Permit u CITY OF TIGARD PLUMBING PERMIT
14 - ' • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00099
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/26/2013
Parcel: 1 S135DC00200
Jurisdiction: TIGARD
Site address: 11845 SW GREENBURG RD 120
Project: Spec Space Subdivision: TIGARDVILLE PARK Lot: 8
Project Description: Cap (2) water closets and (2) lays, add (1) water closet and (1) lay.
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
P
PHONE: 503 - 684 -0550
PHONE: 503 - 619 -7594
FAX:
FEES
Quantity Description Date Amount
4 ea Fixture /Sewer Cap 03/26/2013 $100.08
Specifics: 1 ea Lavatories 03/26/2013 $25.02
1 ea Water Closet 03/26/2013 $25.02
Type of Use: COM 1 12% State Surcharge - 03/26/2013 $18.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $168.13
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 •.t started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow e ules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. ou ay obtain a co• of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ��� / Permittee Signature: Z.:01
d
Call 503.639.4175 by 7:00 a.m. for the next available ins .ecti. • 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 FOR OFFICE USE ONLY
Ci of Ti and E CEIVED Received 1114 q g Date/By: i i Permit No.: d eJ 'ea.)?
13125 SW Hall Blvd., Tigard, 0 Plan Review
Phone: 503.718.2439 Fax: 503.59W 2 6 2 013 Date/By: Other Permit No.:
r+t `
Inspection Line: 503.639.4175
T I G A R D Date Ready/13y: Juris: El See Page 2 for
Internet: www.tigard - or.gov OFT�GARD Notified/Method: Supplemental Information
TYPE OF tNG DIVISION FEE* SCHEDULE
❑ New construction D emolition ff For special information use checklist
Description I Qty. I Ea. I Total
J Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling .1:g Commercial /industrial SFR (2) bath 437.78
El Accessory building SFR (3) bath 500.32
ry g ❑ 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: \ \( / j Catch basin or area drain 18.7 -
-' C��2�1gV,V� r " ° " Drywell, leach line, or trench drain 18.76
City/State /ZIP: \ O 6 ' a. -223
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.. AC Project name: �) 5P fre--€." Manufactured home utilities 50.03
Cross street/directions to job site: \,C� N , " �\N . k qt) Manholes 18.76
V • <�‘*2��u •c� 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.: / 6/ 3 5 e 00 ,3.00 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
C Clothes washer 25.02
`�`a`\nt `r\ Z. %& Q �f ∎ ■Q T Dishwasher 25.02
NO \ Ct1 Q 'C k.L+.k‹.--, \ \---QV' Drinking fountain 25.02
Ejectors /sump 25.02
El PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture /sewer cap I 25.02
�
Nam ur b � �_�` � \ �� L t Floor drain/floor sink/hub ( 25.02
Address: ' \a O5 T C 1-\..\A.. . - S
Garbage disposal 25.02
City/State /ZIP: 1_54,,e � 7 i u SZ 0-1 S Hose bib 25.02
Phone: &4--c . c Fax:�� J Ccg- Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: ��,
Medical gas (value: $ ) Page 2
Contact name: ) Primer 12.51
1�E--,,C.v `-' Roof drain (commercial) 12.51
Address: \ \S� 1hNr 'J \- ` SinldbasitEroDy l 25.02
City/State/ZIP:-UN stir - eCo e, i G CZ- S Solar units (potable water) 62.54
Phone: L5pj )`1 f -• 43 \9 Fax ::(SD3)Liao c4cC Tub /shower /shower pan 12.51
E -mail: ∎ C_ JfP__'�O -, l L��,, vt`p.�.1� Urinal 25.02
CONTRACTOR Water closet / 25.02
p n Water heater 37.52
Business name: L 1 v tea '-'-i-4.‘ Pl v ; l b 1n Et ft 1L` 1 7h (.-. Water piping/DWV 56.29
Address: 17 c N B- S t Other: 25.02
City/State /ZIP: C ( \0 o 0 (2... C?() 6 )3 Subtotal
Phone: ($ p3 ) (Q lei r-1 g9 y Fax: ( ) Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: 1 9 0 Plumbing Lic. no.: 1.70 PI*
State surcharge (12% of permit fee) /,
Authorized signature: �`cZ' � TOTAL PERMIT FEE K160
Print name: / l v �✓Qx.- Gi tee.} Date: 3/2..03 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.
I:\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
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
CJ Any new commercial building with water service 2" and
Bath: - Tub /Shower
greater, except systems designed and stamped by licensed
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru 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"
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 'Z
- 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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet Toilet Z.. f plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
1111 Accumulative Sewer Tally
C 7 T enant Name: Spec Space ** *CREDITS * * SWR # N/A
Site Address: 11845 SW Greenburg Rd #120 P1.M # 2013 -00099
TIGARD
Parcel #: 1 S1 35DC00200
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #5 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 I IP) 32 0 0 0 0 0
- Industrial (over 5 III)) 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 2 4 1 2 -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 2 12 1 6 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 16 2 8 -2 -8
Current Fixture Value -8 divided by 16 = -0.500 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -8 divided by 16 = -0.500 over (under) S (2,332.50)
Enter EDU Change Here -0.500
Notes: ** *CREDITS * **
Authorized Name /Signature: Debbie . \damski Date: 3/26/2013
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 \Sewer l'allyShcet- 4665.xls 07/01/12