Permit -- CITY OF TIGARD PLUMBING PERMIT
''1 ' COMMUNITY DEVELOPMENT Permit #: PLM2012 -00348
71GAAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/29/2012
Parcel: 2S 112 DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 198
Project: Computeration Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Cap (1) break sink
Contractor: DEAN WARREN PLUMBING & REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
P
PHONE: 503 - 624 -6300
PHONE: 503 - 236 -4152
FAX: 503 - 296 -2218
FEES
Quantity Description Date Amount
1 ea Sink 11/29/2012 $25.02
Specifics: 1 12% State Surcharge - 11/29/2012 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 11/29/2012 $47.48
Plumbing
Class of Work: ALT
Type of Const:
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 start-d within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules :dopted by the Oregon
Utility Notifi - •• • enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -009! You may o•• ain a copy of the rules
or direc • estions to O by . ' g 503.232.1987 or 1.800.332.2344. i
Issu :d By: 0 / , /e � /2- _ l Permittee Signature: ittdi
Call 503.639.4175 by 7:00 a.m. for the next available inspect' date.
This permit card shall be kept in a conspicuous place on the job site until c; pletion of the project.
Approved plans are required on the job site at the time of each inspection. '
Plumbing Permit Application
Building Fixtures FOR OFPICF: us[: ONLY
City of Tigard R eceived c ( y( Permit N o.' L D �� - OD 3�a
n 13125 SW Hall Blvd., Tigard,OR 97223 DaDate/By: /�' a
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit N n
Date/By: 9��7 A9f1- VamS
Inspection Line: 503.639.4175
I' I G A R U Date Rea /B 1 1 El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 1 ' w Supplemental Informat
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use cltecklisL
Description I Qty. I Ea. I Total
l Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I- and 2- family dwelling ®.Commercial/industrial SFR (2) bath 437.78
❑ Accessory building Multi-family
SFR (3) bath 500.32
❑ Multi -famil
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: \5 5o o }- FQ.ICL.D Catch basin or area drain 18.76
c/
City /State /ZIP: - 0 p(z G�-}aa({ Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: Page 2
Suite/bldg./apt. no.: (q, b I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Ll o H PuT-r'1-7-yG 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: 1 Lot no.: Fixture or item:
Tax map /parcel no.: A. d C f - DA- Ol Voo Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
CA) \ WA^ ^ c 0 4 Clothes washer 25.02
`�+c.r�i JI Vim• Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: PAS v -Ru,Sr- Fixture /sewer cap 1 25.02
p � Floor drain/floor sirlk/hub 25.02
Address: 15350 ASP tp A- Tl" Garbage disposal 25.02
City /State /ZIP: T l&j rt �( 0 ��2ci Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
// -- Medical gas (value: $ ) Page 2
Business name: PEA.0 (tifkl74 ,(�) P`tANLhlAZ
Contact name: , c)E .pl tL� Roof 12.51
Roof drain (commercial) 12.51
Address: Pf) �� Iii I Sink/basin/lavatory 25.02
City/State /ZIP: po la ( ( IJ.b cn-pR 3 Solar units (potable water) 62.54
Phone: (503) 'n�j- ot EtO L9 Fax:: ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Demt,. ^ WAR,Q,� � (�`kMb( Water 1 m WV 56.29
� P
Address: 7 w,_ 14 I Other: 25.02
City /State /ZIP:•PpQ.._ D Q Subtotal
(TO) Q L W.
Phone: 1,-lp Fax: ( ) Minimum permit fee: $72.50 -
nG � 2 Plan review (25% of permit fee)
CCB Lic.: r, 5 y q 1� �P umbin g Lic. no.: ps d �J State surcharge (12% of permit fee) 9 . '7 0
Authorized signature/ • / TOTAL PERMIT FEE 151
Print name: , � � {�,p Date: I ,2A_ This permit application expires if a permit is not obtained within 180 days
C ' \� 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 - 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" F _cry .a/
3" 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: - Lav/Bar non -food related
- 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:
1:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
4
_ Tenant Name: Computcration SWR # N/A
Site Address: 15350 Sw Sequoia Pkwy #198 PI ,M # 2012 -00348
T1GARq Parcel #: 2S112DA01400
Fixture Value Previous Previous Credits Capped fixture Fixture New New
# value count capped #5 value count added # added value total #s total values
Baptiscry/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
lye Wash 1 0 0 0 0 0
' Floor Drain /Sink: - 2 inch 2 0 0 0 0 0
-3inch 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 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
- 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 /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 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
'l'OTAIS 0 0 1 2 0 0 -1 -2
Current Fixture Value -2 divided by 16 = -0.125 Current I ?DU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -2 divided by 16 = -0.125 over (under) S (606.45)
Enter EDU Change Here -0.130 -
Notes:
Authorized Name /Signature: Debbie Adamski Date: 11/29/2012
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.
I:\ Building \Sewer Tally \Sewer l'allyShcct- 4665.xls 07/01/12
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