Permit CITY OF TIGARD PLUMBING PERMIT
31 1 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00262
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/25/2012
Parcel: 1 S 135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY 246
Project: El Porvenir Subdivision: METZGER ACRE TRACTS Lot: 9
Project Description: (1) mop sink, (1) 3- compartment sink, (1) hand sink (all sinks are food related), (3) 2" floor drain /sink, (1) hose bib,
(1) grease trap, (1) primer, and (1) water heater.
Contractor: MAREK PLUMBING Owner: COMMERCIAL ENTERPRISES LLC
3229 SE 160TH AVE 8320 NW HWY 99
PORTLAND, OR 97236 VANCOUVER, WA 98665
PHONE: 503 - 784 -4972 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Floor Drain /Floor Sink/Hub 09/25/2012 $75.06
Specifics: 1 ea Hose Bib 09/25/2012 $25.02
1 ea Interceptor /Grease Trap 09/25/2012 $25.02
Type of Use: COM 1 ea Primer 09/25/2012 $12.51
Class of Work: ALT 3 ea Sink 09/25/2012 $75.06
Type of Const: 1 ea Water Heater 09/25/2012 $37.52
Occupancy Grp: 1 12% State Surcharge - 09/25/2012 $30.02
Stories: Plumbing
Total $280.21
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. S. - ' Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work • of starte• within 180 days of
issuance, or if work is suspended for more the 180 days, ATTENTION: Oregon law requires you to folio the les adopte• by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 - 0010 through OAR 952 - 001 - 0090. o may •` 'n a co• of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 9 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 oject.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application .
RECEIVED
FOR OFFICE USE ONLY
City of Tigard Received
S E p 1 1 2012 Date/By: �i .Z Permit No,OL/y.20/_elew
• a 13125 SW Hall Blvd., Tigard, OR 97223
I ® Phone: 503.718.2439 Fax: 503.598.1 Plan Review
Other Permit No..
Ins
Inspection Line: 503.639.4175 t OFTIGARD DateB : �ltf�,ZQ / �D`�
T I G A R D p Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method• 776 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
ddition/alteration/replacement ❑ Other: New I - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I- and 2- family dwelling Faonunercial /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: / 1 9 4 - s viz Pot c/ / , c . /--I� t,/# y6 Catch basin or area drain 18.76
City/State/ZIP: ys ti R 9' 7 .�, Z 3 J Drywell, leach line, or trench drain 18.76
ity /State /ZIP:
/ L { g'a z c � Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: l Project name: EL / 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.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
/ 070.6 E Se" /' )O 6 6T 2_17e Ely sTZJ 2 Dishwasher . 25.02
//v/7 /"1 fC9-.^/ eee ) ° /f E/'T Drinking fountain 25.02
Mer/ E -1-- _ /h/ - Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 40 25.02
Floor drain/Iloorsink / 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 a 25.02
Business name: Medical.gas (value: $ ) Page 2
Contact name: Primer 12.51
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 3 - 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: /yam R Ft- p` i /74 Cj __ Water piping/DWV 56.29
Address: 3 2 2. ID' 5 F l a 'O 111 a d tv Other: 25.02
City /State /ZIP: p `,. 71/4,74l'l '/? c'! 7 _z 3 6 Subtotal „25j r P?
iiv pione: (5 3) 7d2 G/ 9'7 z Fax: ( ) Minimum permit fee: $72.50
CB Lic.: .7 5- 6 2 G/ 13 / /y Plumbing Lic. no.: 3G /!L p 2 9, Plan review (25 %of permit fee)
//
Authorized signature: ��2,�`.,� e ic.A.x. ,/,/,,, State surcharge (12% of permit fee) 30 , 00
TOTAL PERMIT FEE .6 ,10, ,R/
Print name: 060R EA-- 6 i z C z ,¢ / Date: 9' a- /z 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.
1: \ Building \Permits\PLMU- PermilApp.doc 10 /01/09 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr. 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
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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
I� 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
Pr ions Capped Added Existing engineer.
Baptistry/Font
Bath -Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
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
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3„ 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
' , - '3ar/naavatory
RRa
O ommercial .. *Note: If the fixture work under this permit results in an
. i Service I / 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\Petmits\PLM- PermitApp.doc 2
Accumulative Sewer Tally Of I....--
Irr Tenant Namc: El Porvenir C- SWR # 2012 -00187
Site Address: 11945 SW Pacific I Iwy., Ste. 246 PLM # 2012 -00262
Parcel #: 1S135DD03301
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
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 HP) 16 0 0 0 0 0
- Commercial (to 5 1 -IP) 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:
- L,av /Bar - Non -Food Related 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 3 9 3 9
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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped [DU Credit 0
TOTALS 0 0 0 0 5 13 5 _ 13
Current Fixture Value 13 divided by 16 = 0.813 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous [DU
Change 13 divided by 16 = 0.813 over (under) $ 3,778.65
Enter EDU Change Here 0.810
Notes:
Authorized Name /Signature: Dianna Howse Date: 9/11/2012
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. I f 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'CallySheet- 4665.xls 07/01/12