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Permit (15) - CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2016 00455 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/25/2016 Parcel: 2S102AC00400 Jurisdiction: Tigard Site address: 9230 SW BURNHAM ST Project: Tigard Tap House Subdivision: None Lot: None Project Description: Interior plumbing:Adding(1)non-food related sink and(1)service sink;Capping(1)tub/shower and(1)clothes washer. Contractor: EXCELLENCE PLUMBING LLC Owner: DOLAN&CO LLC 7913 SW NIMBUS AVE BY FLORENCE T DOLAN BEAVERTON, OR 97008 4523 NE DAVIS ST PORTLAND, OR 97213 PHONE: 503-643-3459 PHONE: FAX: 503-643-2815 FEES Quantity Description Date Amount 2 ea Fixture/Sewer Cap 08/25/2016 $50.04 Specifics: 2 ea Sink 08/25/2016 $50.04 1 12%State Surcharge- 08/25/2016 $12.01 Type of Use: COM Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $112.09 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 ' Issued By: -.9 -ermittee 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 S Building Fixtures FOR OFFICE USE ONLI' City of Tigard Received 13125 SW Hall Blvd.,Tigard,OR 97223 AIG 2 b 016 Date/By: �,yZ �(r �� Permit No.: 104/114,X�� s Phone: 503.718.2439 Fax: 503.598.1960 t1 Plan Review py Date/By: Other Permit No.: Etc�^,( 7,A TIGARD Inspection Line: 503.639.4175 ! F � c.�� tl / /� Internet: www.tigard-or.gov p� 1 Date Ready/By: Jugs: I ® See Page 2 for �st R , It Notified/Method: -i t l..,.� l = rt ,; Supplemental Information TYPE OF WORK-'41"'1. FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist. ZAddition/alteration/replacement ❑Other: Description Qty. Ea. Total New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ID1-and 2-family dwelling `Commercial/industrial SFR(2)bath 437.78 ❑Accessory building IDMulti-familySFR(3)bath 500.32 Each additional bath/kitchen 25.02 D Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: / a 36 5, 14,3 R(.,, ril,,,,,,14-, Catch basin or area drain 18.76 City/State/ZIP: --`-'y, A ki 017 / -7 '1 2 Drywell,leach line,or trench drain 18.76 Suite/bldg./apt.no.: I Project name: .7;;.,/ -11.6Footing drain(no.linear ft.:_) Page 2 e43� Manufactured home utilities 50.03 Cross street/directions to job site: a;-), 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.: Backflow preventer 31.27 A DESCRIPTION OF WORK Backwater valve 12.51 /1 hlt h�J i Clothes washer 25.02 TT J/1� Dishwasher 25.02 a AI / 1 Op S j h k Drinking fountain 25.02 f Ejectors/sump 25.02 - 0 PROPERTY OWNER 1 �/ TENANT Expansion tank 12.51 Name: ! � ' .tn�(J.eFixture/sewer cap 25.02 o9 Address: 903 is, , .5.-, Floor drain floor sink/hub 25.02 City/State/ZIP: 4' Q Garbagebibedisposal 25.02 I � � �� Hose 25.02 Phone:(65b) / ,>, d$ Fax:( ) Ice maker l APPLICANT 12.51 L [`'�CONTACT PERSON Interceptor/grease trap 25.02 Business name: { Medical gas(value:$ ) Page 2 y �ilr Contact name: /�.1 ✓ Mt t;-et Primer 12.51 Address: /�� O 6-1- Roof drain(commercial) 12.51 q� Sink/basin/lavatory 02-- 25.02 5v pi City/State/ZIP: T`i � Q 1 7 7.R3 Solar units(potable water) 62.54 Phone:(65-6) f A 465-7 a I Fax::( ) Tub/shower/shower pan 12.51 s�- 'E-mail: �( j k. & Ze C ie.-lc'/ v4. CQ-h., Urinal 25.02 CONTRACTOR Water closet 25.02 Business name: 404E Water heater 37.52 ��_ lcC P(,,t=r� ;, 1t� Address: -'7(� y � Water piping/DWV 56.29 -I 1 3 5 IVI iY j kJ u S 4 Other: 25.02 City/State/ZIP: eA Veof?, op 97007 Subtotal Phone:( O ) 6:.,43-3y 5C/ Fax:(`� ) (1 3-2 g Minimum permit fee: $72.50 CCB Lic.: I / J 7 l Plumbing Lic.no.: fJ% 3 ''/�� Plan review (25%of permit fee) CCB State surcharge 1 ° permitfee) f , Authorized signature: -WI) C � i r-'�ifeii/ 6 1 - g ( 2/0 of TOTAL PERMIT FEE /a r ey I Print name: I Date: g A ?// 4 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. I:A 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: 50.03 0 to 2,000 $121.90 Footing drain-151 100' 2,001 to 3,600 $169.69 Footing drain-each additional 100' 37.52 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 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$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 Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Other Inspections or Fees 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. $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for 90.00/hr Additional plan review for revisions each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) 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 0 Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" Isometric or Riser Diagram 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal: -Domestic food related -Commercial food related -Industrial food related Comments regarding fixture work: Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related 'f -Bradley -Com/Serv/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 plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 14 Accumulative Sewer Tally Tenant Name: TIGARD TAP'HOUSE SWR# N/A JAIL. Site Address: 9230 SW BURNIL=IM ST PLM 1# 2016-00455 -��------. Parcel#: 2S102AC00400 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 1 4 0 -1 -4 -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 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 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 0 1 2 1 2 -Bradley 5 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 0 1 3 1 3 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 1 6 0 -1 -6 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 2 10 2 5 0 -5 Current Fixture Value -5 divided by 16= -0.313 Current EDU 1 EDU= $5,300.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change -5 divided by 16= -0.313 over (under) $ (1,643.00) Enter EDU Change Here -0.310 * *Round EDUs to the nearest 1/100th: a count ending in.005 shall he rounded up to.01,and a count ending in.014 or less shall be rounded down to.01. Notes: ***CREDIT*** Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 8/25/2016 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. I:\Building\Sewer Tally\SewerTallySheet_5300_070116.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 9230 SW BURNHAM ST, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2016-00455 Don Sylvester 1. Corrections are complete, plumbing ﬁnal - approved Violation Summary: Inspector Contractor