Permit i ll • a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00231
13125 S W Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/21/2009
TIGARD Parcel: 2S 113AD01900
Jurisdiction: Tigard
Site address: 16600 SW 72ND AVE B10
Subdivision: OREGON BUSINESS PARK I Lot: 9
Project: Spec Space
Project Description: Cap (30) fixture units.
Owner. FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
#300 30 ea Fixture /Sewer Cap 08/21/2009 $498.00
1 12% State Surcharge - 08/21/2009 $59.76
PHONE: Plumbing
Contractor:
HARDER MECHANICAL
2148 NE MLK BLVD.
PORTLAND, OR 97208
PHONE: 503 - 281 -1112
FAX: 503 - 287 -5284
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $557.76
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
Issued By: PermitteeSlgnature: o v /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
■
L.
AUG 1 0 9:04 FM- T-381 P.002/004 F-094
1§ ix res 6R/1//riZECEIVED FOR OFFICE USE ONLY
City of Tigard Received • .t i V'm I I= ,
et 13125 SW Hall Blvd., Tigard. OR
1 Phone: 503.639.4171 Fax 50 9
7 3.58.1960 2 1 2009 DateiBy: , .2/ o - Ilia.= Pernnt° ,f7
Plan Revie ,
Dines . .21
Other Permit No.:
Inspection Line: 503.639.4175
CITY OF TIGARD
TIGARD Date Ready/By: 1 .: 121 Soo Page 2 for
Internet www.tigard-or.gov s ON Notdedlivfethod:
7 - *; 7 supplemental infor.tion
?•,i;r4v..ti:::- iiiiig■ iiiF■
3 ••7'j • ' .: :' i. .: . ': ' 7 : :- i ::7: - 7f3: . 1 . 1 , ',,- .. 'LT: ;''.:741
D New construction RIDemolition For spedal Information use checklist
Description 1 Qty. I Ea- I Total
I=1 Addition/aheration/replaceirtent 0 Other -
New 1- 2-family dwellinp (includes 100 it for each utility connection)
.:: ..];;;E ,.'.,.':. : :: ; .:. : ,..:i : : T dui:(611V .: ,§1. JON, ..1 ] ,:: . !' - ...:....,::...,: :. SFR (1) bath 249.20
1:1 1- and 2-family dwelling [21 Commercialimdustrial SFR (2) bath 350.00
El Accessory building 0 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
0 Master builder 1:1 Other.
..... . Fire sprinkler (___ sq. ft.) Page 2
÷•': ..' :::: 7 :. .:' §iiii : : .....:, --: -- - S u
Job site address: I W oo W - 72„ 0 A 1 ,,, c. Catch basin or area drain 16.60
City/State/ZIP: Poixri...4 OE 4 , '7,P.LI Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Sui , rj,. apL no.: R I Project name: 0 g 4* / 0
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
____ Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ___) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear 11.: ____) Page 2
Subdivision: Lot Wat
no.: ...
Filture or item
Tax map/parcel no.: ; .3 ,5-i ? 4 40
Absorption valve . .
.•-•'. ..' :i ••• -- :.: : :-. c ' . --: 1:7•:;:• !.- ':' - 16.60
..
: OF 77''Tt ` - L 1 .: 2 .: • '' - -... ^-.'..... •. ':' :, Backflow preventer Page 2
Yv/D CA1 SO • 1 423uvi..- F/ yjr..aa-j. . Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• : Drinking fountain 16.60
12r 'kit:Obit* OWAa' '.... ':..::*. . '..:: OS iiilA.Sir..i : •
16.60
Name: ?A. /. i c___, . • Pei:, 4,_-r 7 /4- .5crc..■ Afr* / CP Expansion tank 16.60
Address: 45350 5 w _54 n...6.,(ft TheexE-4..,4 y Fixture/sewer cap S 0 16.60 1 -1, .8 1 . - •
City/State/ZIP: p c . 742r4 n 0/2 9 Z Z 9 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
'1,-.' , : :, : •1 ...: isr iiiitre: 1..::: 0 C'O,1■1.f,A' ..
•,• • • ,.. Hose bib 16.60 Ieetwiker 16.60
Business name: 1-1,qa.pE._.e Arta c4-tii.rvi c. A-Z.- Interceptor/grease trap 16.60
Contact name: K. 1 T H E_,A m ay 6 4- Mcdical gas (value: $ _ ) Page 2 ,
Address: 4 ?.1 cla /v g frit )23LNI . Primer 16.60
Roof drain (commercial) 16.60
CitY/StaterLa RoaTi...ervt.b ae 9
Sink/basin/lavatory 16.60
Phone: (..r,-,t, ) 2. 1- i 1 t2- I Fax': (35.3) azr? .13c2Pet Tub/showcr/shower pan 16.60
E Keigien cyze. AP- merePaaroec-rt, e-ofrA tjrinal 16.60
00,::::1 .: ':,. :1:::, :, :: :-;.,. IT:. :......:....;:'.. Water closet 16.60
Business name: ( tu 1 c..A L. Water beater - 16.60
Other.
AddresS: ) I-1* iv g Mi-Y..- ,3Z-Vb
Subtotar Lig? 0.
