Permit (66) CITY OF TIGARD PLUMBING PERMIT
IIIICOMMUNITY DEVELOPMENT Permit#: PLM2016 00389
TWARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/07/2016
Parcel: 1 S 136C604400
Jurisdiction: TIGARD
Site address: 8500 SW SPRUCE ST
Project: Japanese International Baptist Church Subdivision: WEST PORTLAND HEIGHTS Lot: M
Project Description: Rough-in(1)drinking fountain,(1)hose bib,(6)non-food sinks/lays,(1)service sink,(1)urinal,(4)water closets&
(1)water heater.
Contractor: SKOOKUM PLUMBING LLC Owner: JAPANESE INTERNATIONAL BAPTIST C
11576 SW PACIFIC HWY#176 8500 SW SPRUCE ST
TIGARD, OR 97223 PORTLAND, OR 97223
PHONE: 971-231-9071 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 09/07/2016 $25.02
Specifics: 1 ea Hose Bib 09/07/2016 $25.02
2 ea Sink 09/07/2016 $50.04
Type of Use: COM 5 ea Lavatories 09/07/2016 $125.10
Class of Work: ALT 1 ea Urinal 09/07/2016 $25.02
Type of Const: 4 ea Water Closet 09/07/2016 $100.08
Occupancy Grp: 1 ea Water Heater 09/07/2016 $37.52
Stories:
1 12%State Surcharge- 09/07/2016 $46.54
Plumbing
Total $434.34
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions-to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: k Permittee Signatur 1.760,/44A_,0
U \„,___5, „....---, e...4_,44.--v
Call 503.639.4175 by 7:00 a.m.for the next available insp ction date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Appliction
Building Fixtures
City of Tigard Received
t Pennit No.:o 2
III
a 13125 SW Hall Blvd.,Tigard,OR 197,223 9 II %i t 1 E, P1aeReview7 a �� J ("1 �1�0`�� ]�9
Phone: 503.718.2439 Fax: 503:5 8.19 DateBy: Other Permit No.: I,OQ�j/fp..pQ p/
Inspection Line 503.639.4175
TIGARD Date Ready/By: Juts: 0 See Page 2 for
Internet: www tigard or gov Notified/Method Supplemental Information
Y
... ..,,. . 4 3 .,.?_: i ? .. TYP 't tcWil: . ° '. i r&it . d$ ., fE'/`K MPI L
❑New construction 0 Demolition For special information use checklist.
Description J Qty. I Ea. .1 Total
®Addition/alteration/replacement 0 Other. New I-2-family dwellings(includes 100 ft.for each utility connection) "6
Ci3TEGORY OF COiY TRt7,CiTION SFR(1)bath 312.70
0 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 487,78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
0 Master builderEach additional bath/kitchen 25.02 C
0 Other: Fire sprinkler( ,sq.ft.) Page 2
JC1 SITE INFQRMATXONANO.LOCA`C"ION Site utilities:
Job site address:8500 Spruce Street Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Japanese Baptist Church Manufactured home utilities 50-03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
1 Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no,linear ft.:_) Page 2
k'1 Water service(no,linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no G d/ 3(e t^ry O 44/00 Backflow preventer 31.27
n c it DF Backwater valve 12.51
Clothes washer 25.02
(„rough-in for 17 new plumbing fixtures
"y Dishwasher 25.02
Drinking fountain 1 25.02 25.02
Ejectors/sump 25.02
t J ?'R FJ RTY owl'NN1u12` [ ,TENAN3 s . . Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal
4.
Hose bib25.02
I 25.02
Phone:( ) Fax:( ) Ice maker 12.51 25.02
', �< Al}I�1.IG'r+",:f = i ONTACC FPRSQ0Interceptor/grease trap 25.02
Business name:Skookum Plumbing,LLC Medical gas(value:$ ) Page 2
1. 6
Contact name:Suzanne Postula
Primer 12.51
Roof drain(commercial) 12.51
Address:11575 SW Pacific flwy,#176 Sink/basin/lavatory 7 25.02 175.14
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
en Phone:(971)231-9071 Fax::(503)747-6145 Tub/shower/shower pan 12.51
E-mail:suzanne®skookumplumbing.com Urinal 1 25.02 25.02
.. ''',,,'"4:',;',''''''''', ..CIfI 1'1'OI2
Water closet 4 25.02 100.08
,` Water heater 1 37.52 37.52
Business name:Skookum Plumbing,LLC
Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP:
Subtotal 3 g 7-,$Q
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.:209723 Plumbing Lic.no.:PB1723 Plan review (25%of permit fee)
1 n J� State surcharge(12%of permit fee) 4 6.54
Authorized signature: , ,1, , cL/�� Lc_-�
TOTAL PERMIT FEE (.4 3y,34
Print name:Suzanne Postula J LDate:7/19/16 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\Building\Permits'PLMU-PermitApp.doc 10/01!09 440.4616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utahti„rS „.. t2t5' ee(ea) TtltAl ., �S a e e a e
f_. $:49: 0.F91#age. tTgl*it `g. M 4 -.
Footing drain 1'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 i' 2,001 to 3,600 $169.69
/ 3,601 to 7,200
Sewer-1st 100' 62 5q $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 1 6 62.54 Medical Gas Systems:
Water Service-each additional 100' /37.52 y
Storm&Rain Drain-1st 100' 7 62.54 Vtitlolt � P . ,. ,. z
$1,00 to$5,000.00 Minimum tee$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
Otter lopect1OI15'or F es Qt3' Fee(eat Total each additional$100.00 or fraction thereof to
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.
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*.
Quantity by Fixture•Type
• ixtureTypefor. ,Replace/, PIa111.Re}�itif f r Pl mb l g Installati<ol� ,
Work Per€ortnedi c tipped Added .,. �LelacArc;`; Plan review is required for any of the fallowing.
Baptistry/Font Please check all that apply.
Bath Tub/Shower
0 Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Drive Thru El New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780 0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain I 0 Any complex structure as defined in OAR918-780-0040.
_Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3,,
Car Wash Drain Isometric or iser Ditgra l
Garbage Domestic-non-food C3 Isometric or riser diagram is required for new buildings
Disposal Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice MachiRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related 6
-Bradley
-Commercial-food related
-Service 1
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 4 fees assessed for the sewer increase must be paid before the
Urinal 1 plumbing permit can be issued.
Other Fixtures:
C:\Users\Suzanne\Downloads\PLMF_PermitApp.doc 2
Accumulative Sewer Tally
mIii Tenant Name:Japanese International Baptist Church
SWR# 2016-00261
Site Address: 8500 SW Spruce St PLM# 2016-00389
TIGARD
Parcel#: 1S136CB04400
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 1 1 1 1
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:
-Lav/Bar-Non-Food Related 2 0 0 6 12 6 12
-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 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 4 24 4 24
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 13 46 13 46
Current Fixture Value 46 divided by 16= 2.875 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 46 divided by 16= 2.875 over (under) $ 15,264.00
Enter EDU Change Here 2.880 *
*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: Debbie Adamski Date: 7/21/2016
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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8500 SW SPRUCE ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2016-00389
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Correction 's are complete, plumbing final approved
Violation Summary:
Inspector Contractor