Permit CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit #: PLM2011 -00068
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2011
Parcel: 2S112DC00100
Jurisdiction: Tigard
Site address: 15705 SW 72ND AVE
Project: Bridgeport Distributing Subdivision: OREGON BUSINESS PARK III Lot: 2
Project Description: Interior plumbing: capping (20) fixtures.
Contractor: CASCADE PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES
2630 N HAYDEN ISLAND DR #3 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97217 PORTLAND, OR 97224
PHONE: 503 - 624 -6300
HONE: 503- 289 -7095
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
20 ea Fixture /Sewer Cap 03/08/2011 $500.40
Specifics: 1 12% State Surcharge - 03/08/2011 $60.05
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $560.45
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: _
0 i �
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.
03/07/2011 09:07 5032839514 CASCADE PAGE 01/03
Plumbina.Permit Application _ I _
Building Fixtures FOR OFFICE LSE ONLY
City of Tigard Received AIME Permit No: I, a il ,, H -
Date/B : ; •
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
i ® Phone: 503,639,4171 Fax! 503.598,1960 Other Perrot No.:
I?are/By: �/�� L�
' x?l 6 T , I CA R.0 Inspection Line: 503.639,4175 Date Ready /By: iuris: 65 See age 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental information
TYPE Or WORK FEE* S 7 EDULE
For special tnfbrnratiorr use checklist
❑ New construction Demolition •t . Ea. 'Total
_ Desert 'don
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellin;s (includes 100 ft. for each utilit • connection)
CATEGORY OF CONSTRUCTION .. SFR (1) bath 312.70
Q 1- and 2- family dwelling QQ Commercial /industrial SFR (2) bath 437,78
SFR (3) bath 500.32
❑ Accessory building El Multi - family
Each additional bath /kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler (__ sq. ft,) Page 2
JOB SITE E INFORMATION AND LOCATION Site utilities: -_
,lob site address: I '5 105 0 _'7 n d Catch basin or arca drain 18.76
Drywcll, leach line, or trench drain 18.76
City /State /Z1P: f Footing drain (no. linear R.: _) Page 2
Suite /bldg. /apt. no.: Project name:biti A r �• - . 1 r i of M home utilities 50.03
Cross street/directions to job site: ``'"` �� • Manholes 1 8 ,7 6
Rain drain connector 18.76
Sanitary sewer (no, linear ft.: _) Page 2
- - Storm sewer (no. linear t't,:.,_) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: 1 Lot no.: Fixture or item: _
Tax map /parcel110 -: Backllow preventerr 31.27
DESCRIPTION OF WORK Backwater valve 12,51
-- Clothes wisher 25.02
_ 0 11 - al - Y •
- Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25,02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture/sewer cap Lem 25.02 Q * . ' . to.
Name:
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
0 APPLICANT El CONTACT PERSON interceptor /grease trap 25.02
Business name: CASCADE PLUMBING COMPANY Medical gas (value: $ _) Page 2
Primer 12,5 I
Contact name; CRYSTAL JONES Roof drain (commercial) 12.51
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Sink/basin/lavatory .� 25,02
City /State /ZIP: PORTLAND, OR 97217 solar units (potable water) 62.54
Phone: (503) 289 -7095 I Fax: : (503) 283-9514 Tub /shower /shower pan 12.5)
E- mail: CASCADEPLtIM@YAHr1OO.COM Urinal 25.02
- Water closet 25,02
CONTRACTOR Water heater 37.52
• Business name: CASCADE PLUMBING COMPANY . -
OMPANY _
Water piping/DWV 56.29
Address: 2630 N. HAYDEN ISLAND DRIVE #3 Other: r 25.02
City /Statc/ZIP: PORTLAND, OR 97217 - Subtotal 6c0
Phone: (503) 289 -7095 Fax: (503) 283 -9514 Minimum permit fee: 572,50
- -- Plan review (25% of permit fee)
CCB Lie.: 120893 Plumbing Lie. no.: 34 -412PB -- 90 --„ a o Slatesurcharge (12 /oofpermitfeelW IQ.(7 Authorised 5ignatUre: � TOTAL PERMIT FEL 5 q` Print name: CRYSTAL JONES ✓ Date: This permit application expires if a permit is not obtained ,vithin 180 days
after it has been accepted as complete.
r
'Fee methodology set by Tri- County Building Industry Service Board.
1 U iuildinal rmits , ii -perm a p.doe to 1/00 O 440 21C01`1AWEB1
03/07/2011 09:07 5032839514 CASCADE PAGE 02/03
Plumbing Permit AJ!piicationl - City of Tigard
Page 2 _ Supplemental Information
Fee Schedule: Residential Fire Su • 1 ression S stems:
Site Utilities Qty ' Fee (CO TOW Square Footage: Permit Fee:
Footing drain - I" 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 - t st 100' y 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 additions( 100' 37.
— . '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
Q ty. Fee (ea) Total each additional $100,00 or fraction thereof_ to
Other In ections 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 o r 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. ,
A dd i t i ona l p review f or rcv 90.0 /hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum chare - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If '`yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees Please check all that apply,
Quanti by (Fixture Work Performed 0 Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added ExlStinfi engineer.
Baptistry /Font ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub/Shower as defined in OAR9IS -780 0040.
- Jacuzzi /Whirlpool - ❑ Medical gas and vacuum systems for health care facilities.
Car Wash - Each Stall ❑ Any multipurpose fire sprinkler system.
- Drive Thru
Cuspidor /Water Aspirator 0 Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinkin• Fountain • Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 " that meet the qualifications above.
4 „
Car wash Drain
Garbage - Domestic
Disposal - Commercial Comments regarding fixture work:
- Industrial
ice Mach. /Refrin. Drains
Oil Sea,arator (Gas Station) —�
Vehicle Dump Station
Shower - Gang
-Stall M li Al
Sink - Bar/Lavatory ICZIENIIMII —
- Bradley
-Commercial IIII *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes _
Water Extractor plumbing permit can be issued.
Water Closet - Toilet =MIN
Urinal
Other fixtures: - I
C: \Documents and Settings \Cascade Plumbing \Desktop \PLMP- PennitApedoc
Accumulative Sewer Tally Parcel # 2S112DC00100
Tenant Name: BRIDGEPORT DISTRIBUTING This SWRi4 NONE
Site Address: 15705 SW 72ND AVE This PLM# PLM2011 -00068
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 1 1 0 -1 -1
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 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 HP) 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 0 0 0 0
Sink - Bar /Lavatory 2 0 4 8 0 -4 -8
- Bradley 5 0 0 0 0 0
- Commercial 3 0 3 9 0 -3 -9
- 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 8 48 0 -8 -48
Urinal 6 0 3 18 0 -3 -18
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 19 84 0 0 -19 -84
Current Fixture Value -84 divided by 16 = -5.3 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -84 divided by 16 = -5.3 over (under) $ (21,730.00)
Enter EDU Change Here -5.3
Notes: ** *CREDIT* **
Authorized Name /Signature: BRANDEN TAGGART Date: 3/8/2011
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-4100.xls 07/01/10