Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00171
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/21/2012
Parcel: 25101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY, STE# 010
Project: National American University Subdivision: VARNS ACRES Lot: 9
Project Description: TI
Contractor: RUSSELL & SONS PLUMBING INC Owner: TRIANGLE POINTE LLC
PO BOX 192 901 NE GLISAN ST, #100
BATTLE GROUND, wa 98604 PORTLAND, OR 97232
PHONE: 503 - 297 -8791
HONE: 360 - 263 -3377
FAX: 360 - 263 -3378
FEES
Quantity Description Date Amount
2 ea Drinking Fountain 06/21/2012 $50.04
Specifics: 1 ea Expansion Tank 06/21/2012 $12.51
2 ea Fixture /Sewer Cap 06/21/2012 $50.04
Type of Use: COM 2 ea Primer 06/21/2012 $25.02
Class of Work: ALT 1 ea Sink 06/21/2012 $25.02
Type of Const: 14 ea Lavatories 06/21/2012 $350.28
Occupancy Grp: 2 ea Urinal 06/21/2012 $50.04
Stories: 5 ea Water Closet 06/21/2012 $125.10
1 ea Water Heater 06/21/2012 $37.52
1 12% State Surcharge - 06/21/2012 $87.07
Plumbing
Total $812.64
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.
JUN- 15- 2012(FRI) 15:01 RUSSELL & SONS PLUMBING (FRX)3602633378 P. 002/004
Plumbin,Permit Application
Building Fixtures RECEIVED FOR OF/. ICE USE ONLY
i ll 14 City of Tigard p rived ( is /;l , L/ ftpi - OO /7/
Pl 7orit No.:
13125 SW Bull Blvd., Tigard, OR 97223 J U N 15 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/Br Other
Inspection Line: 503.639
TICAlti) CITY �1
or.gov • Cl b a OF TICARD late Ready/By:
Internet www.tlgatd 1 S See P age lementa 2 folnr nrmation
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❑ New construction ❑ Demolition Per special information use checklist.
Description I Qty. I FA. [ Total
❑ Addition/alteration/replacement 131 Other: T.I.
1 i ; { f 4 'pi111h t1 rl•� �`;(� d, , lu�luu wr. nl. a I,1 � � I :,; New 1- 2 dwellings (includes 1001E for each utility connection) a ' I (t > 1 ,1 II 9 t i ±' �ra s !il YiG I � ) bath 312.70
1 . .! '1 ' E1 ,1 n ' a a eta t, 1 ;: SFR(1
�� ,f,hll�il�NI11�1 1 t L d.1 i it l 2' Al 3 � � p u � t ''R � • I ���li{� aAw r � 1
❑ 1- and 2- family dwelling 21 Commercial/industrial SFR (2) bath 437.78 ' Z
0 Accessory building ❑ Multi - family -
SFR (3) bath 500.32 r
Each additional bath/kitchen 25.02 '
0 Master builder ❑ Other (�
i r I j{I� r ti 11 I�'ln , u�}�!u7u:(tt:1�rL�1��! 6a�uut't ui��' ""' v "''�' � � ! ��p 7f `{ �'(i ' t Fire sprinkler (_ sq. {l,) Page 2
ill '! i 7 i,,�l! �lillrl �tit14r1'19J' I t ° �r l l• Iy Id 11L�V +I n rift �� i l'�!�( S� c tt 1111 �!�11�Ii'J
1. 11ii. iii i ,111 a tri 1 '> MINI .�f1i11.' it i EIli`I�hl i 2,1 I Site utilities: -
ti
Job site address: 13333 SW 68 Parkway Catch basin or area drain 18.76 •�
Dtywell, leach line, or trench drain 18.76
Ciry /StutrlZTP: Tigard, OR 47223
tJk/loo 1-- AMFd4e'i44) ( 4/J14 - 0 2 6t TY Footing drain (no. linear ft: ____) Page 2
Suite/bldg./apt. no.:p/d"0( (f Project name: NAU Manufactured home utilities - 50.03
Cross street/directions to job site: Old Farmers Insurance Building Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: __,) Page 2
Storm sewer (no. linear R.: ) Page 2
Water service (no. linear it: _) Page 2
Subdivision: n/a I Lot no.: n/u Fixture or item:
g
Tax map /parcel no.: a/a 13acldlow preventer 31.27
fill r 1 4 11 1 °1 1,+f 11, 1 ‘ 71 l: 111 : :, ' 1I�12a51, 11 i I li F i 11`lilll i l'll` POtin I,IE Backwater valve 12.51
Clothes washer 25.02
