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Permit 1 y �� CITY OF TIGARD PLUMBING PERMIT 11 g - COMMUNITY DEVELOPMENT Permit#: PLM2013 -00024 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/16/2013 Parcel: 2S110AB00200 Jurisdiction: Tigard Site address: 14345 SW PACIFIC HWY Project: Desserts of Distinction Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1 -4 Project Description: Installation of (1) additional hand sink. Contractor: PRO DRAIN & ROOTER SERVICE, INC Owner: KOLVE, G C 3300 NW 185TH AVE #213 14389 SW PACIFIC HWY PORTLAND, OR 97229 TIGARD, OR 97224 PHONE: 503 - 533 -0430 PHONE: FAX: 503 - 296 -2419 FEES Quantity Description Date Amount 1 ea Sink 01/16/2013 $25.02 Specifics: 1 12% State Surcharge - 01/16/2013 $8.70 Plumbing Type of Use: COM 47 ea Minimum Fee Adjustment - 01/16/2013 $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 started within 180 days of issuance, if ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility otification C- -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or dir ct questions to OU • • . al . g 503.232.1987 or 1.800.332.2344. / Issue By: O A�r�f /J // j , Perm ittee Si nature: I � �� Call 503.639.4175 by 7:00 a.m. for the next available spection 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. To: City of Tigard Pege a of 3 2013 -01 -10 23:32:48 (0 MT) From: Osorgfa Risenmay 01- 10- 13;12:11PM;From:roDrain & Rooter Srvc. To:5032962419 ;5035339376 # 2/ 2 Plumbing Permit Application Building Fixtures USE O Q / /��� FOR OFFICE ICI:; N'L\' City of Tigard RECEIVED s : / /, arow%Irzw G ,ierc9.406.4 ;2 I C + 13125 SW Wall Blvd., Tigard, OR 97223 Review Flan Phone: 503.7182439 Fax: 503.598.12 N 10 2013 plan Other Penult Nn,: T 1 G A R D flupectiolt Line: 503.639.4175 Date Ready/13y: Jule: ei See Page 2 for Interact: www,tigord -er,gpv Noiilied/Me11wd: Supplemental Information Y OF TIGA • TYPE. OF`W • a T . fi . ...:..::...::,:..::. :: > ::::•::•:•:. • .. FEE! SCHEDULE: I DING DI1 h >..:::.: .......:...... • Fo r ❑ New construction ■ r emoltbon sp information use eheekGsk Description ( Qty. I Ea. I Total A4iddition/altcration/rcplacement ❑ Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection) CATEGORY: O>~'': CONSTYtucrioN ::.:::.;;:':' `;; :': :: ;:..;:. SFR (I) bath 312.70 0 I- and 2- family dwelling Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 © Accessory building ❑ Multi - family - Each additional bathrkitchtm 25.02 ❑ Master builder _❑ Other: Fire sprinkler (_ sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION r` >:; ':? ' :;,:;' Site utilities: Job site address: I I L. S S &) 'p& k iy Catch bruin or area drain 18.76 City/State/ZIP: ! � Drywall, leach line, or trench drain 18.76 Footing drain (no. linear R.: _ ) Page 2 Suite/bldg. /apt. no.: Project name: S(o /t'S t,(hne)( ()ll Manufactured home utilities 50.03 Cross street/directions to j.. site: ' �,/ ? Manholes 18.76 ., �� L I J r �airiej a0/a'00 d 5 i Rain drain connector 18.76 Sanitary sewer (no. liner R.: _) Page 2 4.4 /` - ' Storm sewer (no. linear ft.: ) Page:2 LKr� C-KAe. A.441L._,p / /y/ 3 Water service (no. linear R.: _) Page 2 Subdivision: Lot no.: Fixture or item: Tax map /parcel no.: Backllow preventer 31.27 •• • i DESCRIPIZON� OF WORtC` ` ': ;: ' ' : : : " `': "'s :; Backwater valve 12.51 7 1 n ,� r- .. n. „I Clothes washer . 25.02 3t•ltt a t I k s.) c, l /\ < 1 Dishwasher 25.02 S Drinking fountain 25.02 ..et r' F ( CyQ 4 otoriirum p 2 5.02 (11-r_ ...-1:4 ' ❑ PROPERTY E T NANT. :; : `;' i = ::`` :'• pension tank 12.51 Name: Fixturelsewer cup 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.(12 City/Stare/ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) ice maker 12.51 • Interceptor/grain tra ©APPLICANT O:;CONTACT:::•PERSONs: trap 25.02 - medical gas (value: $ ) Page 2 Business name: Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory I 25.02 , I 0 City /State/ZIP: Solar uniL'i (potable water) 62.54 Phone: ( ) I Fax:: ( ) Tub/shower /shower pan 12.51 E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR. :l:::;.::: :`. <:;:;::s: :": Water heater 37.52 Business na 'P1 ` r-6. t A ' T2 oj}}t-f Water piping/DWV 56.29 Address 5:50/) &1 (0`j'l' I 2.,( 3 Other. 25.02 City/State/ZIP: 7? olik [(Aye.! ' a 9,1 ■2-1 _ Subtotal Phone: () 53 ( 2 Fax: (5o:�) 2S - � ( y Minimumpemitfee :572.50 7(9.50 CCB Lie.: I ID 5G `f " y Plumbing Lic. no.:3- 7 ? Plan review (25 "/0 of prink fee) ----- State surcharge (12% of permit fee) g,76 Authorized signature: TOTAL PERMIT FEE Lc s C � g�.ac, [ Print name: LI Set_ i t..e. Date: 0 0 / 1 3 'Thus permit application expires If a permit is not obtained within 1 days ` after it has been accepted as complete. •Fee methodology set by Tri•County Building Industry Service Board. I:UtuiWingP milaU'LMU•PcnoilApp.JOO 10 44IM616T(10/02C0M/Wc8) To: Clty of Tlgafq Page 1 Of 3 2013-01-10 23: (OMT) From: G ®orgy Rloan may RECEIVED JAN 10 2013 FAX COVER SHEET CITY OFTIGARD TO City of Tigard BUILDING DIVISION COMPANY City of Tigard FAX NUMBER 15035981960 FROM George Risenmay DATE 2013 -01 -10 23:32:27 GMT RE Addition to existing permit COVER MESSAGE Thank you for adding this to the existing permit at this address. Greg N .12-1-4 (i Fi OA - L. f.b 1 /i C6 -vv 0406 L t. H+ T r5 K a u 21_ R t P tiro t-t ti o-r / J t&) f1ryv , n o1Jr4t- ,4 X 7 Li (//5 \bvi 6- e L * 1 /1t,Ia 9155 JfK__ 0.1 www.efax.com 71 Accumulative Sewer Tally a C "Tenant Name: Desserts of Distinction"CREDITS*' S\CSR# N/;\ Site Address: 14345 SW Pacific Hwy . # 2013-00024 TIGARD - - Parcel#: 2S110AB00200 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 I-IP) 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 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 1 3 1 3 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 2.25 36 '1'O"1':U.S 0 0 0 0 1 _ 3 1 -33 Current Fixture Value -33 divided by 16= -2.063 Current EDU 1 EDU= $4,665.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change -33 divided by 16= -2.063 over (under) S (9,609.90) Enter EDU Change Here, -2.060 Notes: ***CREDI"1'S4"Credits from PLM2012-00358 applied to this permit. Authorized Name/Signature:,Debbie Adamski Date: 1/16/2013 . 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\Scwcr'I'allySheet-4665.xIs 07/01/12