Permit (33) CITY OF TIGARDIN
PLUMBING PERMIT
2: '< COMMUNITY DEVELOPMENT Permit#: PLM2017 00126
T t GA R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/10/2017
Parcel: 1 S 134BC00300
Jurisdiction: Tigard
Site address: 12286 SW SCHOLLS FERRY RD
Project: Spec Space Subdivision: None Lot: None
Project Description: Interior plumbing prior to TI: Installing(2)ft.of sanitary sewer,(40)ft.of water service;Capping(5)3"floor drains,
(2)sinks,and(2)clothes washers.
Contractor: R A WARNER PLUMBING Owner: FW OR-GREENWAY TOWN CENTER LLC
PO BOX 820785 PO BOX 790830
VANCOUVER,WA 98682 SAN ANTONIO, TX 78279
PHONE: 360-772-2490 PHONE:
FAX: 360-263-5354
FEES
Quantity Description Date Amount
2 If Sanitary Sewer 04/10/2017 $62.54
Specifics: 40 If Water Service 04/10/2017 $62.54
g ea Fixture/Sewer Cap 04/10/2017 $225.18
Type of Use: COM 1 12%State Surcharge- 04/10/2017 $42.03
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $392.29
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 • -.01-00.0. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.33
Issued By: •- mittee Signatur.
Call 503.639.4175 by 7:00 a.m.for the next available inspe'tion t ate.
This permit card shall be kept in a conspicuous place on the job site unl. co' pletion of the project.
Approved plans are required on the job site at the time of eac inspection.
Plumbing Permit Application -/ f - - -a CAD
Building Fixtures �es) FOR OFFICE ESE 011
City of Tigard , �` Received h PermitNo.:
Date/By: Y `(i /7 ,OhrXG)/7_a)IA
IN U 13125 SW Hall Blvd.,Tigard,OR r� Plan Review
Phone: 503.718.2439 Fax: 503.5960 i 0 4�1 Date/By: Other Permit No.:. ®'�1 j 7-01)02_5'
Inspection Line: 503.639.4175 Q
Y s'v pC(.�
T I G A R D �C A ate Ready/By: See Page 2 for
Internet: www.tigard-or.gov (dr,-fir 1vtO otified/Method: Supplemental Information
TYPE OF WORKG� ‘14G1," FEE* SCHEDULE
ElNew construction Ion For special information use checklist.
Description I Qty. I Ea. 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
El1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
El Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INNFORMATION AND LOCATION Site utilities:
Job site address: `d 28 G -( ) ,sL �� hey4 ?,.,(1, Catch basin or area drain 18.76
� v" Drywell,leach line,or trench drain 18.76
City/State/ZIP: Y i r a Page(�� Footing drain(no.linear ft.:_) Pa e 2
Suite/bldg./apt.no.: Project name: -. _,l Manufactured home utilities 50.03
Cross street/directions to job site: 5 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:c ) i Page 2 (p) 511
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:4t3) L Page 2 6.) -5-L1
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
' Backwater valve 12.51
DESCRIPTION OF WORK z
r :' Clothes washer 25.02
CA ri � �J}� !/�°GtAd�LS t S e�TC/�UDishwasher 25.02
d'K n V
(IAA.) 'S 111 Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERLY OWNER I 0 TENANT. Expansion tank 12.51
Name: Fixture/sewer cap 1 25.02 6)-9-5';If
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT FIASON Interceptor/grease trap 25.02
Business name: (� __rnee,
���, �
Medical gas(value:$ ) Page 2
dd- t WhFn
Contact name: �,�; y r r t.� RoofPrimdrain
12.51
Roof drain(commercial) 12.51
Address: `P! O `)04. 413 Sink/basin/lavatory 25.02
City/State/ZIP:(6.14,"4,) 1 G5141- a 9 8CO Solar units(potable water) 62.54
Phone:(3( p) 4 R..2-Dict 0 Fax::(j ),qJa- z.3, Tub/shower/shower pan 12.51
�.� � Ex- o Urinal 25.02
E-mail: � Nt 71J1(#J e `ane
.`,
Water closet 25.02
Water heater 37.52
Business name: €t.i -4T/1/t Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 350
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: (S 13 4,7 Plumbing Lic.no.: -5,21 F Plan review (25%of permit fee)
F l 1 v State surcharge(12%of permit fee) ?�
Authorized signature;. P 0
/// TOTAL PERMIT FEF1,t a
Print name: Date: J`��a This permit application expires if a permit is not obtained wr(h flirt-lays
/ 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(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:
Footing drain-151 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 61,,s-L4 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' ` 62.54 14,s-ii 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
Other Ins ections,or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
h 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*. 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
Baptistry/Font 0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4„ ❑ 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./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-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 a fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
.111N a
m 1 Tenant Name: SPEC SPACE SWR# N/A
p.7EW Site Address: 12286 SW SCHOLLS FERRY RD PLM# 2017-00126
TIGA
Parcel#: 1S 11 34BC00300
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
-3 inch 5 0 5 25 0 -5 -25
-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 IIP) 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 2 4 0 -2 -4
-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 2 12 0 -2 -12
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 9 41 0 0 -9 -41
Current Fixture Value -41 divided by 16= -2.563 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous ED U
Change -41 divided by 16= -2.563 over (under) $ (13,568.00)
Enter EDU Change Here -2.560 *
*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: 4/10/2017
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:
12286 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00126
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor