Permit (17) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT / Permit#: PLM2015-00264
/9�`�
13125 SW Hall Blvd.,Tigard OR 97223 503.718.243 Date Issued: 08/10/2015Parcel: 2S104BB07900
Jurisdiction: Tigard
Site address: 14350 SW BARROWS RD 3
Project: Growlers Doggy Day Care Subdivision: RUSSELL'S SCHOLLS FERRY Lot: A
Project Description: For Suites 3 8 3A. Adding(3)floor drains,(1)lav,(4)sinks 8(1)toilet. 1/19/16,REPRINTED to add(1)sink&(1)
dishwasher. Remove(1)floor drain from previous scope of work.
Contractor: ALPHA OMEGA PLUMBING LLC Owner: SPIRIT SPE HG 2015-1 LLC
201 ARDUS DR BY HAGGEN OPCO SOUTH LLC
NEWBERG, OR 97132 2211 RIMLAND DR, STE 300
BELLINGHAM, WA 98226
PHONE: 503-538-7848 PHONE:
FAX
FEES
Quantity Description Date Amount
1 ea Dishwasher 08/10/2015 $25.02
Specifics: 2 ea Floor Drain/Floor Sink/Hub 08/10/2015 $50.04
5 ea Sink 01/19/2016 $125.10
Type of Use: COM 1 ea Lavatories 08/10/2015 $25.02
Class of Work: ALT 1 ea Water Closet 08/10/2015 $25.02
Type of Const: 1 12%Stale Surcharge- 01/19/2016 $30.02
Occupancy Grp: Plumbing
Stories: 45 Misc Administration Fee 01/19/2016 $45.00
Total $325.22
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale 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
Clued
dr
ns NC'b/y/c/a�11/li{/n//g/5/X03.2/3�2�I�1J98,7(�/or/ �00.332.2344.
I \`\_`J?'/�/''✓' K/v' 'i "�! Permittee Signatu
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 thejob site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
City of Tigard Received
Dale,B q Pennil No.: CNaQ(j-OOa1(Q
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
a Phone: 503.718.2439 Fax: 503.598.1960 Date/By. Other Permit No.:
Inspection Line: 503.639.4175 Dale Ready/By: lura. 1 ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Sappkmenld Information
�+t
❑New construction ❑ Demolition For special is orraaB ng checklist'
Description Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility conneetion)
,:,,,g'�{„� SFR(1)bath 312.70
❑ I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath kitchen 25.02
❑Master builder El Other: Fire sprinkler(_sq.ft.) Paget
.��. 'rtfi1B SITE INFORMATION ANb LOCATION - - Site utilities:
Job site address: 5,30 Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear fi.i�) Page 2
Suite/bldg./apt.no.: 4 3pf 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: Lot my: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
R c x g
;777- Backwater valve 12.51
r - I- Clothes washer 25.02
Dishwasher 25.02
tk 1 Drinking fountain 25.02
LOAL. Ejectors/sump 25.02
Expansion tank 12.51
r
Name: Fixture/sewer cap 25.02
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
,n " IntereL tor/ rease trap, 25.02
Business name: - Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Rtw(dmin(commerciap 12.51
Address: Sink asin lavatory 25.02
City/State/ZIP: ar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
-
Water heater 37.52
Business name: Water piping/DW V 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.:
Plan review (25%of permit fee)
Plumbing Lic.Ito.:
State surcharge(12%of permit tee)
Authorized signature: TOTAL PERMIT FEE O
Print name: Date: 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 B.iiding Industry Service Board.
I:Budding Penna,PLMC-PermnA,doe 1001W 44 4616Tf1002 COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
Site lJowes _ fir. Fire(CA) Toad $ 11118re t6otkvPermit :`
Fooling drain- 1" 100' 50.03 0 to 2,000 $121.90
Fooling drain-each additional 100' 37,52 2.001 to 3.600 $169.69
3,601 to 7,200 $233.20
Sewer- Ist 100 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-Ist 100' 62.54 Medical Gass stems:
Water Service-each additional 100' 37.52 y
Storm&Rain Drain-I st 100' 62.54
$1.00 to$5,000.00 Minimum fee.$72.50
Storm&Rain Dmin-each additional 100' 37.52 $5,001.0010$10,000.00 $72.50 for the first$5.000.00 and$1.52 for
y- +. reach additional$100.00 or fraction thereof,to
Others /j9 -0i Ee8 : - 0-07, 1Ohl'
and including SI0,000.00.
Inspection of existing plumbing or for S 10,001.00 to$25.000900 S14&50 for the first S10,000.00 and 51.54 for
which no fee is specifically indicated 90.001hr 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 525.001 AO 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 550,000.00.
