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Permit
CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2012 -00056 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012 Parcel: 1 S136DCO2504 Jurisdiction: Tigard Site address: 7275 SW DARTMOUTH ST Project: Shell Subdivision: HUNTER POLLOCK NO.2 Lot: G Project Description: Cap all interior plumbing fixtures, (1) water closet, (1) lay & (1) mop sink. Contractor: ATLAS PLUMBING CONTRACTORS Owner: AMERICAN INDUSTRIES INC P.O. BOX 1352 1750 NW FRONT AVE STE #106 RIDGEFIELD, WA 98642 PORTLAND, OR 97209 PHONE: 360 - 887 -8054 PHONE: FAX: 360 - 887 -8504 FEES Quantity Description Date Amount 3 ea Fixture /Sewer Cap 03/14/2012 $75.06 Specifics: 1 12% State Surcharge - 03/14/2012 $9.01 Plumbing Type of Use: COM _ Class of Work: ALT Type of Const: Occupancy Grp: Stories: • Total $84.07 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 Notifi - • • enter. 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 q - stions to • N •y calling 503.232.1987 or 1.800.332.2344. Issued : : / Permittee Sign :lure: I 'emu i GF �•O 1 �d' �'--� 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. 03/14/2012 10:13 FAX 5035708713 CPS Construction a 0002 /0006 Plumbing Permit Application Building Fixtures RECEIVED For, OFF,C12 L.SL. cy■Lv _ City of Tigard n 13125 SW Hall Blvd., Tigard, OR , 14 2012 y Plan Review Arc 6 f & ft. Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: T I G A R D Inspection Line: 503. 639.4175 CITY OF TIGA Date Ready/Sy: mtir: 0 See Page 2 for Internet: www.tgard- or. Q# 1 QQ tA�I Notified/Method: Supplemental Information .._....._1_.....,._,� ,. ,.,,.1?EE.: ❑ 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) • `.,_, :! ri::` ::;isi,�!:::-c,':_r;P. i T Y:, c:: :'�i-- __ `v' `a!il.. - t y_'i`_' .., . , - .A�F�£d =w= _4� I�' ~: SFR (1) bath I 312.70 ❑ 1- and 2- family dwelling ► Commercial/mdustrial SFR (2) bath 437.78 ❑ Accessory building ❑ Multi- family SFR (3) bath 500.32 Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 : :, C,I,:::�•.,;.::,:.:a4 U$: SI'• Pli;* ;;li!fF'OR�A1'�O1�T:j:A1�FD:r: 1� . �;;-�a; °, - _ _ _.._ iii:; ::; Job site address: 7275 SW Dartmouth Catch basin or area drain 18.76 City/State/ZIP: Tigard Drywell, leach line, or trench drain 18.76 Manufactured tune home linear ie _J 5 0 . 2 Suite/bldg. /apt. no.: I Project name: Tigard Triangle Manufactured home utilities 50.03 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: 1 Lot no.: Fixture or item: Tax map /parcel no.: / rj / 5 1,2 O oZ So 1 Backflow preventer J 31.27 . Clothes washer 25.02 Removal of old plumbing fixtures Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PR - :a •;, _ - ::,: - Expansion tank Q t ©PFdtT�' '��'�EN" - xP 12.51 Name: American Industries Fixture/sewer cap 3 25.02 Address: Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/ State/ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 __. �ZeI..._.:}];:;AkP0C`,�■#&: t1 te ON`CA, _ Interceptor / trap 25.02 Business name: CPS Construction Inc Medical gas (value: S ) Page 2 Contact name: Ron Kid Primer 12.51 Roof drain (commercial) 12.51 Address: 9825 SW Day Road - Sink/basit ✓ lavatory 25.02 City/State/ZIP: Sherwood Solar units (potable water) 62.54 Phone: (503) 320 -0918 Fax: : (60) () S (7 / 3 Tub /shower /shower pan 12.51 E -mail: ronkief@comcast.net Urinal 25.02 ti'1 = -••LC _ - ".u; - _ _ �:.I _._ _ - . «L•I: - .TIr - ':$, Water closet 25.02 - •':1: Vii': - - `•:1✓ -'�� - 1 ' �:• ° i::1.=1r1 ^.'�: - , ', f.�l:' �� -: •.. .3.' �1._.. -� .....F' _ -•ly ":IL'1 �Ir��:..._.;;:'i� ::...,.:, .. L1 -1 ,. *!FJ, .TRz1 C 1 i 1 : :a ;- -air :.,:L• _ �"- _.. .i!`- F:�nraa::� -�._n :. :�._e�a,a.....�......._.. - "cL,! {!..;_;Eft -_- . .r.- '7�t..,_..::!:::djti' ia `'" + Water heater 37.52 Business name: Atlas Plumbing Water , in WV 56.29 PP g/D Address: PO Box 1352 Other. 