Permit CITY OF TIGARD PLUMBING PERMIT
z ' COMMUNITY DEVELOPMENT Permit#: PLM2020-00013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/09/2020
Parcel: 1 S 134AA01900
Jurisdiction: Tigard
Site address: 10105 SW NIMBUS AVE
Project: Burger King Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: Interior plumbing for TI:Capping(1)water closet; Replacing(2)sinks,(2)water closets, and(1)urinal.
Contractor: AL'S PLUMBING Owner: ROBINSON,JERRY CHRISTOPHER TRUS
5655 CROSSLER CT. S. DIETRICH, NANCY BISHOP
SALEM, OR 97306 9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: 503-508-0041 PHONE:
FAX: 503-375-3444
FEES
Quantity Description Date Amount
ea Fixture/Sewer Cap 01/09/2020 $25.02
Specifics: 1 ea Roof Drain(Commercial) 01/09/2020 $12.51
2 ea Sink 01/09/2020 $50.04
Type of Use: COM 1 ea Urinal 01/09/2020 $25.02
Class of Work: ALT 2 ea Water Closet 01/09/2020 $50.04
Type of Const: 1 12%State Surcharge- 01/09/2020 $19.52
Occupancy Grp: Plumbing
Stories:
Total $182.15
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: Permittee 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.
- Tenant Name: BURGER KING Accumulative Sewer Tally
SWR# N/A
Site Address: 10105 SW NIMBUS AVE PLM# 2020-00013
TIGARD
Parcel#: 1S134AA01900
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 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 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:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 v 0 0 0
-Com/Serv/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 1 6 0 0 -1 -6
Current Fixture Value -6 divided by 16= -0.375 Current I?DU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 lrevious EDU
Change -6 divided by 16= -0.375 over (under) $ (2,204.00)
Enter EDU Change Here -0.380 *
*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: 1/9/2020
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:A Building\Sewer Tally\Scweii'allyShect 5800_070119.xlsx
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard p C�`E�V Ep Date/By:
er
f- Date/By: /
�qj Permit No.:
IN • 13125 SW Hall Blvd.,Tigard,OR 9 f L U '�(�r)i
Phone: 503.718.2439 Fax: 503.598.1 4 Plan Review
,J/�,IV Date/By: Other Permit No. Q � �f�y�� -i
Inspection Line: 503.639.4175 2026 J�� '')L -1 �/
T 1 G A R D Date Ready/By: Jmis: la See Page 2 for
Internet: www.tigard-or.gov q Notified/Method:
TYPE OF W,,,,,,II�tt1
j LGARE ��, Supplemental Information
`ttITll rnnG DIVISION FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
gc Addition/alteration/replacement ❑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 Si Commercial/industrial SFR(2)bath 437,78
ElAccessory building El Multi-familySFR(3)bath 500.32
El Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler
p� ( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: IO IO 5- S I,/ N/1 i ati r Ave- Catch basin or area drain 18.76
I` Z Z 3 Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7,Gg gt
,? Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: vu R(L(Z K.4 . 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.: /5 3 -A 0 t 1cr.A Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
RE pp 446- {�,6ST"f c n FIXTURGS Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewercap t 25.02 07.47,J,?..
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 PERSON Interceptor/grease trap 25.02
Business name: /' LS f t„u�jjr,tfls At/
gas(value:$_) Page 2
Primer 12.51
Contact name: reav L APi
Roof drain(commercial) 12.51 12.51 � .,S‘
Address: S6 S3 C 1OSSr.ERcr- S Sink/basin/lavatory �fi. 25.02 so,oq
City/State/ZIP: SAL EH‘ OR 773 O C Solar units(potable water) 62.54
Phone:(5-63 5.6R„ 0OW/ Fax: :( ) Tub/shower/shower pan 12.51
E-mail: 6[APE_, 12 it c.-‘)M A/ 684 Urinal f 25.02 25,0 2
. Water closet 2 25.02 Sp,o y
Business name: � � Water heater 37.52
At,''� 5r .-�/ . Water piping/DWV56.29
Address: Other:
25.02
City/State/ZIP: Subtotal Its,1.6 Z
J
Phone:(.S wig- 6dq'1 Fax:(*ZS) ��' S 44 Minimum permit fee: $72.50
CCB Lic.: Csbl� Plumbing Lic.no.: Plan review (25%ofpermit fee)
�`� Z7�� State surcharge(12%of permit fee) VI , j
Authorized signature: _
TOTAL PERMIT FEE if g i5
Print name: 20>/ G,A p! Date: %_C‘_ This permit application expires if a permit is not obtained within 180 gays
/ after it has been accepted as complete.
*Fee methodology set by Td-County Building Industry Service Board.
I:1Building\Pamits\PLMU-PermitApp.doe 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-Ist 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.
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
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
❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ 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"
3' Isometric or Riser Diagram
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: -IavBar non-food related 2-
-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 l
Urinal eat
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2