Additional plan review for revisions 90,001ir $50.0(11.00 and up $742.00 for the first$50,000.00 and$1.20 lot
(minimum char e—1/2 hour) reach additional$100.00 m fraction thereol:
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
Qua au 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 ❑ Am new commercial building with water service 2--and
Baptistry Font greater,except systems designed and stamped by licensed
Bath: -Tub Shower
-Jacuu'Whirl ml New e
Car Wash: -Each Stall ❑ as d finediexterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thrat
Cus idor/water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
: ❑ Any multipurpose fire sprinkler system.
Dishwasher -Commercial
-Domestic ❑ 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 fund related
lee Mach.'Refii .Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Ren.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -fav/Bar non-toed 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
W.L. Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
hBuildingvPernitsvPLMF_PcrmitApp.doc 08/04/2011 2
Accumulative Sewer Tally
"Fenno[Name: Growlers Doggy Day&Gniwlers Public House SlC''R# N/.1
Sit,Address: 14350 SW Barrows Rel Suite 3&3A PIAL # 2015-00264
M
Parcel#: 2S104BB07900
Fixture \'aluc Precious PrevioaS Credits Capped Fixture Fixture New New
# value count ea cd#s value count added# added value total#s total values
Ba tiscr•/Runt 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
acuzzi/AA'hid oul 4 0 0 0 0 0
Car AW'ash: -F.ach Stall 6 0 0 0 0 0
-Unvc through 16 1 0 1 0 1 0 0 1 0
Cus idor/Water A, iratur 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
F\c A ash 1 0 0 0 0 0
Flour Drain/Sink: -2 inch 2 0 0 3 6 3 6
-3 inch 50 0 0 0 0
-4inch 6 0 0 0 0 0
-Car\X ash 6 0 0 0 0 0
Garbage Disposal:
-Domestic to 3/4 IIP 16 0 0 0 0 0
-Cummc¢ial to 5 111' 32 0 0 0 0 0
-Industrial over 5 IIP 42 0 0 0 0 0
Ice Machine/Refs getator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sc Gas Station 6 0 0 0 0 0
Rec.\'chicle Dump station 16 0 0 0 0 0
Shower: -Gan er head 1 0 0 0 0 0
-Stall 2 O 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 0 6 12 6 12
- Bmdlcv 5 0 0 0 0 0
-Com/Scry/Utll- Ruud Related 3 0 0 0 0 0
Swimming Poul Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
A atcr Closet-'fold 6 0 0 1 2 1 12 1 2 1 12
Unnal 6 0 1 0 0 0 0
Previous VDU Count 0 0
Capped MU Credit 1.75 28
Ml U.S 0 0 0 0 Il 30 11 2
Current Fixture\All, 2 divided by 16= 0.125 Curmit HDU 1 EDU= $5,100.00
Previous Fixture\'aIle 0 divided be 16= 0.000 Previous EDU
Chang, 2 divided by 16= 0.125 uvcr (under) S 663.00
Enter EDU Change Here 0.130 '
'hound HDlls to the nearest 1/100th: a count ending,in.005 shall be rounded up to.01 and a count ending in 014 or It ss shall be rounded down t 01
Notes: Credits from SVXT2015-00084 applied.
Authorized Name/Signature: Debbic Adamski Date: 8/10/2015
Building Division
-etc The property owner shall retain the ORIGIN \l.sewer tally record. If credits exist,this document will serve as a voucher which must be
'ubmitted trr the•City of'I'igard Building Division to redeem credits towards future system development charges.
