Permit CITY OF TIGARD PLUMBING PERMIT
$ COMMUNITY DEVELOPMENT Permit #: PLM2012 -00139
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2012
Parcel: 1 S135BB00800
Jurisdiction: Tigard
Site address: 10655 SW GREENBURG RD
Project: Ewing Irrigation Subdivision: HILLSBORO Lot: PTS 1 -2
Project Description: Capping (4) lays, (1) sink, (4) toilets & (2) urinals. Adding (1) drinking fountain, (2) 2" floor drains, (4) lays, (2)
sinks, (3) toilets & (1) urinal.
Contractor: RAYBORN'S PLUMBING INC Owner: EWING IRRIGATION PRODUCTS INC
19990 SW DIPOLE RD 3441 E HARBOUR DR
TUALATIN, OR 97062 PHEONIX, AZ 85034
PHONE: 503 - 692 -4139 PHONE: 602 -497 -9530
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 05/24/2012 $25.02
Specifics: 11 ea Fixture /Sewer Cap 05/24/2012 $275.22
2 ea Floor Drain/Floor Sink/Hub 05/24/2012 $50.04
Type of Use: COM 1 ea Hose Bib 05/24/2012 $25.02
Class of Work: ALT 1 ea Primer 05/24/2012 $12.51
Type of Const: 2 ea Sink 05/24/2012 $50.04
Occupancy Grp: 4 ea Lavatories 05/24/2012 $100.08
Stories: 1 ea Urinal 05/24/2012 $25.02
3 ea Water Closet 05/24/2012 $75.06
1 ea Water Heater 05/24/2012 $37.52
1 12% State Surcharge - 05/24/2012 $81.06
Plumbing
Total $756.59
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 • ' or . spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. 'cation Center.' hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire• questions to OUNC by cal • • - 503.232.1987 or 1.800.332.2344.
Issue. By: - / // Permittee Signature: / p
Call 503.639.4175 by 7:00 a.m. for the next available inspecti 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 Application
Building Fixtures
R eceived
C!' of Tigard n/ Permit No.: y
• 131 SW Hall Blvd., Tigard, OR 97223 Date /By: 5/�T om I � P i N � r(�Ql
• Phone: 503.639.4171 Fax: 503.598.1960 Dan Review ate/By: Other Permi
D t No.:
I_ I GA It I) Inspection Line: 503.639.4175 Date Ready /By: Juriss: RI See Page 2 for
Internet: www.tigard -or.gov Notified/Method: _ Supplemental information
TYPE OF WORK • '. -. FEE' SCHEDULE IMMA 40057
0 New construction 0 Demolition For special information use checklist
_ Description I Qty. Ea. Total
Ir� Addition/alteration/replacement 0 • 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
building SFR (3) bath 500.32
❑ Accessory g ❑Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other. Fire sprinkler ( sq. R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /066 .5tAi G R_F__ be-4 Qo• Catch basin or area drain 18.76
City/State/ZIP: 11 OlLt�<ropi Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: I Project name: t g . ( 5 ni q /44ZJ 4 77OJi 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: I Lot no.: Fixture or Item:
Tax map /parcel no.: /S / h Siltzi Mike) Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
mite Clothes washer 25.02
DE1 NO A ND Al.-0 / p I.1 � ,� iteI NG Dishwasher 25.02
Drinking fountain 1 25.02 ZS 02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap I I 25.02 ,,Z75: 22.
Address: Floor drain /Floor sink/hub _ .2. 25.02 co .vg
Garbage disposal 25.02
City /State /ZIP: Hose bib 1 25.02 15, D 2
Phone: ( ) Fax: ( ) Ice maker 12.51
■ APPLICANT ■ CONTACT PERSON Interceptor/grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Primer 1 12.51 12 .51
Contact name:
Roof drain (commercial) 12.51
Sink/basin/lavatory e 25.02 15). ` 2,
Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal / 25.02 2.S.O Z
CONTRACTOR Water closet 3 25.02 7S D 6
l Water heater , 37.52 3 7.52,
Business name: J41 604e'1 S P4e1„,&,,, we, Water i to DWV 56.29
PP g/ _
Address: 0 Q c 6• Other: 25.02
City /State /ZIP: �RLA7 -!/1(1 e51,e„6 4 d 7 7 0 62 Subtotal 675.53
Phone: (Sp3) 69 1/l3 Fax: (SD3) gei7 2 2g Minimum permit fee: $72.50
Plan review (25% of pennit fee)
CCB Lic.: . Plumbing Lic. no.: 3 -�C6 State surcharge (12% of permit fee) 11 i Ob.
Authorized signature:
7 5 1 51.
This permit application expires if a permit is not obtained withi....... .._, -
Print name: V _ r 'y Date: �� after It has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I: Building Permits PennitApp.doe 1001.09 440- 4616T(10 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 - l' 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
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", 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.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain I
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" A. ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
g
Comments regarding fixture work:
-Industrial
Ice Mach. /Refrig. g. Drains 41r L � n' _.- A f"I 6/ tPAS
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory 4 4 L
- Bradley
- Commercial ! [. 2. g *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 9
_ Urinal Z.. I
Other Fixtures:
http : / /www.tigard - or.gov /city_hal I/ departments /cd/docs /PLM F -Perin itAp jdoc
C A
: Tenant Namc: Ewing Irrigation Accumulative Sewer Tally SWR # N/A
TIGARD Site Address: 10655 SW Greenburg Rd PLM # 2012 -00139
Parcel #: 1S135BB00800
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s 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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 2 4 2 4
- 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 1-1P) 16 0 0 0 0 0
- Commercial (to 5 1 -1P) 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:
- Lay/Bar - Non -Food Related 2 0 4 8 6 12 2 4
- Bradley 5 0 0 0 0 0
- Com /Serv/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 4 24 3 18 -1 -6
Urinal 6 0 2 12 1 6 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS _ 0 0 11 47 13 41 2 -6
Current Fixture Value -6 divided by 16 = -0.4 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -6 divided by 16 = -0.4 over (under) S (1,800.00)
Enter EDU Change Here -0.4
Notes: ** *CREDITS * **
Authorized Name /Signature: Debbie Adamski Date: 5/24/2012
•
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 1'allySheet- 4500.xls 01/18/12