Permit CITY OF TIGARD ` ? PLUMBING PERMIT
111111 °'' COMMUNITY DEVELOPMENT f , / Permit #: PLM2011 00143
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 1 Date Issued: 05/11/2011
Parcel: 1 S136CD00401
Jurisdiction: TIGARD
Site address: 8020 SW PFAFFLE ST, STE# 100
Project: H & S Holdings Subdivision: CITY BIBLE CHURCH Lot:
Project Description: Adding (4) bathrooms and (2) lunchrooms to office building. 7/5/11, reprint permit to include suites 100 & 200.
Contractor: VENNE PLUMBING LLC Owner: PFAFFLE OFFICE, LLC
17678 SW GALEWOOD DRIVE PCCC LLC
SHERWOOD, OR 97140 915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: 503 - 624 -9309 PHONE:
FAX: 503 - 684 -0940
FEES
Quantity Description Date Amount
2 ea Floor Drain /Floor Sink/Hub 05/10/2011 $50.04
Specifics: 2 ea Sink 05/10/2011 $50.04
4 ea Lavatories 05/10/2011 $100.08
Type of Use: COM 4 ea Water Closet 05/10/2011 $100.08
Class of Work: ALT 2 ea Water Heater 05/10/2011 $75.04
Type of Const: 1 12% State Surcharge - 05/10/2011 $45.03
Occupancy Grp: Plumbing
Stories:
Total $420.31
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.
I
CITY OF TIGARD PLUMBING PERMIT
11111 - COMMUNITY DEVELOPMENT Permit #: PLM2011 -00143
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2011
TIGARD Parcel: 1 S136CD00401
Jurisdiction: TIGARD
Site address: 8020 SW PFAFFLE ST
Project: H & S Holdings Subdivision: CITY BIBLE CHURCH Lot:
Project Description: Adding (4) bathrooms and (2) lunchrooms to office building.
Contractor: VENNE PLUMBING LLC Owner: PFAFFLE OFFICE, LLC
17678 SW GALEWOOD DRIVE PCCC LLC
SHERWOOD, OR 97140 915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: 503 - 624 -9309 PHONE.
FAX: 503 -684 -0940
FEES
Quantity Description Date Amount
2 ea Floor Drain /Floor Sink/Hub 05/10/2011 $50.04
Specifics: 2 ea Sink 05/10/2011 $50.04
4 ea Lavatories 05/10/2011 $100.08
Type of Use: COM 4 ea Water Closet 05/10/2011 $100.08
Class of Work: ALT 2 ea Water Heater 05/10/2011 $75.04
Type of Const: 1 12% State Surcharge - 05/10/2011 $45.03
Occupancy Grp: Plumbing
Stories:
Total $420.31
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. :a.o.c . _ • 4.
Issued By: - / - ermittee 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.
Plumbing Permit Applicati er'ECCP fr rt
Building Fixtures
MAY 1 2011 Daceiv ed -
City of Tigard ee B , / o / � Permit No.: A0y /� Q ( [/ 3
V 13125 SW Hall Blvd., Tigard, OR 9 y
��� �, .)f Plan Review
2 Phone: 503.718.2439 Fax: 503.598'.4960 Ut 1 i+a�!�tt D Date/By: Other Permit No:: / //
T I G A RD
Inspection Line: 503.639.4175 BUILDING DDiVls! r.' Date Ready/By: Juris: El See Page 2 for
Internet: www.ti ardor, ov t "
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE " ,
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
® Addition/alteration/replacement ❑ 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 ❑ Multi- family '
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 80x0 Pfaffle Catch basin or area drain 18.76
City/State /ZIP: Tigard, or Drywell, leach line, or trench drain 18.76
/�� Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: A I Project name: 11 qt /w't/ A/� jt Manufactured home utilities 50.03 ir :
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.: /, 3� e� 4 0o / Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Tenant improvement. Adding 4 bathrooms and 2 lunch rooms to office building
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: NS; S Holdings Fixture /sewer cap 25.02
Floor drain/floor sink/hub 2 25.02 50.04
Address: 4850 SW Scholls Ferry Road, Suite 104
Garbage disposal 25.02
City/State /ZIP: Portland, Or 97225 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: Venne Plumbing,LLC Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Ryan Venne
Roof drain (commercial) 12.51 'L..,'0 ,�Z
Address: 17678 SW Galewood Drive Sink/basin/lavatory 6 25.02 1 y00'68
City/State /ZIP: Sherwood, Solar units (potable water) 62.54
Phone: (503) 624 -93090 Fax: : (503) 684 -0940 Tub /shower /shower pan 12.51
E- mail:, ryan @venneplumbing.com Urinal 25.02
Water closet 4 25.02 100.08
CONTRACTOR
Business name: Venne Plumbing, LLC Water heater 2 37.52 75.04
Water piping/DWV 56.29
Address: 17678 SW Galewood Drive Other: 25.02
City/State/ZIP: Sherwood Subtotal
Phone: (503) 624 -9309 Fax: (503) 684 -0940 Minimum permit fee: $72.50 /)1C / Vel
CCB Lic.: 194292 11- Plumbing Lic. no.: pb596 q I 1 l 1 Plan review (25% of permit fee)
` State surcharge (12% of permit fee) t15 .t)-5
Authorized signet TOTAL PERMIT FEE �,0 I
Print name: Lindsay Venne Date: 5/9/11 This permit application expires if a permit is not obtained within 1
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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:
Stonn & Rain Drain - 1 st 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 /1u $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/ Plan review is required for any of the following. Performed:. Capped Added Relocate q y ow g'
Baptistry/Font Please check all that apply.
Bath Tub /Shower ❑ Any new commercial building with water service 2" and
Jacuzzi/Whirlpool 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 ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain '❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
4,, Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic - non - food a am s re q red g
Disposal - Domestic - food related that meet the qualifications above.
- Commercial-food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work: •
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay - Non -food related (p
- 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 t{ fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
Accumulative Sewer Tally Parcel # 1 S136CD00401
Tenant Name: I-I & S Holdings • . This SWR# 2011 -00068
Site Address: 8020 Sw Pfaffle St This PLM# 2011 - 00143
Fixture Value Previous Previous Credits Capped Fixture Fixture New Ncw
# 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 2 4 2 4
- 3mch 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 FIP) 16 0 • . , 0 0 0 0
- Commercial (to 5 HP) 32 . . . 0 0 ' o 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 0 6 12 6 12
- 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 ' : . 0 . . 4 . , 24 4 24
Urinal 6 0 • 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit ". 2 32
TOTALS 0 0 0 0 12 40 12 8
Current Fixture Value 8 divided by 16 = 0.5 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 8 divided by 16 = 0.5 over (under) $ 2,050.00
Enter EDU Change Her 0.5
Notes: EDU credits from demo permits, BUP2007 -00579 & BUP2009 -00 , ed to this permit.
Authorized Name /Signature:. Debbie Adamski • . Date: .5/10/2011 . .
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: \Buil ding \Sewer Tally \SewerTallySheet- 4100.xls 07/01/10