demolition For special information use checklist: Description I Qty. I Ea. I Total Clddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) SFR(1)bath 312.70 ❑ 1-and 2-family dwellingCommercial/industrial SFR(2)bath 437.78 I C ❑Accessory building ElMulti-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 Site utilities: Job site address: 1 � J �a�p� Catch basin or area drain 18.76 City/State/ZIP: Drywell,leach line,or trench drain 18.76 7 -1 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: '(lp 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: Lot no.: Fixture or item: Tax map/parcel no.: �j0 Backflow preventer 31.27 pZ`j� 76 Backwater valve 12.51 Clothes washer 25.02 N+-u-t-cA 3Lt1U:�, 3 Sils (Zj a' L%Ai.1,1Y 50Y, Dishwasher 25.02 j 0v.Q 2 Nuf5 w1fqDrinking fountain 25.02 1J5tALL. %YEt..� 8�K- Slti; Ejectors/sump 25.02 Expansion tank 12.51 .• Name: Prgc_t V'5Y Fixture/sewer cap ' 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 5 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 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 Water heater ( 37.52 Business name: D WAla.Q_EN Water piping/DWV 56.29 Address: Qp � Other: 25.02 City/State/ZIP: 4C�?_Tuz _ Q(Z 'i lac,3 Subtotal Phone:(�� )�-� Fax:( ) Minimum permit fee: $72.50 g �(0,?5 6 Plan review (25%of permit fee) CCB Lic.: i5q l I� Plumbing Lic.no.: State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE 5 Print name:(V V t Date: 1 -I -(� 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. li\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: Footing drain-I"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-1 st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-I st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Stone&Rain Drain-1 st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Stone&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 a .�*�'. � ;: ,' each additional$100.00 or fraction thereof,to and includin $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*. 3 „ MW uanti" Fixt a Plan review is required for any of the following. Fixture Typ, Replace/_ Please check all that apply. Work Performe .' Capped—. Added Relocate Baptistry/Font El Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Stall El New exterior plumbing site utilities for any complex structure Car Wash: -Each S Drive tall as defined in OAR918-780-0040. Cuspidor Water Aspirator T ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic El 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" r wa 00 ¢rl`9; - -Car Wash Drain ElIsometric or riser diagram is required for new buildings Garbage -Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refri .Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Duinp Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Seiv/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 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: 'TAP Plastices ***CREDL'I'S*** SWR# N/A Site Address: 15957 SW 72nd PLM# 2016-00030 Parcel#: 2S112DC00701 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped ed#s value count added# added value total#s total values Ba tise /Pont 4 0 0 0 0 0 Bath: -Tub/Shower 4 0 0 0 0 0 -jacuzzi/Whirlpool 4 0 0 1 0 0 0 Car Wash: -Each Stall 6 0 0 0 0 0 Drive through 16 0 0 0 0 0 Cuspidor/Water.'�s irator 1 0 0 0 0 0 Dishwasher: -Commercial 4 0 0 0 0 0 Domestic 2 0 0 1 0 0 0 Drinking Fountain 1 1 0 0 0 0 0 Eve Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 5 10 0 -5 -10 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 TIP 16 0 0 0 0 0 -Commercial to 5 HP 32 0 0 0 0 0 -Industrial over 5 IIP 42 0 0 0 0 0 Ice M achine/Refrigerator Drain 1 0 0 0 0 0 Living Unit 16 0 0 0 0 0 Oil Se 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 3 6 0 -3 -6 Sink: Lav/Bar-Non-Food Related 2 0 3 6 1 2 -2 -4 -Bradley 5 0 0 0 0 0 Com/Sery/Uti]-Food Related 3 0 1 3 0 -1 -3 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 2 12 0 -2 -12 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 3 18 0 -3 -18 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TO'1',1I.S Ej 0 0 17 55 1 2 -16 -53 Current Fixture Value -53 divided by 16= -3.313 Current EDU 1 EDU= $5,100.00 Previous fixture Value 0 divided by 16= 0.000 Previous EDU Change -53 divided by 16= -3.313 over (under) S (16,881.00) Enter EDU Change Here -3.310 * *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 Adamski Date: 1/27/2016 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. I:ABuilding\Sewer TallyASewer'l'allySheet_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 15957 SW 72ND AVE, TIGARD, OR, 97224 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2016-00030 Don Sylvester 1. Corrections are complete - plumb. ﬁnal approved. 2. Note: adjust water ﬂow on drinking fountain. Violation Summary: Inspector Contractor