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Permit (41) 11111 n TIGARD City of Tigard June 24,2019 Associated Plumbing Co. 200 NE Victory Ave., #C Gresham, OR 97230 Re: Permit No. PLM2019-00114 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 6955 SW Sandburg St Project Name: Pape Material Job No.: N/A Refund: ® Check #232386 in the amount of$350.28. ❑ Credit card "return"receipt in the amount of$ ❑ Trust account"deposit"receipt in the amount of$ Notes: Online payment made by applicant during change in scope of work resulted in an overpayment of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. I:\Building\Refund rnaekil3--A atd 64,1Qfegon 97223 •'503'639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov 1111 I " City of Tigard T I G A RD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Associated Plumbing Co DATE: 6/10/2019 200 NE Vistory Ave "C" Gresham, OR 97230 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 422371 Case#: PLM2019-00114 Date: 3/29/2019 Address/Parcel: 6955 SW Sandburg St Pay Method: CreditCard Project Name: Pape Material EXPLANATION: Online payment made by customer during scope of work change resulted in overpayment. Refund 100%of overpayment. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Cash Over 100-0000-48001 $350.28 TOTAL REFUND: $350.28 APPROVALS: SIGNATURES DATE: If under$5,000 Professional Staff .C" �--, If under$12,500 Division Manager If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY, Case Refund Processed: Date: ,-f By: ,� �* I:\Building\Refunds\RefundRequest.doc x 09/01/2010 IINII CITY OF TIGARD RECEIPT r 13125 SW Hall Blvd.,Tigard OR 97223 • 503.639.4171 TIGARD Project Name: Pape Material Site Address: 6955 SW SANDBURG ST Receipt Number: 434451 - 05/21/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2019-00114 $-350.28 Total: $-350.28 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 232386 DHOWSE 05/21/2021 $-350.28 Payor: Associated Plumbing Co. Total Payments: $-350.28 Balance Due: $0.00 Pono 1 of I 11111 CITY OF TIGARD RECEIPT A• 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Pape Material Site Address: 6955 SW SANDBURG ST Receipt Number: 422371 - 03/29/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2019-00114 Floor Drain/Floor Sink/Hub 230-0000-43101 $75.06 PLM2019-00114 Ice Maker 230-0000-43101 $25.02 PLM2019-00114 Primer 230-0000-43101 $37.53 PLM2019-00114 Sink 230-0000-43101 $75.06 PLM2019-00114 Tub/Shower/Shower Pan 230-0000-43101 $12.51 PLM2019-00114 Urinal 230-0000-43101 $25.02 PLM2019-00114 Water Closet 230-0000-43101 $50.04 PLM2019-00114 Misc Other Fee 230-0000-43101 $75.06 PLM2019-00114 12%State Surcharge-Plumbing 100-0000-24001 $87.07 PLM2019-00114 Cash Over 100-0000-48001 $350.28 � Total: $812.65 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 000242 PUBLICUSERO 03/29/2019 $812.65 Payor: Quinn Closson Total Payments: $812.65 Balance Due: $0.00 Panes 1 of 1 . City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit Action T I(l A R l) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ity Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) ,4$SO > 4 C.ce/y g/iJ 6- Mailing Address: .2o 0 Uj C 7 o rt-y City/State/Zip: GZ ,l3 Cl, (�X-- 9 7,1. 3 O Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): • - -- VOID PERMIT APPLICATION. REFUND ERMIT FEES (attach copy of original receipt and provide explanation below). 111 '. i E FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: Site Address or Parcel #: se.0 v,,.1 Ac?t Project Name: / - Subdivision Name: Lot#: EXPLANATION: �� /Y1 oCe /i foul✓ v�jN €t S1cp e Signature: v�ls-�`�i}^�-C--- ate: V3h Print Name: �� ,�� f . Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date y /y By 1 Route to Records: Date.S74 B 4' Refund Processed: Date it D /9 By Invoice Processed: Date By Permit Canceled: Date n//// By reel Tag Added: Date By I:\Building\Forms\RegPermitAction_120518.doc CITY OF TIGARD PLUMBING PERMIT . ' COMMUNITY DEVELOPMENT Permit#: PLM2019-00114 T i( \] R 1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/01/2019 Parcel: 2S 101 DD00401 Jurisdiction: Tigard Site address: 6955 SW SANDBURG ST Project: Pape Material Subdivision: SALEM FREEWAY SUBDIVISION Lot: 1 Project Description: Interior plumbing for TI:Capping(1)2"floor drain/sink,(5)sinks,(5)water closets,and(2)urinals;Adding(1) dishwasher,(2)ice machines,and(1)shower stall;Relocating(3)2"floor drains/sinks,(3)sinks,(2)water closets, and(1)urinal;Installing(3)primers and(3)coffee makers. Contractor: ASSOCIATED PLUMBING CO Owner: PAPE PROPERTIES INC 200NE VICTORY AVE"C" ATTN LANCE JORGENSEN GRESHAM, OR 97230 355 GOODPASTURE ISLAND RD STE 30 EUGENE, OR 97401 PHONE: 503-492-1922 PHONE: 541-334-3437 FAX: 503-492-1923 FEES Quantity Description Date