Permit (81) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00163
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/29/2016
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15660 SW PACIFIC HWY A-5
Project: Willoughby Hearing Aid Center Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Cap(1)existing sink.
Contractor: NORTHWEST WATER WORKS Owner: ROTC OREGON LLC
40110 SE MEADOW SONG RD ATTN: SCHOEBEL, RICHARD
SANDY, OR 97055 8905 TOWN CENTRE DR, STE 108
SAN DIEGO, CA 92122
PHONE: 503-314-1470 PHONE:
FAX: 503-668-0375
FEES
Quantity Description Date Amount
1 ea Sink 03/29/2016 $25.02
Specifics: 1 12%State Surcharge- 03/29/2016 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 03/29/2016 $47.48
Plumbing
Class of Work: ALT
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 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 dire estions to .• NC by calling 503.232.1987 or 1.800.332.2344.
Issuled By: Permittee Sig ature:
Call 503.639.4175 by 7:00 a.m.for the next available ins ction 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 AppIRE EIVED
Site Utilities 8 2016
FOR O1TI( E LSE ONLY
MAR 2Received /Co
City of Tigard � Permit No. , �Jiver,
p 1.3125 SW Hall Blvd.,"rib<u 7 TIGARD Plan Date/evie - • • C'`�
Phone: 503.718.2439 Fax. 9 p Plan Review
�Y
Date/By: Other Permit Nu-'.
Inspection Line. 503.639/DIL, I �l DIVISION Date Ready/By: turfs: 0 See Page 2 for
T C3 RA Internet: www tiBard-or.<ov �� o
b o Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCIIEDt5LE
❑New construction ❑Demolition
ForFsped al information use checklist _
Description gly. Ea Total
tiAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(l)bath 312.70
E 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: _
lob site address: 15660 SW Pacific HwyCatch basin or area drain 18.76
r._...._...._...__.___..---- -_-- -,._..._.._...____._...._.._..._..._.__._ - Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:A-5 Project name:New Sound Manufactured home utilities I 50.03 i
Cross street:directions to job site: Manholes I 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear Ii.: ) Page 2
Storm sewer(no.linear ft.: ) I Page 2
t-
Water service(no.linear tt.: ) Page 2
Subdivision: Lot no.: Fixture or item: - -
Tax snap/parcel no.: o2 5/(CICO a1 e2-w Backflow preventer 1 31.27 I
DESCRIPTION OF WORK Backwater valve 12.51
- Clothes washer 25.02
Cap off a sink Dishwasher 25.02
Drinking fountain I 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT.. Expansion tank 12.51 -R
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink./hub 25.02
Address: Garbage disposal 25.02
City/'State/ZIP: Hose bib I 25.02
Phone:( ) Fax:( 1 Ice maker 12.51
0 APPLICANT - 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:
Medical gas(value:$ ) Page 2
Primer 12.51 --
Contact name: Roof drain(commercial) 17.51
Address: Sink/basin/lavatory I 25.02 25.02
City/State/ZIP: Solar units(potable water) 62.54
_ -
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: -1-- Urinal 25.02
Water closet 25.02
CONTRACTOR
-._ __- Water heater 37.52
Business name:Northwest Water Works ---- ` WaterpipinglDWV 56.29
Address:40110 SE Meadow Song Road Other: 25.02
City/State/ZIP:Sandy,OR 97055 - - Subtotal_ 25.02
Phone:(503)668-0375 Fax:( ) Minimum permit fee: 872.50 72.50
CCB Lic.: 113197 h(soil It Plumbing Lie.no.:3-333PB Plan review (25%of permit tee) - I
/7/7 77 _ --_--__----- State surcharge(12%of permit fee) 8.70
Authorized signature: t./ -y� �i - rOTAI.PERMIT 1'1;E 8L20
Print name:Melissa Newberry I Date:O3/25/4W This permit application expires if a permit is not obtained within 180 days
atter it hats been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
l-illtdlding;Perntit5t'LMU Permit App doe IG/O1-09 440-1616T(111-'02/COMiwl:°n)
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-i" 100' 50.03 _0 to 2.000 S121.90
Footing drain-each additional 100' 37.52 2.001 to 3.600 5169.69
3.601 to 7,200 S233.20
Sewer- 1st 100- 62.54
7.201 and greater S327.54
Sewer-each additional 100' 37.52
Water Service- 1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100 37.52
Valuation: Permit Fee:
Stonn&Rain Drain- 1st 100' 62.54 SI.00 to 55,000.00 Minimum fee S72.50
Storm&Rain Drain-each additional 100' 37.52 55.001.00 to S10,000.00 S72.50 for the first 55,000.00 and S I.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional SI00.00 or fraction thereof,to
and including S 10.000.00.
Inspection of existing plumbing or for S 10.001.00 to$25.000.00 5148.50 for the first S10,000.00 and$1.54 for
which no fee is specifically indicated 90.001w each additional SI00.00 or fraction thereof,to
(minimum charge-I'2 hour) and including 525.000.00.
Inspections outside of normal business 90.00 hr 525,001.00 to$50.000.011 5379.50 for the first S25,000.00 and SI.45 for
hours(minimum charge-2 hours) each additional 5100.00 or fraction thereof,to
Reinspection Fees 90.00,hr and including S50.000.00.
Additional plan review for revisions 90.00.hr S50.001.00 and up 5742.00 for the first 550.000.00 and S1.20 for
(minimum charge 1 2 hour) each additional SI00.00 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 Plumbing Installations -
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
❑ Any new commercial building with water service 2-and
Baptistry%Font greater,except systems designed and stamped by licensed
Bath: -TubiShower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thm
Cuspidor'Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose tire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eve WashSubmit 2 sets of plans with any of the above.
Floor Drain:'sink: -2-
3 Isometric or Riser Diagram •
- ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach.:Refig. Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LawBar non-food related
-Bradley
-ComiServ,'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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
i:y Building\Permits"PLMF_PcrmitApp.doc 08/04/2011 2
i II 4
IN SIN eCenter SWR# N/A
Site Address: 15660 SW Pacific I Iwy A-5 PLM1# 2016-00163
TIGARD
Parcel#: 2S110DCO2200
Fixture Value 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 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eve 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 1 IP) 16 0 0 0 0 0
-Commercial (to 5 IIP) 32 _ 0 0 0 0 0
-Industrial (over 5 I IP) 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 s 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 4 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Serv/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 I?DU Count 0 0
Capped El)U Credit 0
TOT.ALS 0 0 1 3 0 0 -1 -3
Current Fixture Value -3 divided by 16= -0.188 Current 1?DU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous I?DV
Change -3 divided by 16= -0.188 over (under) S (969.00)
Enter EDU Change Here -0.190 '
*Round IDUs 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: 3/29/2016
Building Division
Note "1'he property owner shall retain the ORIGIN.Al.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.
l:ABuilding\Sewer TallyASewer'tall-Sheet_5111u_07111I5.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
15660 SW PACIFIC HWY A-5, TIGARD, OR,
97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00163
Don Sylvester
1. Cap off existing waste,vents,& water - approved
Violation Summary:
Inspector Contractor