City/State./ZIP: 8,p_ pz 0
Minimum permit fee: $72.50
Phone: ($o)&8 I- 1 Lt 2. Fax: ( 50_3) .2 -) - 5 219 Residential backflow minimum permit fec $36-25
ei permit fcc)
CCB Lic.: go q
< t.' (4110 II Plimibing Lie. no.: p a _ 2 .
State surcharge (12% of penult fee) 59'
Authorized signanue: ,t -r*cy---- 111111 ,5 Plan review (25%
TOTAL PERMIT FEE s 57 IL: V
Print name: Ke. 66 )17)5yEjr, Dam: e .... A i _,,ci This permit application expires if a permit is not obtained within
180 days after It has been accepted S1,5 complete.
*Fee methodoIoy sct by Tri-County Building Industry Service Board.
D.Bu5dingTermic\PLM1 Wring 440-e61ertiorozcos4rwzro
.z.
AUG-21-2009 09:04AM FROM- T-381 P.003/004 F-094
- -
Page 2 - Supplemental Information -
Fee Schedule: Residential Fire Suppression Systems:
;Sliatillifitir •:.1 ' Siiiip=•:Vais.:- 7 : .6---coir...,:,:v.:•4 • 7.... :. :I.: .::r1,-•:-
.. .._ ._ ._ . . ..... .:: . #..T .‘K...1;' ;*-.:1:.::...k..cl 14a.!, i.CPP:!..; ;.-• -;:;:':7:::::::....
Footing drain - l'' 100' 55.00 0 to 2.000 $115.00
Footing drain - each additional 100' 46.40 2.001 to 3,600 $160.00
3,601 to 7.200 S220.00
Sewer - 1st 100' 55.00 _7,201 andiereater i S309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100 55.00
Medical Gas Systems:
Water Service - each additional 100' 46.40
- ,::YirliWiliiiiii T •••:.''• - ' ' ':'''''•':. •
Storm & Rain Drain - 1st 100' 55.00
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
• -
idaii,iiii:;: - ;7,..: . .:71:::::; ::i9%ti;'. :;',,F....P):7..;',.:T.V.::: additional S100.00 or fraction thereof to and
ineludial $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000,00 $148.50 for the first $10,000,00 and 51.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and including 525.000.00.
Rain Drain, single family dwelling 6525 $25,001.00 to $50,000.00 $37930 for the first $25,000.00 and $1.45 for
,
tech additional 5100,00 or fraction thereof to
Inspection of existing plumbing or or
and including $50.000.00.
specially requested inspecaions - per hour 72,50
$50,001.00 and up $742.00 for the first $50,000.00 and 81_20 for
Subtotal:
- each additional 5100,00 or fraction thereof
, ...- ...-
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following .
please indicate work performed by fixture. Failure to Please cheek all that apply,
accurately report fixtures could result in increased sewer fees* d Any new commercial building with water service 2" and
,.H.: .. .' . ..1 .. : .i: Qiiiiitiii bY (Fortiiii) W6rkPirforriiid „' greater, except systems designed and stamped by licensed
..T
.r oc eii i .....t y ik : . . . .. -- L....i . ' : :- ;::. ' , '' ' - 1.... '7. '277 :1 i'..:. ,'" ' ' Iti engineer.
7......:.:;r1:::: .1; :::::' - . • '.:' : ...:••...*. '''..: :: l'i-gii;ixi' •,' ..6iiiit4i I' '. Aikiett : VESiiiiiiV. 0 New exterior plumbing site utilities for any complex structure
Baptistry/Font
- as defined in OAR918-780-0040.
Bath -Tub/Shower El Medical gas and vacuum systems for health care facilities.
-Jacuzzi/whirlpool 0 Any multipurpose fire sprinkler system.
Car Wash -Each Stall _ 0 Any complex structure as defined in OAR918--780-0040.
-Drive Thru
Cuspidor/Water Aspirator
Submit 2 sets of plans with any of the above.
Dishwasher -Commercial
-Domestic - -
Drinking Fountain
Eye Wash ltT Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
CD /
Car Wash Drain -
Garbage -Domestic - Comments regarding frxture work:
Disposal -Commercial
-Industrial --__________
lee MachJRefrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump station
Shower
Sink -Bar/Lavatory / 1
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet 9
Urinal 2
Other Fixtures:
i:SuildimAParmitsustm-PennitArmsloc 12/27/06
Accumulative Sewer Tally Parcel # 2S113AD01900
Tenant Name: Spec Space This SWR# N/A
Site Address: 16600 SW 72nd Ave., B10 This PLM# PLM2009 - 00231
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s 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 1 6 0 -1 -6
- Car Wash Drn 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 I-IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 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 1 2 0 -1 -2
Sink - Bar /Lavatory 2 0 17 34 0 -17 -34
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 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 9 54 0 -9 -54
Urinal 6 0 2 12 0 -2 -12
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 30 108 0 0 _ -30 -108
Current Fixture Value -108 divided by 16 = -6.8 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -108 divided by 16 = -6.8 over (under) $ (24,480.00)
Enter EDU Change Here -6.8
Notes:
Authorized Name /Signature: Dianna Howse Date: 8/21/2009
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 Tally \SewerTallySheet- 3600.xls 06/25/08