25.02 City/State/ZIP: Ridgefield, W 2 Subtotal 75. o � Phone: (360) 887 -8054 Fax: ( ) Minimum permit fee: $72.50 ' CCB Lic.: 165718 - P ing Lic. no.: PB 149 Authorized sigrtatu ,i �r% Plan review (25% of permit fee) State surcharge (12% of permit fee) ?. d / 7 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. �Q • Fee methodology set by Tri- County Building Industry Service So at " 1: 16uilding \Permits\PLMU- PermitApp.do° 10 /01/09 440- 4616T(10/02/COM/WEB) 03/14/2012 10:13 FAX 5035708713 CPS Construction 0] 0003 /0006 .Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: • - _- r.; _. •a __ , s ,�_ y;n a :::��;..�: � - ::, fl 1 ,:�'�n:: r. -:r.: , ^v!aer :u:chf.: .Lt .', �.•c _ 3�. - , �. , , ...__rw.. _._.._� • �rac .m.,....la._.....,..-- .,R... � .a1..,td�e _� r - l.ce�.C: = :+1 _ �_^ =;=i .;I,�CS-LiA`a: ; =_:: ri,i::� :. �.,:• -:� � �:' 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 $23320 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 S'�r.N�i�F.WY, i�;l�y: : � : zi=..•.- V�11f�rWJy .,::il:.rr::+r_r_;��Yj: __:- ::�_;,',';'�'�,� 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 i, ;t 5; each additional $100.00 or fraction thereof, to r01; ( .. �x ' ,:r,,, ,, .. 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 * . FixtnreT f r:._._ •.-::::: .:,- _::e:,- :,�.;..;....-.._,... .. ,` ".: :: Plan review is required for any of the following. . Work= Pestorinedc:•:" '�;'�:i'= ':'-.?`;` Capped. -;. ?.:Added.. :,-:=�Rekeaie�s �4 Y • Please check all that apply. Baptistry/Font PP Y 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 The, ❑ 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" ❑ Isometric riser diagram Wash Drain ' ;; ``= ;:'`�.;;.,, - - _ -- •-: , . _ _.:..:•.' . ° .. _ :. Garbage - Domestic -non -food gram required for new buildings 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 permit results in an Washer - Clothes P Water Extractor increase of sewer EDU5, 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: http: / /www.tigard- or.gov/ city_ hall/departments /cd/docs/PLMF- PermitApp2doc 11 Accumulative Sewer Tally 4 • C ,. 'Tenant Name: Shell Building ** *CREDITS * ** SWR # N/A TIGARD Site Address: 7275 SW Dartmouth St PIN # 2012 -00056 Parcel #: 1S136DCO2504 Fixture ' Value Previous Previous Credits Capped Fixture Fixture New New # value count capped #s value count added # added value total #5 total values Baptistry/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 I-IP) 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 0 0 0 0 Sink: - Lav /Bar - Non -Food Related 2 0 1 2 0 -1 -2 - Bradley 5 0 0 0 0 0 - Com /Scrv/Util - Food Related 3 0 1 3 0 -1 -3 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 1 6 0 -1 -6 Urinal 6 0 0 0 0 0 • Previous EDU Count 0 0 Capped EDU Credit 0 '1'O'1'AI.S _ 0 0 3 _ 11 0 _ 0 -3 -11 I Current Fixture Value -11 divided by 16 = -0.7 Current EDU 1 EDU = $4,500.00 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -11 divided by 16 = -0.7 over (under) $ (3,150.00) Enter EDU Change Here -0.7 Notes: ** *CREDI'T'S * ** Capping all existing fixtures in building . Authorized Name /Signature: Debbie Adamski Date: 3/14/2011 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 \Sewer I'allyShcet- 4500.xis 01/18/12 03/14/2012 10:13 FAX 5035708713 CPS Construction g10004 /0006 Ron Kief Full Name: Zea Travis . Last Name: Travis First Name: Zea Company: Atlas Plumbing Business Address: 31020 NW 51st Ave PO Box 1352 Ridgefield, WA 98642 Business: 3608878054 Mobile: 3604305765 Business Fax: (360) 887 -8504 E-mail: atlasplumbingllc @yahoo.com E -mail Display As Zea Travis (atlasplumbingllc @yahoo.com) CCB 165718 Plumbing no. PB 149 • 1 03/14/2012 10:13 FAX 5035708713 CPS Construction a 0001 /0006 CPS Construction, Inc Day Road Design, tic General Contractors - Oregon CCB#102248 - Washington State CPSCOI *005R0 Fax To: City of Tigard/Building Dept From. Ron Kief Fax: Pages: 6 Phone: Date: 03/14/12 Re: Tigard Triangle — 7275 SW Dartmouth, Tigard — BUP2012 -00015 & 00011 Attached is a plumbing permit application for the demo and/or removal of the existing plumbing fixtures at the above address. Please have someone get the count today as they are being removed today as well. • • 9825 SW DAY RD., SHERWOOD, OR 97140 -7220 OFFICE /MOBILE 503.320.0918 - FAX 503.570.8713 EMAIL - RONKIEF@4 COMCAST.NET