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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2016-00058 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/04/2016 Parcel: 1 S 134AA01900 Jurisdiction: Tigard Site address: 10115 SW NIMBUS AVE 200 Project: Spec Space Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B Project Description: Landlord work in preparation for T.I.Capping(1)water closet,(1)lav&(1)water heater. Contractor: JAMES ROOD PLUMBING INC Owner: ROBINSON, CONSTANCE A 125 S 1ST AVE#542 BY KILLIAN PACIFIC LLC HILLSBORO, OR 97123 500 EAST BROADWAY, STE 110 VANCOUVER,WA 98660 PHONE: 503-547-0491 PHONE: FAX: 503-547-0492 FEES Quantity Description Date Amount 3 ea Fixture/Sewer Cap 02/04/2016 $75.06 Specifics: 1 12%State Surcharge- 02/04/2016 $9.01 Plumbing Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $84.07 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 quest' OUNC by calling 503.232.1987 or 1.800.332.2344. Issue y: Permittee Signat e: Call 503.639.4175 by 7:00 a.m.for the next available insp ' n 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 AyylkA *EC E 1 VE D Building Fixtures City of Tips JAN 2 8 2016 D y 1(P �e„nttl�.. N�OIIQ-eeo5,8 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review Phone: 503.7 t$2439 Fax: 503 O F rI G A R D Date/By: Qdxr Permit No Inspection Line: 503.639-4175 13 U I LD I N G DIVISION Due Ready/By: Juris: Q1 Sw r.%.._,or Internet: www.tigard-or_gov Notified/Method: Supplemental lafffmation ❑New construction Demolition For tial' ormation use c1raw st Description I QM. I Ea Total E)Addition/alteration/replacement ❑Other. New 1-2-family dwellin (includes 100 ft.for each utility connection) (� SFR(1)bath 312.70 N ❑1-and 2-family dwelling CommercialAindustrial SFR(2)bath 437.78 0 SFR(3)bath 500.32 � ❑Accessory building ©Multi-family Each additions!bath/lcitchen 25.02 ©Master builder ❑Other: Fixe sprinkler C_sq.ft.) Page 2 Site utilities: Job site address; I 1 s !> k Catch basin or area in 18.76 CitylState/Z1P: �� ' Arywell,leach ling or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 u' idg_/apt.no.: Project name: PSC Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no-linear ft_:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear It.:_} Page 2 Subdivision- coot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31,27 I�ackwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejcct9Wwmp 25.02 Expansion tank 12.51 Name: i Fixture/sower cap 25.02 7 Floor drain/floor sink/hub 25.02 Address: (garbage disposal 25.02 City/State/ZIP: Hose bib. 25.02 Phone:( ) Fax:( ) loc maker 12.51 Interceptor/grease trap 25.02 Business name: Medical ps(value:S ) Page 2 Primer 12.51 Contact name: Roof drain(comtncrcial) 12,51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet 25.02 Water beater 37.52 Business natnc: Water piping(DWV 56.29 Address: it32. 41 Other: 25.02 City/State/ZIP: Subtotal Photte: 6 ) p Fax:($a]) 9 , Minimum permit fee: M-50 Plan review (25 CCB Lie.: . Plumbing tic.no.: PC Yr9 (25%of permit fee) State surcharge(12%of permit fee) 41,04 Authorized signature: � ,,r TOTAL PERMIT FEE .07 Print name' Date: / Pis Permit application expires if a permit is got abtaioed withln,180 days after it Nn Wn accepted at complete. "Fee methodology set by Tri-County Building Industry Service Board. i 1'�6uI141ngU+er h�Pitlil-ParmitAPP-dos 10/01/09 4404616T(I0V02/00M/W68) i Plumbing Permit Application - City of Tigard Page 2-Supplemental Information j Fee Schedule: Roideeitial Fire Suppression Systems..III NO= Footing drain-1"100' 50.03 0 to .,000 $121.90 Footing drain-each additional 100' 37.52 2001 to 3,(>n0 $169.69 3 601 to 7 200 $233,20 Sewer-1st 100' 62.54 7 7 20 and gieater $327.54 Sewer-each additional 100' 37.52 I Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Storm&Rain Drain-1st 100' 62.54 $1,00 to$5,000.00 Minimum fee$72.50 Stone&Rain Drain-each additional 100' 37.52 $5,001.00 t4$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$t OOAO or fraction thereof,to and including$10,000.00. inspection of existing plumbing or for $10,001.00 $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 -U2 hour) I and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001-W. $50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours minimum c --2 hours7each additional$100-00 or fraction thereof,to Reinspection Fees 90.00/hr , and including$50 000.00. Additional plan review for revisions gp,pp/hr . $50,001.00`�nd up $742.00 for the first$50,000.00 and$1.20 for (minimum w 1f2 hour) each additional$100.00 or fraction thereof Subtotal: I Commercial Fixture Work. Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer tees*_ Nam Plan rcvi�v is required for any of the following. Please cheek all that apply. Bath s /I ont Tub/Shower C1An Any, commercial building with water service 2"and Jactimi/Whirl ;t ;cr,except systems designed and stamped by licensed Gar wash -Each Stall cngTecr. -Arive Thru ❑ NexT exterior plumbing site utilities for any complex structure Cuspidor/Water 6irator as defined in OAR918-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain © Any complex structure as defined in OAR918-7840040_ E e Wash Floor Drain/sink .2" Submit 2 sets of plans with any of the above. 4r Car Wash Dfain Garbage Domestio--non-food ❑ IsorI ebric or riser diagram is required for new buildings Disposal -Domestio-food related thatlmeet the qualifications above. -Commercial-fbod related Industrial-food related ICO MachJRcfTig,Drains oils arator Cas station Colin MORlts regarding fixture wor Rea.Vehicle Dum Station C (Dt _ Shower -Gang -stall Sink/Lav -Non-food related -Bradley Commercial-Food related -$GrvicG Swimming-Clothes Pool Filter Washer *Note: If the fixture work under this permit results in an washer Water Extractor increase of sewer EDUs,a sewer permit will be issued and WaterCloset-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: C:1Usersljim\DownloadslPLMF_PermitApp(9).doe 2 Accumulative Sewer Tally q _ Tenant Name:pec Space ***CREDITS*** SWR#N/A Site Address: 10115 SW Nimbus Ave#200 PLM# 2016-00058 Parcel#: 1 S 134AA01900 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values Ba tine /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 1 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 0 0 0 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 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 1 1 0 0 0 0 Sink: -Lav/Bar-Non-Food Related 2 0 1 2 0 -1 -2 -Bradley 5 0 0 0 0 0 -Com/Sery/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 1 6 0 -1 -6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 2 8 0 0 -2 -8 Current Fixture Value -8 divided by 16= -0.500 Current EDU 1 EDU= $5,100.00 Previous Fixture Value 0 divided by 16= 0.000 'Previous EDU Change -8 divided by 16= -0.500 over (under) $ (2,550.00) Enter EDU Change Here -0.500 *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: Date: 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:\Building\Sewer Tally\SewerTallySheet_5100_070115.xlsx