Permit CITY OF TIGARD PLUMBING PERMIT
II ' -' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00273
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/07/2011
Parcel: 2S101AB00100
Jurisdiction: TIGARD
Site address: 12005 SW 70TH AVE
Project: Acupuncture Clinic Subdivision: Lot:
Project Description: TI - THIS PERMIT CANNOT BE FINALED UNTIL BUP2011 -00017 HAS BEEN FINALED.
Contractor: WESTERN PLUMBING Owner: RED ROCK BUSINESS ASSOCIATES LLC
9460 SW TIGARD, AVE STE 101 23077 SW NEWLAND RD
TIGARD, OR 97223 WILSONVILLE, OR 97070
PHONE: 503 - 639 -5296 PHONE:
FAX: 503 - 684 -9015
FEES
Quantity Description Date Amount
1 ea Clothes Washer 08/25/2011 $25.02
Specifics: 1 ea Floor Drain /Floor Sink/Hub 08/25/2011 $25.02
• 2 ea Sink 08/25/2011 $50.04
Type of Use: COM 3 ea Lavatories 08/25/2011 $75.06
Class of Work: ALT 1 ea Tub /Shower /Shower Pan 08/25/2011 $12.51
Type of Const: 3 ea Water Closet 08/25/2011 $75.06
Occupancy Grp: 1 ea Water Heater 08/25/2011 $37.52
Stories: 1 12% State Surcharge - 08/25/2011 $36.03
Plumbing
Total $336.26
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: . / 1/ /
//
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.
08/25/2011 09:54 5036849015 WESTERN PLUMBING INC PAGE 01/03
P1 umbing Permit An ca t a vED ,
Building Fixtures AUG 2 5 2011 FOR OFFICE USE Ohl;
City of Tigard
1111 13125 SW hell �t1vd, Tigatd. OR V ' Tl :: s ' ; i permit No.: , ( gey /—00 273
2 ' Phone: 503.639.4171 Pax: 5 i , 4 _1' u�' DIVISION klau Review /� p
TIGARD Inspection Lime: 503.639.4175 _ /' 7 abAr Pc�it No.: e�pit 1;Z
- ,, , _ ) nt 2 Foe
In4ernEt wwW.tJgard ar gov Ne a r /�� / Jt�: ® See Ra
� � 1, • �?' 1 � pi r . , $ �� '� yam. / � !/ Bu•, ie info anon
New construction [1 Demolition For . . ,
rslfa7eleRlion use ehe Cklist ,
0 Addition/alteration/replaceno �IE� Total
:,: v dwellings cat Od►e�
.; ; . connection New �. x- family d (includes 100 ft. £ oF each utility
i*fikiiir', SY' 40k'' :. 312.70
L%' 1- and 2-family dwelling 0 CommereiaYindnstrial SFR (2) bath
[] Accessory building ❑Multi- ta�iily SFR C3) batb MI 500.32
0 Master builder 111 Okher
Each adAi &o 4 bwth/latclten 25.02
. < ' ` 1 IQM D Pile sprinkler ( u!, ft.) Page 2
� ���. , :; Site Rdlttfes:
Job site address acos ��•�'_ C�dck hasun or area drain 18.76
CityiStabe/21P i • 1 I % Drywell, leach line, or trench drain EllEEEIMMIIII
Suite/bldg- /apt no.: Project name. - � -
,, _V .. ik 4 41.\ _ j � L W Manufaebued home utilities 50.03 Mil
Cross Meet/directions to job site: "' t t, @. t' •i' b' Manholes
38.76 Mil
Rain drain connector � MEI
IS . �, r 1 it . Sanitary sewer (no. linear ,ft.: _,,,_ J Page 2
Stour sewer (no, linear R _) Mill Page 2 MEM
Subdivision: Water service (no- lineal- ft.: _.) WU
LOt map
ap /parce .: 026 mo.. FirgEre or it
Tax
l no • ��
�! � >3ackElowpneveaeer 31.27 ME
'i ::•, 13aC1C .
i;.�/T�` , , ii water vacive
Cl et ea washer { % 25.02 „km r
• Dishwasher 25,02
25.02
Mountain
Ej ector/
Ejectors/ tap 25.02
, .1; . i 'o , , y ` Eapaasiantank n ' ono
25.02
Name:
Address: Floor dlain/lloer aink/lnutl in. 25.02 -. A
City/Stine/ZIP:
a disposal 25.02
Hose bib 25.02
Phone:
Fax ( ) Ice maker III 12.51
f p ea
,' : a Gnterreeptor /grQase trap 25.02
Business name: medical gas (value; $ ) �
Contact name :�
Address: "" Roof draiix () 12.51
Sink/basln/lavato y Ito. 25 -02
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax- : ( ) Tub/shower/Mower pen 12.51
Wil
Urinal Illin 25.02
1 ( 4 ; g Watet closet , 1 � 2 " 2 e 1
W
Western Phmahirrg, Inc. atef hea8er �
13ttsiness name: W ti
Water piping/DWV 1111 56.29
Address: 9460 SW Tigard Avenue Suite 101 other: .02 0
56.29
city/state/via: Tigard, OR 97223 Subtotal , ► 'ti
Phone: (503) 639 -5296 Fax; (503) 684.0015Minimxan permite $72.50 Mal. I
CCU Lic.: 2439 Plumbing Lie. no.: 34-29113 Plan review (25%ofpermitfee) a
Authorized signature: 6 J State surcharge (12% of permit fee) p r � i•�
! •� • Il • t �!� TOTAL PERMIT FEE W � 7.(p
Pit name: Dacia Jensen w 1 bIs WHIG a mires if a permit is not obtained with 50 days 5 •
Date: ,. application e
after la bas been accepted as complete.
•Tr m..44, nl..m, err by 'n-Lrn ,.. , R Tn�h,awy n.,..i..- Rnp.,i
08/25/2011 09:54 5036849015 WESTERN PLUMBING INC PAGE 02/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:
eaid
e>atiai F;
• ., ..• : ,,,..,. .cession
� . ; � Suppression Systems:
tr a>te
Footing drain -1 � ,100' X50.03 � a ;�,� .: l,� . �� . �., �er��l�' �'�0t' :
���� ..
0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 " 2 to 3,671-0 .. $169.69
Sewer - let 100' 62.34 3 601 to 7.200 $233.2 -
Sewer - each additional 100' 37.52 7 I 5327.54
Water Service - let 100° 62.54 Medical Gas S Stems:
Water Service - each additional 100' 3732
Storm & Rain Drain 1st 100' °' "' f ' r, "
62.54 51.00 to$ ... ,::,: .;,. F ::
Storm Rain Drain - dditional 1 00• _ 000
37. a�: , ?. ; ; ; "::' ;.,,; '.."I‘::.:;.•;;;:.
each ee $72.50 _ . -'-
°
y y� ,yyy ��1 y ,yy{�{ S ,001.00 to $10 $7 05 for the fast $5,000.00 and $152 for
TTein ?l � os. r ' 00 *) " 'i 't��'^'°' , eee atictitional $100.00 or frachoe thereof, to
Inspection nfesistiug plumbing or for acct inclu SI0 000.00,
which no fee Is specifically indite 90.00/hr $&0,00I.00 to $25,000.00 $14 &50 for - the a first S10,000 -00 and $1.54 for
miuitnu - 112 hour) each additional $100.00 or reaction thereof, to
Inspections outside of normal business 90.00/hr and . 50 f i _ 525 000 -00.
hours (minimum charge - 2 haunt)
to $50, 000.00 $379 for the first $25,000.00 sad $1.45 for
Reinspection Fees , 90.00/hr each additional $100.00 or fraction thereof to
and include, $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
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof
Subtotal: -- `
Commercial Fire Work:
Are you capping, adding or replacing fixtures? If" es" P
please indicate work performed by fixture. Failure to ' , .. r iii Ira` y1f; f ? w`x f C 0 ; .,
accurately
Plan review is required for any of the following.
.. , ., , increased ,
; .. yewel-
in �� fees*. Please char$ all that apply.
. ,;;
t : 11.,;,,,.aJ c 1 Any commercial building with
� new dmg war service 2" and
. .:> i � . 'r. and stamped by licensed
Baptistry/Pont New exterior
Oath - Tnb/Shower as defined in OAR9l$ ? sire utiliti
0 for ssty complex stracttue
-Tacui tMbirlpool
car wash Lash Stilt 0 Medical gas and vacuum systems for health cater facilities_
Drive 7lmu
0 Any multipurpose fire � system.
Gltsaidor/Water Aspirator ❑ Any complex structure as defmed in OAiR918- 780 -0040.
Dishwasher - Commercial
-Dome is Submit 2 sets of plans with any of the above.
Drmkit Fotmtaw -
Eye Wash �
2"
slk , •; . ::. , � ...'., ... . �r,....,., .
Floor Draln/si
2" ■ isometric or riser diagram is required for new buildings
an _ that meet the civallfic atiorls above.
Car Wash Drain.
Garbage - Domestic
Disposal - Commercial
In e! Comments regarding fixture work:
Ice Macbefrig. Drains
Oil .., , nos station ._
Rec. Vehicle Dump Station
Shower -Gang
-star -
-
Sink - Bar/Lavatory - "-`
-Bradley
-Commercial f* ,.. *Mote: If'the fixture work under this permit results in au
swim,rrin Pool Fitter increase of sewer IDUs, a sewer permit will be issued and
s . fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor - plumbing permit can be issued.
Water Closet - Toilet - - 3 - . .
Urinal
Other Fixtutcs;
Accumulative Sewer Tally
Tenant Name: Acupunture Clinic - 1', . , , . . - , ' ,. SWR # 1201;1- 001'28- = - - -
. ;"`; 1 Site Address: .12005 SW 70th Ave + d . PLM # 20'41,:76027,731 :' bM.:3 Parcel #: 25,101 AB ? 00100 _ r . z :. _ , .. +..1.,, i ; , l'
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 .b t - a4^ +. 0 V n)+^ 0 0 0 0
Bath: - Tub /Shower 4 � , _- 0 r T , 0 , ;�.r -.
` 3 s . .° 0 0 0
- Jacuzzi /Whirlpool 4 tk1P::i 0 5k V 7, '� ,' 0 0 0 0
Car Wash: - Each Stall 6 a _` _' - :''_ - 0 0 - �� ., 0 0 0 •
- Drive through 16 0 `)�� 0 r 'tIl' ° " _ 0 0 0
Cuspidor /Water Aspirator 1 - t
0 — 0 f, - - - � ' '_ ,. 0 0 0
Dishwasher: - Commercial 4 0 ":'_ -j: 0 1$,, 0 0 0
- Domestic 2 - ' a i 7, 0 w.. 0 ?' 4 " 0 0 0
Drinking Fountain 1 ;,; , 0 0 i %r''�>> ' ; - 0 0 0
Eye Wash 1 0 - 0 �_ „� 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 ° ,- '-"• °.1 'r. 2 1 2
- 3 inch 5 , :"�` - , . 0 ' 0 o;y + :.. , -' - _- 0 0 0
- 4 inch 6 0 0 r= 3 °` -- 0 0 0
- Car Wash 6 0 ";~ti *;:., 0 94.11! ., ...', 2 0 0 0
Garbage Disposal:
- Domestic (to 3/4 HP) 16 0 - . - , = 0 = - - 0 0 0
- Commercial (to 5 FTP) 32 0 ,, __ -__ _ - 0 0 0 0
- Industrial (over 5 FIP) 42 = ? -' 0 - 0 _ 0 0 0
Ice Machine /Refrigerator Drain 1 ` I 3-� � ,a ",: 0 0 0 0 0
Oil Sep (Gas Station) 6 0 - 0 0 0 0
Rec. Vehicle Dump station 16 - - 0 - ' „ „ 0 a '' -i. -. _ „`i_' 0 0 0
Shower: - Gang (per head) 1 ,? 0 ' - .. 0 ? „; ,'"' 0 0 0
- Stall 2 0 0 : ' 2 1 2
Sink: •
7,av Bar - Non -Food Related 2 - - ., 0 M, "' 0 1 _ +
/ 5 .,, ;. 10 5 10
- Bradley 5 ,... _ - 0 0 0 0 0
- Com /Sere /Util - Food Related 3 '1,. . „ , 0 ` 0 _ 0 0 0
Swimming Pool Filter 1 ,,,, • 0 a , . 0 , - 0 0 0
Washer - Clothe s 6 n 0 .:, « , t fJ ) t ,M ,
_ ., -i 1: „ 0 r1, _ 6 1 6
Water Ex tractor 6 --. _ , 0 ,,'" 'g „ „,,,,,,_ 0 „ , „ __ . 0 0 0
Water Closet - Toilet 6 - - , 0 n� - 0 ,= 3 18 3 18
Urinal 6 . 0 0 ”' #'. . �f, 0 0 0
Previous EDU Count L` „,,,i'.x;i_ -,;, 0 0
Capped EDU Credit -.:” 0
TOTALS 0 0 0 0 11 _ 38 11 38
Current Fixture Value 38 divided by 16 = 2.4 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 38 divided by 16 = 2.4 over (under) $ 10,800.00
Enter EDU Change Here ; '2.4
Notes: No demo credits at this time.
Authorized Name /Signature: DcbbieWdamski- _ r,` . , - , _ __ Date: - ;8425/2.011' ' ' ' : -_ . 4
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 \Sewer'f allyShcet- 4500.x15 07/01/11