IAB...Id... hcct_511 M I_o7u l l5.vlsx
Accumulative Sewer Tally
Tenant Name: Growlers Doggy Day&Growlers Public House SWR # N/A-RFV ISION 1
Site Address: 14350 SW Barrows Rd Suite 3&3A x 2015-00264
Parcel#: 2S104BB07900
Fixture Value Previous Precious Credits Capped Fixturc Fiamre New New
# value count ea cd#s value count added# added value total#s total values
Ba tiscry/Punt 4 0 0 0 0 0
Hath: -'lub/Shower 4 0 0 0 0 0
acuzzi/\C'hirl uol 4 0 0 0 0 0
Car Wash: -Hach Stall 6 0 0 0 0 0
-Drivc through 16 1 1 0 1 0 1 0 0 0
Cus idur/Water As iratur 1 0 0 0 0 0
Dishwasher. -Commercial 4 0 0 1 4 1 4
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
F( c Wash 1 0 0 0 0 0
Pleur Drain/Sink: -2 inch 2 0 1 2 0 -1 -2
-3 inch 5 00 0 0 0
-4 inch 6 0 0 0 0 0
-('at Aash 6 0 0 0 0 0
Garbage Disposal:
-Domestic to 3/4 111' 16 0 0 0 0 0
-Commercial to 5 1111 32 0 0 0 0 0
-Industrial over 5 IIP 42 0 0 0 0 0
Ice\1aehine/Refri gcratur Drain 1 0 0 0 0 0
Livin.Unit 16 0 0 0 0 0
Oil Sc Gas Station 6 0 0 0 0 0
Rcc.Vehicle Dump station 16 00 0 0 0
Shower: -Gan (per head 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-lav/Bar-Nun-Food Related 2 0 0 1 2 1 2
-Bradlcv 5 0 0 0 0 0
-Cum/Scry/Unl-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
\Vater Clusct-'I'oil,t 6 1 0 1 1 6 1 0 1 -1 1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped IMU Credit 0
'1'O'1.\I S 0 0 2 8 2 6 0 -2
Current Fixture Value -2 divided by 16= -0.125 Current HDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDI
C:hangc _' divided be 16= -0.125 uvcr (under) S (663.00)
Enter EDU Change Here -0.130
'Round IMUS to the nearest 1/100th: a count ending in.1X15 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: Credits from SWIZ2015-00084 applied. 1/19/16,adding(1)sink&(1)dishwasher. Removing(I) Ouur drain& (1) toilet from scope of work.
Authorized Name/Signature: Debbie:Adamski Date: 1/19/2016
Building Division
ntC 7'he proPerry owner shall retain the ORIGIN.\1.sewer tally record. I f credits exist,this document will serve as a voucher which must be
'ubnaitted t1:1"
the•City of'I'igard Building Division to redeem credits towards future system development charges.
IA It...1 '1g\4"cr'1611, 1 a11YSh,ct_51(r)_u7oI 15slss
CITY OF TIGARD PLUMBING PERMIT
III ■ ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00264
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/10/2015
Parcel: 2S 1048807900
Jurisdiction: Tigard
Site address: 14350 SW BARROWS RD 3
Project: Growlers Doggy Day Care Subdivision: RUSSELL'S SCHOLLS FERRY Lot: A
Project Description: Adding(3)floor drains,(1)lay,(4)sinks&(1)toilet.
Contractor: ALPHA OMEGA PLUMBING LLC Owner: SPIRIT SPE HG 2015-1 LLC
201 ARDUS DR BY HAGGEN OPCO SOUTH LLC
NEWBERG, OR 97132 2211 RIMLAND DR,STE 300
BELLINGHAM,WA 98226
PHONE: 503-538-7848 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Floor Drain/Floor Sink/Hub 08/10/2015 $75.06
Specifics: 4 ea Sink 08/10/2015 $100.08
1 ea Lavatories 08/10/2015 $25.02
Type of Use: COM 1 ea Water Closet 08/10/2015 $25.02
Class of Work: ALT 1 12%State Surcharge- 08/10/2015 $27.02
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $252.20
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 N. . . -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or d -ct questions to O• C by c. ing 503.232.1987 or 1.800.332.2344.
sued By: OIL `� / Permittee Signature: ,r� /,
R=� . - I. .• j�
Call 503.639.4175 by 7:00 a.m.for the next available inspection dat-.
This permit card shall be kept in a conspicuous place on the job site until comply•.n of the pr•,ect
Approved plans are required on the job site at the time of each inspection.
PFribing Permit Applic 1 1 1 yCEIVEP
Building Fixtures
AUG 1 O Received _
City of Tigard UU 2015 Permit No:
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: /Q i,S (,/i/�1t!O�
Plan Revie
Phone: 503.718.2439 Fax: r rr Date/By: Other Permit No i L paw/5 09:,7
Inspection Line: 503.639.41 75 !�VAV Date Ready/By: tuns ® See Page 2 for
IL.nItf) ig g BUII 1� GDIi`IS>I
Internet www.tl and-or. o Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
Elconstruction El For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
SFR(2)bath 437.78
❑ 1-and 2-family dwelling ®Commercial/industrial
SFR(3)bath 500.32
El Accessory building El Multi-family Each additional bath kitchen 25.02
El Master budder 1 El Other'. Fite spsinktes t sq.ft.) 1 Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: 14350 SW Barrows Road Suite 3
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: l Project name: Growler's Doggy Daycare Manufactured home utilities 50.03
Cross street/directions to job site:Walnut/Barrows off Murray/Schools Ferry 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
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I El TENANT Expansion tank 12.51
Name:Aluli Real Estate Holdings LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 3 25.02 76470
Address:415-C Uluniu Street
Garbage disposal 25.02
City/State/ZIP:Kailua,HI 96734 Hose bib 25.02
Phone:(503)972-7191 Fax ( ) Ice maker 12.51
C4 APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name: KLY INC dba Growler's Doggy Daycare Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Krysta York "'-
Roof drain(commercial) 12.51
Address:2636 NW 26th Ave Suite 201 Sink/basin/lavato J 25.02 l
ry' U-5� /-LAV 5
City/State/ZIP:Portland,OR 97210 Solar units(potable water) 62.54
Phone:(503)804-6965 1 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: krystaagrowlersdoggydaycare.com Urinal 25.02
Water closet I 25.02 015,0?!
