Permit • CITY OF TIGARD
PERMIT
IN COMMUNITY DEVELOPMENT COMMUNITY PLM2013 00079
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/13/2013
TIGARD Parcel: 1 S134AA01800
Jurisdiction: Tigard
Site address: 10110 SW NIMBUS AVE B6
Project: Impact Medical Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 2
Project Description: (1) laundry tray installation
Contractor: BEAVERTON PLUMBING INC Owner: HANSON, RONALD D
13980 SW TV HWY ROBINSON, CONSTANCE A
BEAVERTON, OR 97005 ROBINSON, CHESTER TRUST ET AL
203604 EAST FINLEY RD
KENNEWICK, WA 99331
PHONE: 503 - 643 -7619 PHONE:
FAX: 503 -643 -7620
FEES
Quantity Description Date Amount
1 ea Laundry Tray 03/13/2013 $25.02
Specifics: 1 12% State Surcharge - 03/13/2013 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 03/13/2013 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
•
-Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notifica •• • Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct q -stions to • NC by calling 503.232.1987 or 1.800.332.2344.
Issued B : i / A/ , Permittee Signatur _■ik
Call 503.639.4175 by 7:00 a.m. for the next available inspecti • date.
•
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Plumbing Permit Application RECE D
Building Fixtures MAR 1 3 2013 I (,l c 11 l, (1 1 tin 0\1
City of Ti CITY OF TIGARD ma 3i 3 1 S f
• 13125 SW hall Blvd,. Ti Permit No.: a 3 - DUU�9
-' g arb , 503 972 A3y x r ILDING DI VISIO 'a 't Ieeview
Phone: 503.7182439 Fax 503.548.1 , , - ly: ()titer Permit w°.:,2 ap/ _
I I , r•. Intern , Inspection Line: 5 03.639.4175
Dalt et W W W. r.gov f
RC �y � ( ®$C n eat 2 In f
c _ ti Nntifted/Mctbod: l :pp C ental Info
, , .
0 :
New construction
❑ Demolition For . geld information rise checklist
® Addition/alteration/replacement ❑ Other. - I cription Ha, Total
,:;• New 1- 2 -family dwellings (includes 100 ft. for each utility connection)
} >, � ' 1 -and 2-family uM .' '' . °. <';-,° a.- • SFR. (1) bath 312,70
Y � � ® Commercial/industrial SFR (2) bath 437.78
CI Accessory building ❑ Multi -family SFR (3) bath 500.32
� nz,tat auum0nal Oaln/kttcnen 25.02
El Master builder ❑
.': � ` , y'," . ,� -spy- Fire sprinkler C _ sq. Page 2
4.4..,...,,:,. , .._ f • . 1 k t.� 0 7' 1� T ,
..4, Site utilities:
Job site address:. '. 0 SW NIMBUS AVE /0 I 1 D Catch basin or area drain 18.76
City/Statc/LIP: TIGARD, OREGON 97223 Dtywell, leach line, nr trench drain 18.76
StniteJbld J L no,: Hooting drain (no. linear ft.: �) Page 2
Sap Project name: SCIIOLLS BUSINF,SS PARK B-6 Manufactured home utilities
Cross street/directions to job site: 50.03
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear It: ) Page 2
• Stem, sewer (no. linear ft.: Page 2
Subdivision Water service (no. linear ft.: ,, ) Page 2
I Lot no.: Fixture or item:
Tax map/parcel no.: Back(low ptcvcnter -- 31.27
xr ", •. llackwater valve
INSTALL (1) FIBERGLASS LAUNDRY TRAY z Clothes wayhcr 25.02
" - Dishwasher 25.02
Drinking fountain 25.02
Hlermrc /e, m.r. .G. 075
■
"x ::E : rrwr::. �' a .r :. e nsion tank
x :, : .y ' G: > .: !I±F;: :: a Fop 12.51
Name: . :....: _ .. _ r
Fixture/sewer cap 25.02
Address: Floor drain/floor sink/lrub 25.02
-
City/Stale/72: (Garbage disposal 25.02
Hose bib 25.02
Phone: ( ) lax: ( ) lee maker 12.51
..
,, ;.., , � . . . %`. y ,
>; :. .. � � .. ', ,.. rtin.3�"','' � :;?ti! v kV r. N x',s^ ..` : Intcrceptvr /grease trap 25.02
Business twine: BEAVERTON PLUMBING, INC Medical gas (value; S ) P age 2
Contact Warne: ROXANNE CRIER Primer 12.51
Address: 13980 SW TUALATIN VALLEY HWY Roof drain (commercial) 12.51
Sidabesin/Iavatory 25.02
City/Slate/MP: BEAVERTON, OREGON 97005 Soles units (potable water)
62,54
Phone: (503) 643 -7619 I Fax :: (503) 643 -7620 Tub /shower /shower pan 12.51
E -mail: Urinal
Pf: 25,02
. :•, a:: Water ektset 25.02
BusineM name: BEAVERTON PLUMBING, INC Water heater 1752
Water piping/DWV 56.29
Address: 13980 SW TUALATIN VALLEY WY Other Laundry tray X 25.02 25.02
City/State/71P: BEAVERTON, OREGON 97005 Subtotal 25.02
Phone: (503) 643 -7619 Fax: (503) 643 -7620 Minimum permit fee: $72.50 72.50
CC.13 Lie.: 12889 - Plumbing Lie, no.: 34 - -4 Plan review (253b of permit fee)
- _�
Authorized sigt ur State surcharge (12% ofpermit fee) 8.70
- ' ..Ss. 3,. t 9. ..)\...) TOTAL. PERMIT PEE 81,20 •
Print name: ROXANNF G1tlER Datc: 03/13/13 I •1'hie permit opprwattoo expires Ira permit is not obtained within NO days
after It hax boon accepted as complete.