Demolish select plumbing on ground Door. Dishwasher 25,02
New plumbing for tenant improvement on ground floor. Drinking fountain O (j 25.02 50.04
Ejectors/sump 25.02
1 11 1 1`l 1r t a� ho l u ,uruai r ^ ( tit tit �tt����r�- " w
l ��i►.. '• =11i r'i mi�r.1 � ' ,, 1 , " E l fl iilli; ��iii111i�1t1+!"�"�I Mr v '` 1 10 1 Expaasiontank 1 12.51 12.51
Name:
Fixriue/sewcrcap 9._ 25.02 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
, ,t�'¢u q��:� ,nu t; ;q+ t +• a n , 0: „ul-
} 1" , ' 1w ila;! ii IEI aTc ra h} a i t '' l � q��11C!liil i ' "`°, aIEI 4 �;r ' ; M' IlV Jntcreclmr /gtrase tntp J 25.02
Business name: Russell & Sons Plumbing Inc Medical gas (value $ ) Page 2
Contact name: Mark Muonio Primer 2 12.51 25.02
Roof drain (commercial) 12.51
Address: PO Box 192 Sink/basin/lavatory ; i "?' 14 25.02 350.28
City /State/ZIP: Battle Ground, Wa 98604 Solar units (potable water) 6234
Phone: (360) 263.3377 I Fax :: (360) 263.3378 Tub/shower/shower pan 12.51
E -mail: mark@rsplumbing.net
Urinal 0 Z 25.02 50.04
{ + , !! } j t I „ n ✓ water closet 5 25.02 125.10
ig��� !E>; tp 1 � 1't' I t E�g E" l�i:f = 1'f1�'1''�I{I ltt� E 1,1E y1 ErT ;1 �([• , � "I�„ Il �;irii �`
�t�i ;(f lMI %v
"LL,��3 ',1 :,I� al�:!�!, 1! ?1�J': I 1,;1 ,i.�! {' °��r � _rat L!�hll�`..,' �•llf,�.l1�1 i1i11d ��JIIE`1.�U1 Ul' `t Water heater 1 37.52 3732
Business name: Russell & Sons Plumbing Inc
Water pipin fJDW V rt .66 X639--•
Address: PO Box 192 Other op a[ nk) I _ 25.02 25.02 6
City /StatdLIP: Battle Ground, Wa 98604 Subtotal -V 6
P hone: (360) 2633 3377 Fax: (360) 263.3378 Minimum permit fee $7150
Plan review (25% of permit fee) 489/r" o
CB Lie.: 148999 lambing Lie. no.: 37 -511PB State =charge 12 °� of t fee 90,.02 /�
sttr
Authorized signature: 41.4447-,14,1 TOTAL PERMIT PEE L03&87 ai l q
Print name: Mark Muonio I Date: 6.13.2012 I 'rids permit application expires if a permit is n obtained within 180 days /`
after it has been accep as ot co mptctc.
*Pee methodology act by Tri- County fiuilding Industry Service Bond. '
1: Wullainaisrsaift1PLINU.PerinitAnn.tkic 10/01/LO 440461(Trtnm21mnvwk111
JUN- 15- 2012(FRI) 15:02 RUSSELL & SONS PLUMBING (FAX)3602633378 P. 003 /O04
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee �f gill chedule: f1Rq'��p�yg1 1 1 !� r i � Residential Fire Su. r ression S . teats:
i ,fail t.almlltftfGj 1� 1' i f I .1��+ i 1 ! I :. W .. ^W �I I I' �, � • ' : T .+ , '. ,
' G I iii UI M n1I1 -' 1ri1 R L ' �i '1 t I
...".4r: . -' _ I ►:SIntalittyI. - L I I • I .. 411 :17) ' 1' .�
Footing dnrin -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 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 S stems:
Water Service - each additional 100' 37.52" w t. i !�!��in t ml � 1�'ji 'r�I aC1 n�iliil�i3J ���
Storm & Main Drain - I st 100' 62.54 $1.00 to $5,000.00 Minimum fcc $72.50
Storm & Rain Drain - each additional 100' 3732 $5,001.00 to $10,000.00 $72.50 for the first 55,000.00 and $1.52 for
110th i tin I : Rt Rjl {� ••}}M� iI d �? 1 it �y., 11 y� fraction 1 +�I. ' � ' I�Natc� �ININtA!��.�llt�t�) each additional or fin thereof, to
and includ' l • $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 includi : $25 000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the tat $25,000.00 and $1.45 for
hours (minimum charge -2 hours) each additional $100.00 or fraction thereof; to
Rciuspection Fees 90.00/hr and includ' ..• $50 000.00.