Amount 1 ea Dishwasher 03/21/2019 $25.02 Specifics: 13 ea Fixture/Sewer Cap 03/21/2019 $325.26 3 ea Floor Drain/Floor Sink/Hub 03/29/2019 $75.06 Type of Use: COM 2 ea Ice Maker 03/29/2019 $25.02 Class of Work: ALT 3 ea Primer 03/29/2019 $37.53 Type of Const: 3 ea Sink 03/29/2019 $75.06 Occupancy Grp: 1 ea Tub/Shower/Shower Pan 03/29/2019 $12.51 Stories: 1 ea Urinal 03/29/2019 $25.02 2 ea Water Closet 03/29/2019 $50.04 75 Misc Other Fee 03/29/2019 $75.06 1 12%State Surcharge- 03/29/2019 $87.07 Plumbing 350 Cash Over 03/29/2019 $350.28 Total $1,162.93 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 ma obt. n a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ifr. Permittee Signature: A/ ted 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 e pr•ject Approved plans are required on the job site at the time of each inspection. Plumbing Permit Applicatio> 1 VED Building Fixtures 1OR 01 IR I I .l. Oyl l Cityof Tigard MAR 2 8 2019 Received / / Permit No.: c' Ill • 13125 SW Hall Blvd.,Tigard,OR 97223 Dare/By: 3 }l !�l �L , / J %/� Phone: 503.718,2439 Fax: 503.598. ry�� O IGp� Plan Review Other Permit /J ,7 ,` �Y i l9 1 i711 �Dtate/By AJ44/ t`-* J 11C;/\Kl3 Inspection Line: 503,639.4175 BUILDING D V)S1�N1ateReady/By: Juris: El SeePage2for Internet: www.tigard-or.gov 1 V t� Notified/Method: Supplemental Information TYPE OF WORKk FEE* SCHEDULE 0 0 New construction 0 Demolition ` For special information use checklist ,t4 . " . Description I Qty. I Ea. I Total 0 Addition/alteration/replacement 0 Other: 1ZI ` New 1-2-family dwellings(includes 100 ft.for each utility connection) r CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 El Accessory buildingMulti-family SFR(3)bath 500.32 0 Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 6955 SW Sandburg St. 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:Pape Material Handling 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: l Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Tenant improvement. 3 _ Dishwasher / 25.02 ,2,5"---,,o. Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap /3 25.02 3,9s--. 24) Floor drain/floor sink/hub 3 25.02 "75-.e Address: Garbage disposal 25.02 City/State/ZIP; Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 2,..-- 12.51 ,S".Gta ®,APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name:The Pape Group inc. Medical gas(value:$ ) Page 2 Contact name:Quinn Closson - Primer 12.51 7 7,7 Roof drain(commercial) 12.51 Address:P.O.Box 407 Sink/basin/lavatory 3 25.02 -23-,44.. City/State/ZIP:Eugene,Or.97440 Solar units(potable water) 62.54 Phone:( 541 )334-3437 Fax::( ) Tub/shower/shower pan / 12.51 / ..5-1 E-mail Urinal / 25.02 6,Z.5^:02 CONTRACTOR - Water closet 25.02 -d-r)7 Water heater 37.52 Business name A� 7e.A,r.7 /A ; t. . Water piping/I/WV 56.29 7 Address: f � 4,,1 Other: C. t`.?lye, ,,,f '#.cam 5 :S 25.02 / •i)4,, ' f' City/State/ZIP: 6-e 5 . - 4,,C?_ -7„�; as Subtotal 7)5 j Phone:(.. -,,z5') cr 9t,-f 9 Z l_ Fax:(.4.;:),?) i'e3 2.} Minimum permit fee: $72.50 CCB Llc: ....,5-7e,,,,, Plumbing Lic,no.: c'?,6-4-yr�,i' Plan review(25%of permit fee) , State surcharge(12%of permit fee) (,� signature. ~ " ..f.-„,---- Authorized r_ �: 4y. 7 TOTAL PERMIT FE ry o?, G>.S Print name: ! Date:w7T This permit application expires if a permit is not obtained within 180 days rt „4 ,.C1/'. -///f' --' 3 Z b'''%f after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. i:\Building\Permits\PLMU-PertmtApp.doc 10/01/09 440-4616T(I0/02/COM/WEB) Plumbine 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: 3 0 to 2,000 $121.90 50.0 Footing drain-1'100' 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 Other Inspections or Feeseach additional$100.00 or fraction thereof,to Qty Ree,(ea) Total 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 Additional plan review for revisions 40 00/hr each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type.for Replace/ Please check all that apply. Work Performed: Capped Added Relocate 0 Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR91$-780-0040. _Drive l'hru 0 Medical gas,and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher -Commercial /j 1�5/ 11(,, ❑ Any complex structure as defined in OAR918-780-0040. -Domestic �` Drinking Fountain fD Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" / 3" 3„ Isometric or Riser Diagram 0 Isometric or riser diagt arrl 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 Machator(Gas.Drains a - /X It firiCc"71R-- Oil Separator Station) Rec.Vehicle Dump Station ,..., Shower: -Gang m'-" --.pG et$SO "771-V />d en b,4 1,0 342-9,49 8 7' -Stall 0 - Sink: -Lav/Bar non-food related T -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 1-- plumbing permit can be issued. Water Closet-Toilet 5- Urinal 2— ) I:\Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2 Plumbing Permit Application _ - Building Fixtures IVE. FOR OFFICE FSE Oyl.l City of Tigard MAR 2 1 2019 Received Permit No.: L_ 41 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: 3��`�/ ,pd )d 1 G 1/i Phone: 503.718.2439 Fax: 503.598.19 Plan ReviDatemy:ew/// _ 114 : S l� 1� ....Plan Other Permit No.: ,0 C'-�y� T 1 GA R D Inspection Line: 503.639.4175 3E�� DIVISIONa Ready/By: ....