Permit •
CITY OF TIGARD PLUMBING PERMIT
• 1111 COMMUNITY DEVELOPMENT Permit #: PLM2012 00303
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/18/2012
Parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7272 SW DURHAM RD, STE# 100
Project: Indio Spirits Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 25 -27,2:
Project Description: Cap (1) sink and add (1) trench drain. 11/6/12, reprinted to add (1) dishwasher, (1) floor sink & (1) hand sink.
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97293 PORTLAND, OR 97224
PHONE: 503-236-4152 PHONE: 503 - 624 -6300
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 10/18/2012 $25.02
Specifics: 1 ea Floor Drain /Floor Sink/Hub 10/18/2012 $25.02
1 ea Primer 10/18/2012 $12.51
Type of Use: COM 1 12% State Surcharge - 10/18/2012 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 10/18/2012 $9.95
Plumbing
Occupancy Grp:
1 ea Dishwasher 11/06/2012 $25.02
Stories: 1 ea Floor Drain /Floor Sink/Hub 11/06/2012 $25.02
1 ea Sink 11/06/2012 $25.02
0 12% State Surcharge - 11/06/2012 $9.01
Plumbing
Total $165.27
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 . • ons . SUNG by calling 503.232.1987 or 1.800.332.2344.
Issued By: __ / , Permittee Signature: 4
_ I "
Call 503.639.4175 by 7:00 a.m. for the next available insp- ction date.
This permit card shall be kept in a conspicuous place on the job site u ii .mpletion of the project.
Approved plans are required on the job site at the time o :: ch inspection.
V CITY OF TIGARD PLUMBING PERMIT
°1 COMMUNITY DEVELOPMENT Permit #: PLM2012 00303
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/18/2012 `
Parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7272 SW DURHAM RD, STE# 100
Project: Indio Spirits Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 25 -27,2:
Project Description: Cap (1) sink and add (1) trench drain.
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 15350 SW SEQUOIA PKWY #300 .
PORTLAND, OR 97293 PORTLAND, OR 97224
P
PHONE: 503 - 624 -6300
PHONE: 503 - 236 -4152
FAX: 503 - 296 -2218
., FEES
Quantity Description • Date Amount
1 ea Fixture /Sewer Cap 10/18/2012 $25.02
Specifics: 1 ea Floor Drain /Floor Sink/Hub 10/18/2012 $25.02
1 ea Primer 10/18/2012 $12.51
Type of Use: COM 1 12% State Surcharge - 10/18/2012 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 10/18/2012 $9.95
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 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: / / 0 Permittee Sig
. - � � �� i 'l /e.- ( 4
., / \
Call 503.639.4175 by 7:00 a.m. for the next available inspec ion 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 Annlicati 247 L - ct:3O
Building Fixtures ECEIVED
City of Tigard Received II
�+ Date/By: if Cr A. f Permit No.: c.l�/6�a/ -. o0 3 G
a 13125 SW Hall Blvd., Tigard,OR 9723 3O O v 2 12
C Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
�� OF TIG o Date By:
Inspection Line: 503.639.4175 Date n R D Internet: www.tigard-or.gov Read B lu ris: WI Page 2 for
1 1 G ardor. ov Ready /By: g
g g BUILDING f DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use check list
Description I Qty. I Ea. I Total
RI Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ I- and 2- family dwelling ❑ Commercial/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: - 7 Z s v 0 4.14, , Catch basin or area drain 18.76
City/State/ZIP: Drywell, leach line, or trench drain 18.76
y 7 ✓� do - q 2214 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: 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
/ ( Z0 4-41-4P9 - 5 To /2<I! h�j �`o'Gr - f Dishwasher / 25.02
✓ Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
pcic fi � Fixture /sewer cap 25.02
Name: 0
// Floor drain/floor sink/hub / 25.02
Address: /S ?F.:3 Sw S ,tra.'.) /" 14 µ ✓I Garbage disposal 25.02
City /State /ZIP: P�Jc 6/1 r 2L 2 v Hose bib 25.02
Phone: (s--6 �) ‘ CQ Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: ' n _ �J,� / Medical gas (value: $ ) Pa 2
Primer 12.51
Contact name: 6,
Roof drain (commercial) 12.51
Address: pd Y7ah 14' )O / Sink/basin/lavatory / 25.02
City /State /ZIP: / -t .a 7 - 4 ).2.- f 5 Solar units (potable water) 62.54
Phone: ( ) 765cG - 94' FC Fax: : (327); 9- 12fg Tub /shower /shower pan 12.51
-
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Water P i p to WV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7--C-e.f
CCB Lic.: /5 4 / S Plumbing Lic. no.: 2C- 73 4-,0A Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE 74.0
Print name: ,Ibe A j Date: L This permit application expires if a permit is not obtained within 180 days
l �' b / / after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(I0 /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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P 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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: - Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2" 1
