Permit CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT Permit #: PLM2012 -00343
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/21/2012
Parcel: 1 S135DC00200
Jurisdiction: TIGARD
Site address: 11825 SW GREENBURG RD 215
Project: Spec Space Subdivision: TIGARDVILLE PARK Lot: 8
Project Description: Cap (1) existing water closet and replace existing (1) water closet and (1) lay with ADA fixtures.
Contractor: LIVESAY PLUMBING Owner: TWO G'S REAL ESTATE LLC
175 NE 5TH AVE 18395 WOOD THRUSH ST
CANBY, OR 97013 LAKE OSWEGO, OR 97035
PHONE: 503 - 684 -0550
HONE: 503 - 619 -7594
FAX:
FEES
Quantity Description _ Date Amount
1 ea Fixture /Sewer Cap 11/21/2012 $25.02
Specifics: 1 ea Lavatories 11/21/2012 $25.02
1 ea Water Closet 11/21/2012 $25.02
Type of Use: COM 1 12% State Surcharge - 11/21/2012 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
•
Total $84.07
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of O •pecialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if is not started within 180 days of
issuance, or if work is suspended for more the 180'days. ATTENTION: Oregon law requires you to ollow e rules adopted • the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -s 690. Y- may obtain a opy •f 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.
Plumbing Permit Application
Building Fixtures RECEIVE . rolz (inch: usi: ONI.V
`
City of Tigard Received / z 02/ 42_ I /O ;7 Permit No.:
a 13125 SW Hall Blvd., Tigard,OR 97223 NOV 2 1 2012 Date/By: pC �U 8U1c}'�3�3
Phone: 503.718.2439 Fax: 503.598.1960
Plan .71 C Other PermitNo..a )00 p(aol3c
B
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: kris: : ® See Page for
TIGARD
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WO - 1LDIIVG DIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special injormalion use checklist
Description I Qty. I Ea. I Total
❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
\ CATEGORY OF CONSTRUCTION SFR (l) bath 312.70
❑ 1- and 2- family dwelling ommercial /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: t l �'i�5- �R.f6� Q c Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: T1 U It �_ q1 ZZ 3
� Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.:,' 1 I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: G 13 " "-'„) 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
Z-1-.) ���c� Clothes washer 25.02
.) et Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: ' 0 C, / S F-��T�I_ ercroe rE u L. Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: fit waa,S p{
3 9 S (c 59- i Garbage disposal 25.02
City /State /ZIP: LA. �E O,S 6..>�C / •CSi2- q Hose bib 25.02
Phone: ( )( Ir .r / OS Fax: (9j) 620 5-51r 2 Ice maker Ri•APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: S p,�D' 1J Roof drain (c9matcrcial) 12.51
Address: / f 3 9 & ---- 6 _, 060 77.f2.43H. Sink/basC lavatOry ) / 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( 663 .7 o 5' 73 4 / Fax: : ( ) Tub /shower /shower pan 12.51
Urinal 25.02
E -mail: kt.,4 t $ Q G C-S Poi2 7 j), C O 4
Water closet ! 25.02
CONTRACTOR Water heater 37.52
Business name: L VES tV 6 6 Water piping/DWV 56.29
Address: r 11,.,,,,,, 11,.,,,,,, Other: 25.02
City /State /ZIP: Subtotal
� J F Z !J-$'t 3 Fax: (,113 )'q - 2.63Z Minimum permit fee: $72.50
Plan review (25% of permit fee)
4 /one:
B Lic.: / / 7 2 0 7 bing Lic. no.: 96'I tOCD State surcharge (12% of permit fee) 0/
Authorized signature / TOTAL PERMIT FEE (T 17,19
Print name: - b r I Dat)( 2,11 This permit application expires if a permit is not obtained within 180 days
r after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\ Bu ilding \Permits\PLMU- PermitApp.doc 10/01/09 440.4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard ` r . -,, : c '7
Page 2 - Supplemental Information `P t -cc i y , -
Fee Schedule: `• Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total , Square Footage: Permit Fee:
Footing drain - 1" 100' 50.03 '• "O to •2;000 t\ ' i ' ia; $121.90
Footing drain - each additional 100' 37.52 a'� 342;00 li fo 3,600; 11 Y IV $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54
7,201 and greater $327.54
Sewer - each additional 100' 3732
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) 1 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
- Jacuzzi/Whirlpool engineer.
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 ❑ Any complex structure as defined in OAR918 - 780 - 0040.
Drinking Fountain , i,
Eye Wash - Submit 2 sets of plans with any of the ab
. Floor Drain/sink: - 2" .
- 3" Isometric or Riser Diagram
❑ Isometric or•riser diagram; is required'for.iiew buildings
-Car Wash Drain
Garbage - Domestic non -food that meet,the,qualifications above. . -
Disposal: - Domestic food related
- Commercial food related •
- Industrial food related 4
Ice MachJRefrig. Drains . Comments regarding fixture "work: .
Oil Separator (Gas Station) . ; 1
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/Bar non -food related
- Bradley
- Com/Serv/Util food related
- Service • *Note: If.the;fixture workunder.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 • 4.1 „ plumbing permit can be issued.;,..
Urinal - • • .
Other Fixtures: • • • •
I:\ Building \Permits\PLMF- PermitApp.doc 08/04/2011 2
91 -
v
Tenant Name: Grccnburg Plaza Sewer Tally SWR # N/A
Site Address: 11825 SW Grccnburg Rd, Suite 215 PI Al # PI ,M2012-00343
TIbA RD:
Parcel #: 1S135DC00200
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 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 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: . •
- Iav /Bar - Non -Food Related '2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Com /Scrv/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 1 6 0 -1 -6
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
TOTALS 0 0 1 _ 6 0 0 -1 -6
Current Fixture Value -6 divided by 16 = -0.375 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 .Previous EDU
Change -6 divided by 16 = -0.375 over (under) 5 (1,772.70)
Enter EDU Change Here -0.380
Notes:
EDU Credit for future sewer fees.
Authorized Name /Signature: Dianna 1 -lowse Date: 11/21/2012
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.
1: \ Building \Sewer Tally \Scwcrl'allyShcct- 4665.xls 07/01 /12