Additional plan review for revision 90.00/h $50,001.00 and up $742.00 for the lust $50,000.00 and $1.20 for
(minimum charge- 1/2 hour) each additional $100.00 or fraction thereof,
Subtotal:
Commercial Fixture Work:
Arc 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 *.
U 1'1 { I ..• I N ... I 1 1✓, I•.� N.- W� ggyy ,,�.� h� H:•1'n NiH 1 l.:l •
�,,�i91ri�)ilil��i i I{ l# i i ; ai t.oatnnwvTilf i'' ; lll,�,:, • 1 0il � � ,, .: iii ' li_ it 11 U
' „i'Y ,,�, I l �{�t • , i � E I'91dN ` : � j�1�°"': , i'� l Pl rev is required for any of the following.
"St b” o; t � , Ili r „ �� riu.. , i „1 1 i t gin rat y &
Bu try/Fnm i'>>,r� ti,...,P .......i,. I N! I Please check all that apply.
8a h -Tub/Shower ❑ Any new commercial building with water service 2" and
- lacurzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complat structure
LLspldor/WaterAspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health cure facilities.
- Domestic El Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure us defined in OAR918- 780.0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
- 3"
• Iv ���p� r, t were 11 2 ti Q HHWHIH Rill I �!
Car Wash Drain HNt i 1 Iikur�'e: l�; l]<ifl> e. i',5, ; , Aprti . $.0Yt11 0 i� ` ion
Garbage - Domestic - non-food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic-food related that meet the qualifications above.
- Commercial -food related
- Industrial- food related I
Ice MachlRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station Renovate existing r'estrooms to meet ADA
- Shower -Gang Add 7 new sinks
-Stall
Sink/L.av -Non-food related I - 6 g Add 1 water heater
- Bradley Room #111, fixtures are non - functioning .
- Commercial -fond related Replace 2 drinking fountains to meet ADA
- Service I
Swimming Fool Filter * If the fixture work under this permit results in an
Washer - Cloches .
p
Water Extractor increase of sewer ED1Js, a sewer permit will be issued and
Water Closet - Toilet . 0 5 fees assessed for the sewer increase must be paid before the
urinal 1 2 plumbing permit can be issued.
Other Fixtures:
RfShared Documents\l Current Jobs \Commetcial\National American TI 4)171Cnntract \Permit \PT.MF- ParmitAnn.rdnr. •
IN Accumulative Sewer Tally
• Te nant Name: National American University * * *CRE.DI'I S * ** SWR # N/A
Site Address: 13333 SW 68th Pkwv #010 PI,M # 2012 -00171
TIGARD
Parcel #: 2S101DA00104
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 0 0 0
Eve 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 1 -IP) 16 0 0 0 0 0
- Commercial (to 5 1-IP) 32 0 0 0 0 0
- Industrial (over 5 1 -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 0 6 12 6 12
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 1 3 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 2 12 0 -2 42
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0.6 9.6
TOTALS 0 0 2 _ 12 7 15 5 -6.6
Current Fixture Value -6.6 divided by 16 = -0.4 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -6.6 divided by 16 = -0.4 over (under) $ (1,800.00)
Enter EDU Change Here -0.4
Notes: Credits from PLM2012 -00169 applied to this permit. Credits still remaining.
Authorized Name /Signature: Debbie Adamski Date: 6 /20/2012
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
•ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\ Building \ Sewer "rally \Sewer l'allyShcct- 451111.xIs 01/18/12
JUN- 15- 2012(FRI) 15:01 RUSSELL & SONS PLUMBING (FRX)3602633378 P. 001 /004
RUSSELL & SONS' PLUMBING, INC. �, pig �'�
P.O. BOX 192 N , ; � j , t 1 h i �� t, 4,I tkt 1 .
BATTLE GROUND, WA 98604 f ,,T�� '! II; i .•
PHONE: (360) 263- 3377il +:i , ;I I ' d poi
FAX: (360) 263 -3378 40
FAX
TO: The City of Tigard FROM: Mark Muonio
ATTN: PAGES: 4 including cover
FAX: 503.598.1960 DATE: 6.15.12
REGARDING: Plumbing Permit App & Payment
❑ URGENT ❑ REVIEW ❑ COMMENT REPLY
I understand the building permit has been applied for by the general contractor (SD Deacon). The
application # is B000111.
Thank you