3" Isometric or Riser Diagram
4 " ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non -food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav /Bar non -food related I
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
WaterCloset - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I: \ Building \Permits\PLMF- PermitApp.doc 08/04/2011 2
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received man Permit No.:
n Date/By: �� _,/ e L N /�Oj� 5,75 a 13125 SW Hall Blvd., Tigard,OR 9722 l T-. 1 $ [ 102 Plan Review D
C Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:.. t
' Inspection /. eO 2/3
ection Line: 503.639.4175 G ��RDD� D Re
p �; �Gtillll Date Ready/By: furls: ® See Page 2 for
TI G A R D
Internet: www.tigard - orgov .DING DIVISION Notified/Method: Supplemental Information
TYPE OF FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
' IKAddition /alteration/replacement ❑ Other: New I - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
SFR (2) bath 437.78
❑ 1- and 2- family dwelling gf CommerciaUindustrial SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ O ther: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain I 18.76
Job site address: 1.21 a 94. V3I
Drywell, leach line, or trench drain ` 18.76 V6,
City /State /ZIP: 11 OR.. al 3 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: `Qt) I Project name: ,3(%O 519(0_%-r" 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.: ) I Page 2
Subdivision: p%CCe ! l a 1 0/06O I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
- DESCRIPTION OF WORK Backwater valve 12.5 l
/�,� Clothes washer 25.02
1.-f►t I �I') K . Dishwasher 25.02
• POD ( r (L E t'.) 434 D (c --I.i L) ` Drinking fountain 25.02
Ejectors /sump • 25.02
Vk OWNER I ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name: QaL -r-9_,,,,..51-- -r-9_,,,,..51-- r Floor drain/floor sink/hub 25.02
Address: ` gliF IS (:) ° p eck_04,j Garbage disposal 25.02
City /State /ZIP: "n GA-(LD " L i Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: D �1:tt,3 (Al4.tJ , Medical gas (value: $ ) Page 2
Primer ' / 12.51 /.2. s7
Contact name: ... 12444
Roof drain (commercial) 12.51
Address:
Sink/basin/lavatory c? I 25.02 z. p2_
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( 5p)3) '?..50 - Cktiko Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: DE 0 (Ali ?e.Elt,, P((A.Yi) NG Water piping/DWV 56.29
Address: 9 0 t I -& t p i Other: \ 25.02
City /State /ZIP: Q ocz . 71 . 4 . 0 , 3z , .pp..._. l - -Qo3 Subtotal
Phone: Fax: (50 ) 9,
(Sg) T A L 94 _ g Minimum permit fee: $72.50 7 2,..50 O
f
CCB Lic.: 1 69 Plumbing Lic. no.: a c- 136iee, Plan review (25% of permit fee)
State surcharge (12% of permit fee) o O
Authorized signs (/ ,5
TOTAL PERMIT FEE 3/ .
•
Print name: Date: )Q - IS - t 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- PermitApp.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 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 - 1 st 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
p 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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
engineer.
- Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic El Any complex structure as defined in OAR918- 780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
3" l Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
- Car Wash Drain
Garbage Domestic non - food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non -food related f
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
"Tenant Name: Indio Spirits SWR # 2012 -00213 .
Site Address: 7272 SW Durham #100 PIN # 2012 -00303
c�a R , Parcel #: 2S112AD01000
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: - "l'ub /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
,ye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 0 0 0
-3inch 5 0 0 1 5 1 5
- 4 inch 6 0 0 0 0 0
- Car Wash 6 . _ 0 0 0 0 0
Garbage Disposal:
•
- Domestic (to 3/4 P) 16 0.
HP) 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
Shower: - Gang (per head) 1 0 0 0 0 0 i
- Stall 2 0 0 0 0 0
Sink:
- Lay/Bar - Non -Food Related 2 0 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Com /Sery /Util - Food Related 3 0 0 0 0 0
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 IiDU Credit 0
TOTALS 0 0 1 2 1 5 0 3
• Current Fixture Value 3 divided by 16 = 0.188 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous I ?DU
Change 3 divided by 16 = 0.188 over (under) S 886.35
Enter EDU Change Here 0.190
Notes:
Authorized Name /Signature: Debbie Adamski Date: 10/18/2012
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•1•allytihect- 4665.xls 07/01/12