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Permit n CITY OF TIGARD PLUMBING PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: PLM2013 -00195 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/20/2013 Parcel: 2S110AB00200 Jurisdiction: Tigard Site address: 14455 SW PACIFIC HWY Project: Canton Phoenix Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1 -4 Project Description: Cap (2) water closets. Contractor: OWNER Owner: BULL MOUNTAIN INVESTMENTS LLC ATTN JERRY KOLVE 14389 SW PACIFIC HWY TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 2 ea Fixture /Sewer Cap 06/20/2013 $50.04 Specifics: 1 12% State Surcharge - 06/20/2013 $8.70 Plumbing Type of Use: COM 22 ea Minimum Fee Adjustment - 06/20/2013 $22.46 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 i rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility N 'cation Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules ::est0n5to OU alp, alling 503.232.1987 or 1.800.332.2344. 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 �" FOR OFFICE USE ONLY 71 City of Tigard DCP dg0 3 Permit No.: 016/7/3 -OO /f s U 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Pl 0 P hone: 503.718.2439 Fax: 503.598.1960 DateBy: an Review Other Permit No.: T I G A Iz D Inspection Line: 503.639.4175 Date Ready/By: Sufis ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information • . TYPE OF • - . • , FEE* SCHEDULE • ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement /® Other: CA 50 New I- 2- family dwellings (includes 100 ft. for each utility connection) '. ' CATEGORY OF CONSTRUCTION 1 SFR (I) bath 312.70 1:1 1- and 2- family dwelling FICommercialIindustrial 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: l ` 1 `t 55 ._w. . P L \-1-1 „N , Catch basin or area drain 18.76 City /State /ZIP: . - i� tiRl � D ev-- 1- `"" Drywell, leach line, or trench drain 18.76 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt.no.: 1 Project name: COO I Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 CM ∎) l - n 1 30 S c 0 R 'S � (n I t c C rr . Q ` Rain drain connector 18.76 �lJ r 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 0 C Clothes washer 25.02 14P'QI) 14 R � � � ,I1-1 Fa C7t U t Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ititF PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture /sewer cap 25.02 2� Name: G C V 1 ?- Floor drain/floor sink/hub 25.02 Address: ` , Pm__ R 1��Jg S(i.J t'`) Lk. Garbage disposal 25.02 City /State /ZIP: Tt G y.. ftD CDQZ 0 1 7 2 -2- Hose bib 25.02 Phone: (SO3 Gar) '3O ° Fax: (5b3 '7, Se (l Ice maker 12.51 a--APPLICANT Ca PERSON . Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 \ 1 Primer 12.51 � Contact name: -- 1-c) ( Roof drain (commercial) 12.51 Address: \' 3 S1.�J , 1'I sc k W Sink/basin/lavatory 25.02 City/State/ZIP: /+, tY �� � � vR C( 2.2.. Solar units (potable water) 62.54 Phone: (5 o 39 69 9,p, Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: C At IJ 1 - G-2lop_i C - 6-1Q1 - 6-2 Z yA_Bno . co to Urinal 25.02 CO RACTOR Water closet 25.02 (Owt.)(77e) Water heater 37.52 Business name: G C L . f c- Water piping/DWV 56.29 Address: 1 A_ 3 l 5 ;-A-) C 4-C H(.0 Other: 25.02 City/State /ZIP: T rr C Pt. R D 0 Q q7 Z Z`i Subtotal Phone: ( ,x(51 „© gd R 7 Fax: (563 C 9 5g l I Minimum permit fee: $72.50 72 , 60 CCB Lic.: / P bing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) 9.70 Authorized signature: 0.91/4_ I TOTAL PERMIT FEE gf .01O Print name: IN. L A_ 0 \Ao l 1 N S Date: . poll 3 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. 1:\ Building \Permits\PLMU•PermitApp.doc 10/01/09 440- 4616T(10 /O2ICOM/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 Quanti 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 El 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" 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: -LavBar 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 Water Closet - Toilet plumbing permit can be issued. Urinal - Other Fixtures: I: \Building\Permits\PLMF PermitApp.doc 08/04/2011 2 71 Accumulative Sewer Tally v C T enant Name: Canton Phoenix "*CREDITS''" S \VR # N/A TIGARD Site Address: 14455 SW Pacific Hwy PLM # 2013 -00195 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: - Bach Stall 6 0 0 0 0 0 - Drive through 16 0 0 0 0 0 Cuspidor /Water A spirator 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 Flour 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 1 -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: - I,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 0 0 0 Swimming Pool I:ilter 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 0 -2 -12 Urinal 6 0 0 0 0 0 Previous I.DU Count 0 0 Capped [DU Credit 0 • TO' I';U.S 0 0 2 12 0 0 -2 -12 Current Fixture Value -12 divided by 16 = -0.750 Current EDU 1 EDU = $4,665.00 Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU Change -12 divided by 16 = -0.750 over (under) $ (3,498.75) Enter EDU Change Here -0.750 Notes: 44-4- CR13DI'I'S Authorized Name /Signature: 'Debbie Date: 6/20/2013 Building Division Note: The property owner shall retain the ORIGINAL sever tally record. l f 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 \Seder Tally \Sewer I'alh'Shcet- 41665.x1s 07/01/1 2