CONTRACTOR
Water heater 37.52
Business name: a (pnn,_ Q, e ac, gu ,a ;: j C/ Water piping/DWV 56.29
Address: 2 U i , Other: 25.02
City/State/ZIP: /A )1 `5Y- G17/6',2- Subtotal j-a�•r
Phone: e/7 1) D29 S- o r 2,. Fax:( ) Minimum permit fee: $72.50 ,-----
i5
Plan review (25%of permit fee) ._-
CCB Lie.: /q[0 Plumbing Lie.no.: t,
/ %fl State surcharge(12%of permit fee) /� - sue'
Authorized signature: ) TOTAL PERMIT FEE +]Sj
Print name: ✓✓ ( Date: This permit application expires if a permit is not obtained within 1180 days
',ew )-6/5+ �J 5 03 Ir after it has been accepted as complete.
7 "Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Perrnits\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
Sewer-1st 100' 62.54 3,b0J to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service- 1st 100' 62.54
Water Service-each additional 100' 37.52 Medical Gas Systems:
Storm&Rain Drain- 1st 100' 62.54 Valuation: Permit Fee:
Storm&Rain Drain-each additional 100' 37.52 $1.00 to$5,000.00 Minimum fee$72.50
Qty. Fee(ea) Total
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
y. oa
Other Inspections or Fees each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including$10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr and including$25,000.00.
hours(minimum charge-2 hours) $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
Reinspection Fees 90.00/hr each additional$100.00 or fraction thereof,to
Additional plan review for revisions 90.00/hr and including$50,000.00.
(minimum charge 1/2 hour) $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof.
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
Quanti 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
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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 1.l 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 Sepaaatot teas Statism)
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in
Washer-Clothes an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet j fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\Owner\Downloads\PLMF_PermitApp.doc 3
III Accumulative Sewer Tally
/i Tenant Namc: \lathnasium RI(\IS1?D 8/10/15 SWR# 2015-00084 RI?\'#2
1It;Attu
Site Address: 14350 S\\'Barrows Rd#2 PLM# 2015-00211
Parcel#: 2S104BB07900
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 Is 36 3 6 -15 -30
-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 l'nir 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 F, 0 0 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 0 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count ll 0
Capped EDU Credit 0
TOTALS 0 0 18 36 11 30 -7 -6
Current Fixture Value -6 divided by 16= -0.375 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -6 divided by 16= -0.375 over (under) $ (1,938.00)
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: 7/14/15,revised to add(18)capped fixtures(12 floor sinks&(6)floor drains)8/10/15,REVISED for Growlers Doggy Day Care,adding
(3) floor drains,(1)lay,(4)sinks&(1)toilet.
Authorized Name/Signature: Debbie.idamski Date: 8/10/2015
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.
1:\Building\Sewer'Pally\Sewer 1'allySheet_5101_070115.xlsx
Accumulative Sewer Tally 401 o— aleuej- 14a-S-Ay
;II • q Tenant Name:Mathnasium REVISED 7/14/15 SWR#2015-00084
r i n ti Site Address: 14350 SW Barrows Rd#2 PLM#2015-00211
Parcel#: 2S104BB07900
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 o o
-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 18 36 0 -18 -36
-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 O 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 1 2 1 2
-Bradley 5 0 0 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 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit, 0
TOTALS 0 0 _ 18 36 2 _ 8 -16 _ -28
Current Fixture Value -28 divided by 16= -1.750 Current EDU 1 EDU- $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -28 divided by 16= -1.750 over (under) $ (8,925.00)
Enter EDU Change Here -1.750 •
'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: 7/14/15,revised to add(18)capped fixtures(12 floor sinks&(6)floor drains)
Authorized Name/Signature: Branden Taggart x2449/Debbie Adamski Date:7/6/2015-7/14/15
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\Sewe frallySheet_5100_070115.xlsx