Permit I CITY OF TIGARD PLUMBING PERMIT
C COMMUNITY DEVELOPMENT Permit# PLM2012 -00266
Date Issued 09/18/2012
.TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S102AA03000
Jurisdiction Tigard
Site address 8740 SW SCOFFINS ST
Project Cosale Office Subdivision TIGARD HIGHWAY TRACTS Lot 24
Project Description Replace (1) sink, add (1) sink & (1) shower stall
Contractor LIBERTY PLUMBING Owner LANSING, ROB
11124 NE HALSEY, 3534 17237 KELOK RD
PORTLAND, OR 97220 LAKE OSWEGO, OR 97034
P
PHONE 503 - 544 -4673
PHONE 503 - 888 -8830
FAX 503 - 912 -0184
FEES
Quantity Description Date Amount
2 ea Sink 09/13/2012 $50 04
Specifics 1 ea Tub /Shower /Shower Pan 09/13/2012 $12 51
1 12% State Surcharge - 09/13/2012 $8 70
Type of Use COM Plumbing
Class of Work ALT 10 ea Minimum Fee Adjustment - 09/13/2012 $9 95
Type of Const Plumbing
Occupancy Grp
Stories
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 wor' not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION Oregon law requires y.. to follow the rules adopted by the Oregon
Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952-001-00•6 You ay obtain a copy of the rules
or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
�• 4.10
Issued By �•�. Permutes Signature
11riftl
Call 503 639 4175 by 7 00 a m for the next available inspectio •"'-
This permit card shall be kept in a conspicuous place on the job site until completion o
Approved plans are required on the job site at the time of each inspection ._
Plumbing Permit Application
RECEIVED
City of Tigard R eceived a Per mit No
I
a 13125 SW Hall Blvd , Tigard, OR 95th 1 3 2012 Date/By / / 3 Nadu _
G Phone 503 718 2439 Fax 503 598 1960 Datty ew Other Permit No �/
CITY Inspection Line 503 639 4175 i v �p r �
T I G A R U Internet www U aril -or Ov C OF Date Ready/By loos H1 See Page 2 for
g gov DIVISION Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist
❑ New construction 11 Demolition
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 (I) bath 312 70
❑ 1- and 2- family dwelling commercial /industrial SFR (2) bath 437 78
SFR (3) bath 500 32
Cl 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 8 ' 7 l..--) S 10 s ( cs 11 l' Catch basin or area drain 18 76
' G �' Drywell, leach line, or trench drain 18 76
City /State /ZIP 1 ` 5� t 0 �- ` Z 3 Footing drain (no linear ft ) Page 2
.6
Suite/bldg /apt no Project name 46[—C. —. t 2 / !- Manufactured home utilities 50 03
Cross street/directions to job site ( C5 .F1+ 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 /L ,. I Lot no Fixture or Item:
Tax map /parcel no / ? eta D J ?,�r� � Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12 51
Clothes washer 25 02
Dishwasher 25 02
Drinking fountain 25 02
Ejectors /sump 25 02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Name Fixture /sewer cap 25 02
Floor drain/floor sink/hub 25 02
Address
Garbage disposal 25 02
City /State /ZIP Hose bib 25 02
Phone ( ) Fax ( ) Ice maker 12 51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
Business name Medical gas (value $ ) Page 2
Contact name Primer 12 51
Roof drain (commercial) 12 51
Address Sink/basin/lavatory 25 02 611 0 `(
City /State /ZIP Solar units (potable water) 62 54
Phone ( ) Fax ( ) Tub /shower /shower pan 1 12 51 I 2.. Sl
E-mail Urinal 25 02
Water closet 25 02
CONTRACTOR
Water heater 37 52
Business name � I .f. � � �` f � � C... Water prpmg/DW V 56 29
Address ( 112 �C t1a I , p < pi Other 25 02
City/State /ZIP Port l� O 0--- 1 9722 O 7 Subtotal Asit
Phone ( ) 3) 863 (3 _ Fax p Fax (Su3 )112,— — S193_ ?P2' 0084 Minimum permit fee $72 50
!^� t1GG n Plan review (25% of permit fee)
CCB Lie t ` t 6255 108 , Plumbing Lie no 3 —L iq.? Pt3
State surcharge (12% of permit fee) _
Authorized signature 1 ,�� �� TOTAL PERMIT FEE
oft„ This permit application expires if a permit is not obtained within 180 days
Print name I' O I N � bat 3(_‚n- after it has been accepted as complete
* Fee methodology set by Tn -County Building Industry Service Board
I \Buildmg\ Permits \PLMU- PermiApp doe 10/01/09 440-4616T( 1 0/02/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 - 1 100' 50 03 0 to 2,000 $121 90
Footing drain - each additional 100' 37 52 2,001 to 3,600 $169 69
3,601 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
Q ty. Fee (ea) Total each additional $100 00 or fraction thereof, to
Other Inspections or Fees 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 Exishng 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 El Medical gas and vacuum systems for health care facilities
Drive Stall ❑ 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
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach /Refrig Drains
Oil Separator (Gas Station)
Rec Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *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
Urinal
Other Fixtures
I \Building\Permits\PLM- PermitApp doc 2
Accumulative Sewer Tally
l'enant Name Cosale Office SWR # 2012 -00189
Site Address 8740 SW Scoffins PI,M # 2012 -00266
rIGARD: Parcel # 2S102AA03000
I.txturc Value Previous Previous Credits Capped Fixture I.ixturc Ncw New
# value count capped #s value count added # added value total #s, total values
Baptistry/Font 4 0 0 0 0 0
Bath - I ub /Showcr 4 0 0 0 0 0
- Jacuiii /Whirlpool 4 0 0 0 0 0
Car Wash - Mach 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
l'.yc 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 HP) 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
Showcr - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 1 2 1 2
Sink
- Lay/Bar - Non -food Related 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Com /Scry /Util - Food Related 3 0 0 0 0 0 i
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water I•.xtractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0 '
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
IOIAI,S 0 0 0 0 2 4 2 4
Current fixture Value 4 divided by 16 = 0 250 Current EDU 1 EDU = $4,665.00
Previous fixture Value 0 divided by 16 = 0000 Previous EDU
Change 4 divided by 16 = 0 250 over (under) S 1,166 25
Enter EDU Change Here 0 250
Notes
Authonzed Name /Signature. Debbie r \damski Date 9/13/2012
Building Division
Note I'he property owner shall retain the ORIGIN AL sewer tally record if credits exist, this document will serve as a voucher which must be
submitted to the City of 1 igard Building Division to redeem credits towards future system development charges
1 \Budding \Sewer tally \ Scwer 1 allyShect -4665 sIs 07/01 /12