Permit (86) IN *4
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00116
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/04/2017
[- B. g Parcel: 2S112DD00701
Jurisdiction: Tigard
Site address: 15824 SW UPPER BOONES FERRY RD
Project: Spec Space Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Capping(1)water closet and(1)lavatory; Replacing(1)water closet and(1)lavatory;
Relocating(1)sink.
Contractor: DEAN WARREN PLUMBING&REMODELING INC Owner: PACIFIC REALTY TRUST
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-236-4152 PHONE: 503-624-6300
FAX: 503-296-2218
FEES
Quantity Description Date Amount
2 ea Fixture/Sewer Cap 04/04/2017 $50.04
Specifics: 2 ea Sink 04/04/2017 $50.04
1 ea Water Closet 04/04/2017 $25.02
Type of Use: COM 1 12%State Surcharge- 04/04/2017 $15.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $140.11
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.
Issued By: • jynature: Ai 4,
Call 503.639.4175 by 7:00 a.m.for the next available in •e•-'on date.
This permit card shall be kept in a conspicuous place on the job site • it completion of the project.
Approved plans are required on the job site at the time .f each inspection.
Plumbing Permit Application
Building Fixtures FOR OFFICE use O Lv
City of Tigardi, ,,Received
13125 SW Hall Blvd.,Tigard,OR 9722 Date/By: Ll /-7Permit No.: pi ��i 7i I iv
_ Phone: 503.718.2439 Fax: 503.598.1960 PlArti(evtew 9
Ijg /gy. Other Permit No. c _o 7b 70
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for (J�
Internet: www.tigard-or.gov
' Notified Method:
rY� rr-C, Supplemental Information
TYPE OF WORK A' > FEE* SCHEDULE
❑New construction 0 Demolition" For special information use checklist.
Description Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF.CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling Comercial/industrial SFR(2)bath 437.78
, m
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
X JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 5 CSG Y JG. r� •- Catch basin or area drain 18.76
�C. 8 kI /art.
City/State/ZIP: /✓ Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
;u' DESCRIPTION OFN WORK = 12.k Backwater valve 12.51
Agji6e s J•-lei /- C d;i Clothes washer 25.02
Dishwasher 25.02
( .)/2 /- (-- / - G4V
// Drinking fountain 25.02
it. !/.4/4-,n / - C/4 Ejectors/sump 25.02
r �� PROPERTY OWNER - '� . `'x�� 'IEHAT.=t. � Expansion tank
12.51
Name: //c)`t/rS„,
Fixture/sewer cap 25.02 ),u ce
Address: / ��j s L Floor drain/floor sink/hub 25.02
" ""'""..i �'3'"7 7 4 Garbage disposal 25.02
City/State/ZIP: 'I,SJ,,,,j c/j 9 >) yt f Hose bib
25.02
Phone:(S ) G,),i(_c cc Fax:( ) Ice maker 12.51
4 y:.. PI CA IT , a coN , CTP'ERS01+i _: Interceptor/grease trap 25.02
Business name: ck, Medical gas(value:$ ) Page 2
Contact name: Sc Primer 12.51
Address: ,c70),:. /i/7c ,
Roof drain(commercial) 12.51
Sink/basin/lavatory 2 25.02 �;-e).(
City/State/ZIP: ,9.-1-y c,A_ 7 )y r3 Solar units(potable water) 62.54
Phone:( c2- ) .7 g C - 5 Y e"( Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
'CO:,. C. R ,,_,; 0_ ~ Water closet #./ 25.02 2 S',c2_.`{ Water heater 37.52
Business name:f u'v j f4 m b
Address: fI \ J/� 61 Water piping/DWV 56.29
/ G. c)i\ /1Y76/ i/ Other: 25.02
City/State/ZIP: / -t7,....,...4 l (- Subtotal /2,). /0
/[ '!L- 7.1-/',..3
Phone:45'1 ) ? ,di,/5---01,.,
Fax:( ) Minimum permit fee: $72.50
CCB Lic.: /5-1(9/cy Plumbing Lic.no.:) (-7.i �� Plan review (25%of permit fee)
�"" State surcharge(12%of permit fee) [57..6'
Authorized signature i.
TOTAL PERMIT FEE 1'
Print name: i l , A�cS Date:Lf.Nom! This permit application expires if a permit is not obtained within 180 days
7
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PennitApp.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 . Fee(ea) Total ; 'Square Footage: ' Permit Fee:;
Footing drain l't 100' 50.03 0 to 2,000 $121.90
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' 37.52Valuation: 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{eat 0 ,I. 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.
Additional plan review for revisions 90.00/1r $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
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*. 'mallReview for Plumbing Installationst
Quantity by Fixture Type Plan review is required for any of the following.
Fhtur" ype or Reply/ 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.
-Jacu7li/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
1=1Any 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"
-3" -I ometiricor Riser bitagra _:
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 / (4.'J
-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
a
Accumulative Sewer Tally
■ F Tenant Name: SPEC SPACE SWR#
IiiTIGARD-
Site Address: 15824 SW UPPER BOONES FERRY RD PLM# 2017-00070
Parcel#: 2S112DD00701
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
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3inch 5 0 0 0 0 0
-4inch 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 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= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -8 divided by 16= -0.500 over (under) $ (2,650.00)
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: ***CREDIT***
Authorized Name/Signature:BRANDEN TAGGART X2449 Date: 4/4/2017
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:
15824 SW UPPER BOONES FERRY RD, LAKE
OSWEGO, OR, 97035
Record Type: Record ID:
Commercial - Plumbing PLM2017-00116
Inspection Type: Inspector:
399 Plumbing final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor