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Permit CITY OF TIGARD PLUMBING PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: PLM2011 00380 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/28/2011 Parcel: 2S102CB03200 Jurisdiction: Tigard Site address: 9975 SW FREWING ST 220 Project: Spec Space Subdivision: FREWING'S ORCHARD TRACTS Lot: 21 Project Description: Install (1) lay and (1) water closet. Credits from PLM2008 -00348 applied to this permit. 1.7 EDU credits still available. Contractor: ALL PRO PLUMBING SERVICES LLC Owner: BY PICOCO 2210 SE CELEBRATION CT MASSIH LLC HILLSBORO, OR 97123 4343 VON KARMAN AVE 3RD FL NEWPORT BEACH, CA 92660 PHONE: 503 - 579 -5555 PHONE: FAX: 503 - 259 -2555 FEES Quantity Description Date Amount 1 ea Lavatories 12/28/2011 $25.02 Specifics: 1 ea Water Closet 12/28/2011 $25.02 1 12% State Surcharge - 12/28/2011 $8.70 Type of Use: COM Plumbing Class of Work: ALT 22 ea Minimum Fee Adjustment - 12/28/2011 $22.46 Plumbing Type of Const: Occupancy Grp: Stories: 2 Total $81.20 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 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 1.800.332.2 ' Issued By: •ermittee Signature: ipir Call 503.639.4175 by 7:00 a.m. for the next available inspe ion 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 Applic , hi 1 1 CEI ED Building Fixtures `/ �( [� FOR OFFICE USE ONI.I City of Tigard DEC 2 3 2011 Permit N I, � ' / /� 380 DateBy Received 44 111 e 13125 SW Hall Blvd., Tigard,0 97223 Plan Review . Phone: 503.718.2439 Fax: 5109/4(16F TIGARD Date/By: Other Permit No.: �-�� TIGARD Inspection Line: 503.639.41 DIVISION Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction El 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 El m 1- and 2- family dwelling Comercial /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: q f ] 5" ft„/ cre hi J _ f Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: T 5 ivy d 0 i t 9 ?--LZ 3 Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: Z z 6 ) I Project name: 13.' 111 P6- y k. Manufactured home utilities 50.03 Cross street/directions to job site: c; C, ti , f re bi/ / h h J 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.: / c © O Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 F 1 Xi U t` I ti. S ± ,". 17 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 %PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: ✓I�CV/ L �t G Fixture /sewer cap 25.02 GL tNt, Floor drain/floor sirk/hub 25.02 Address: C, Set ke f 5 r� Garbage disposal 25.02 City /State /ZIP: Zi Ice 0.5 CrX- Hose bib 25.02 Phone: (5 3 ) '7 L ► LI L/L 0 J Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory / 25.02 c2-5:° .° 2 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 CONTRACTOR Water closet / 25.02 O` 570, 1 Y\f /� Water heater 37.52 Business name: 1I 0'0 Pll) m hl fl f SP/ t(t?S . Waterpiping/DWV 56.29 Address: 9:2,1 0 ,s, f C; e t e 1 Dr ( QYl Ck Other: 25.02 City/State/ZIP: Subtotal ty �� l S���.o 4� X17 1Z Phone: (50 3) S 19 G5-55 Fax: ( S 03) 'ice.) 2555 Minimum permit fee: $72.50 7 A . 5 0 1 p / c Plumbing Lic. no.: Plan review (25% of permit fee) CCB Lic.: ` D n O I fAt g pv 17 Z State surcharge (12% of permit fee) �' 7V Authorized signature:.. _ .. _ �` 1 hi TOTAL PERMIT FEE y I , Pv Print name: `., -2 A (jZV-- Date: / Z 2 I 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 Building Industry Service Board. l: \Building\Permits\PLMU- PermitApp.doc 10/01/09 440 - 4616x(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 - 1s` 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: 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 Other Inspections or Fees Qty. Fee (ea ) Total each additional $100.00 or fraction thereof, to p 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/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 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/ Work Performed: Capped Added Relocate Plan review is required for any of the following. 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. -3" 4 " Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic - non - food s g q g Disposal - Domestic 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/Lav - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this ermit results in an Washer - Clothes p Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: I: \Building\Permits\PLMF- PermitApp.doc 02/24/2011 2 Accumulative Sewer Tally a Tenant Name: Spec Space S\ R # N/A Site Address: 9975 SW Frewing St #220 PLM # 2011 -00380 Parcel #: 2S102CB03200 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 0 0 0 0 - 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 11P) 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: - 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 2.2 35.2 TOTALS 0 0 0 0 2 8 2 -27.2 Current Fixture Value -27.2 divided by 16 = -1.7 Current EDU 1 EDU = $4,500.00 Previous Fixture Value 0 divided by 16 = 0.0 Previous 1:DU Change -27.2 divided by 16 = -1.7 over (under) $ (7,650.00) Enter EDU Change Here -1.7 Notes: Credits still available from PLM2008- 00348. Authorized Name /Signature: Debbie Adamski Date: 12/23/2011 Building Division r ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be bmitted to the City of Tigard Building Division to redeem credits towards future system development charges. I: \Buil ding \Sewer Tally \SewerTallySheet- 4500.xls 07/01/11