'tree metbodnlugy set by Tri- County Building Industry Service Beam
1 :\ euading1Pe rmitsttlMU•Perndtppp.doc IWOI/09 440 161o'r(I0/02/COM/wWi)
plumbing Permit Application - City of Tigard
Page 2 - Supplemental information
Fee Schedule:
{�pppp� ���
S ;,.1 f1A10 Vii:`''' :. 'r ,':t: , , v'•']' 71 ::"To.'.:-._ +'Sf:' .lyMi
pegs n stems:
Footing drain - I 100' i 51 ..11i'F e,: ,
5 0.03 O to 2,000 5121.90
Footing drain - each additional 100' r 37.52 EMI 2,001 to 3,600 $169,69
3,601 to Sewer -1st 100' 62.54 7,201 and greater _ $327.54
Sewer - each additional 100' 37.52
-
Water Service - 1st 1.00' 6234
Medical Gas
cc each additional - ;..,5; Systems:
Water Service
Lional 100' 37.52 M
$i.00to 5,000. P it e c$ 7 2. ''
i
$.5
rm &Rain Drain - 1st L00' : - ;� ,
w .
' 62.54 , .
001.00 to $10,
Storm
& Rain Drain - each additional 100' � OU Minimum fee $72
3 7.52 .00 • $72.50 fit the first $5,1300.013 and $1.52 for
1 ' "`' s ' + f i :. : 'Ql � ' ''' g' i 'v: 9 each additional $100.00 or fraction thereof, to
inspection of existing plumbing or for and including $10,000.00,
which no fee is specifically indicated 90.00/hr ■ $10,001.00 to $25,000.04
each a [i for the first $10,000.00 and fur
minimum c -1/2 hour each additional $ 100.130 or fraction thereof, to
Inspections outside of nunnal business - 90.00/hr and including .50 ot the first $25,000.00
hours minimum char: e —2 hours $ZS,001.00 to $50,000.0(1 $379.50 for the first $25,000.00 and $1.45 fur
Reinspection Fees 90.00/hr each additional $100.00 or fraction thereof, to
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 i hr
(minimum — 1/2 hour) each additional $100.00 or traction thereof
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing matures? If "yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Fnrtare`= for:. a ` ....::I*n R i rw f r Plliitlr <:It1 tI...-i'::.:::..011
`Wo1'Icperf "'`•:::'. '' :. Capped Added Rayo�l to Plan review is required for any of the following, •
Baptiwtry/Font - Please check all that apply.
Bath - Tub/Shower ' El Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash - Each Stall engineer.
- Drive Thru 0 New exterior plumbing site utilities for any complex structure
C r/Waxr As irator as defined in OAR918 750
Dish washer - Commercial ^ — ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drin Fo untain ❑ Any complex structure as defined in OAR9114- 780 -0040_
1?yc - Wash
Floor t)tain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
4"
;,
Car Wash Drain
pTf<t•
Garbage - Domestic non - fis Isometric or riser diagram is required for new buildings
Disposal -Domestic—fond related that meet the ualifications ab
- Commercial —food related
- Industrial -food related
Ice MachiR Drains
Oil Separal`w (cier` Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower Gang IL hr_ '{ \ LO--` a k I -� C _ h . - _
- Stall ___L44.4...ta&ri t� `~
Sink/I.av -food related -
Nam - Bradley
-Commercial-food related
- Service
Swimming Pool Filter
v Washer - Clothes — *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - 'loilct "— fees assessed for the sewer increase must be paid before the
Urinal - plumbing permit can be Issued.
Other Fixtures: I
http J / w w w.tigard - or.gov/ city— hallidepartmtents/cd/docs/PLM F- PntmitAmdoe
Accumulative Sewer Tally
!PI o . Tenant Name: Spec Space SWR # 2013 -00053
Site Address: 10110 SW Nimbus B -6, Tigard, OR 97223 PI.M # 2013 -00079
TIGARD
Parcel #: 1S1 34AA01 800
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 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:
- Lav /Bar - Non -Food Related 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Com /Serv/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
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16 = 0.125 Current MU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous I?DU
Change 2 divided by 16 = 0.125 over (under) S 606.45
Enter EDU Change Here 0.130
Notes:
Authorized Name /Signature: Shirley Treat Date: 03/13/2013
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 \SewerTallyShcet- 4665.xls 07/01/12