&:...e H See Page 2 for Internet: www.tigard-or.gov lJ Nohfied/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE 0 New construction 0 Demolition For special information use checklist Description Qty. I Ea. Total WI 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 .Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 9'5'�- 5-6./ %ltrj 5 Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: O/ /��/ ,,,,,,c_ 4,7 L23 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: ' I Project name: G fe - it- � 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.: J id/.Dll(Y yC Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 / Clothes washer 25.02 -,o r . 0/ J i sr D de..,,/4 , Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: ,�Q�.' /� .,k,/ /14-1--'7//%1-"o .r. / ' Floor drain floor sink/hub 3 25.02 75 ,(,� Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 3 12.51 32,5-3 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 3 12.51 3 753 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 3 25.02 7`i•Civ City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan / 12.51 0_,5') E-mail: f� Urinal / 25.02 5"V a r Water closet 25.02 sz.,od, eomieAcmR Water heater 37.52 Business name�sSdLt,f7r-,p VT.-4,,4,,�j/JG 46 , Water piping/DWV 56.29 Address: ,...e- > eJdX /,L-, Other: 25.02 Subtotal 3/ ,7S' City/State/ZIP: �aj�=�L/,s�- j O""� 9630 ,- Phone:(QJ').-y91- /'I Z ZL Fax:('5253)Cl�'i z- „1.z..3 Minimum permit fee: $72.50 CCB Lic.: 5j��9�j Plumbing Lic.no.: 1.. .-- -i''/Z._P5' Plan review (25%of permit fee) State surcharge(12%of permit fee) 3753 Authorized signature: `' TOTAL PERMIT FE xo.a-li Print name: ...e..<1 ..1 /Ji!/d•efy,�lzi Date: ' z./g This permit application expires if a permit is not obtained 'thin 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(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-1''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 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 Other Inspections or Fees Qty. Fee(ea) 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 Plan Review for Plumbing Installations Fixture Type for Replace/ d f Plan review is required Work Performed: Capped Added Relocate 9 any of the following. Baptistry/Font Please check all that apply. Bath -Tub/Shower ❑ Any new commercial building with water service 2"and -Jacuzzi/Whirlpool pool - greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ 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 ❑ Any multipurpose fire sprinkler system. Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" 3 Submit 2 sets of plans with any of the above. Isometric or Riser Diagram Car Wash Drain 0 Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains '3 Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall f Sink/Lav -Non-food related 2- -Bradley-Bradley -Commercial-food related -Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet L fees assessed for the sewer increase must be paid before the Urinal / plumbing permit can be issued. Other Fixtures: C:\Users\Susan\Downloads\PLMF_PermitApp(1).doc 2 It Accumulative Sewer Tally Tenant Name: PAPE MATERIAL SWR# N/A T G n Site Address: 6955 SW SANDBURG PLM# 2019-00114 Parcel#: 2S 101 DD00401 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 1 2 1 2 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 1 2 0 -1 -2 -3inch 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 2 2 2 2 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 1 2 1 2 Sink: -Lav/Bar-Non-Food Related 2 0 5 10 0 -5 -10 -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 5 30 . 0 -5 -30 Urinal 6 0 2 12 0 -2 -12 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 13 54 4 6 -9 -48 Current Fixture Value -48 divided by 16= -3.000 Current EDU 1 EDU= $5,650.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change -48 divided by 16= -3.000 over (under) $ (16,950.00) Enter EDU Change Here -3.000 * *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: 3/21/2019 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_5500_070118.xlsx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 6955 SW SANDBURG ST, TIGARD, OR, 97223 Record Type: Record ID: Commercial - Plumbing PLM2019-00114 Inspection Type: Inspector: 399 Plumbing final Don Sylvester Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor