Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2013 -00224
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/02/2013
Parcel: 2S112AA00600
Jurisdiction: Tigard
Site address: 6713 SW BONITA RD 200
Project: Central Distribution Subdivision: MILLMONT PARK Lot: 49
Project Description: Cap (1) drinking fountain and (1) mop sink, replace (1) existing water closet with ADA water closet.
Contractor: PORTLAND MECHANICAL CONTRACTORS Owner: WALTON CWOR NELSON 13 LLC
2000 SE HANNA HARVESTER DR BY CTMT - WALTON RE TAX
MILWAUKIE, OR 97222 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE: 503 -656 -7400 PHONE:
FAX: 503 -655 -0620
FEES
Quantity Description Date Amount
2 ea Fixture /Sewer Cap 07/02/2013 $50.04
Specifics: 1 ea Water Closet 07/02/2013 $25.02
1 12% State Surcharge - 07/02/2013 $9.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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 Notification 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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344. l
Issued By: J� Permittee Signature: Off. 4./0/4)z__/ �'�.., G �0 "VV /
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.
07/01/2013 08:59 5036550620 PMC GROUP PAGE 02/04
Plumbing Permit Applicati rt._
Building Fixtures C AVE
City of Tigard Received y
1114 • ,, II a 7 a �3 Permit No.�1./y� /.3 -,61,202r 13125 SW Hall Blvd., Tigard, OR 972 ® 201 Date/By: 1 Plan Review
7 Phone: 503.639.4171 Fax: 503 Date/By: Q(f Other Permit Nett/9020/3-10 '
� p
T I G A R D Inspection Line: 503.639.4175 Gay OF flGP RD Date Ready /By: Juri ® See Page 2 for
Internet: www.tigard- or.gov A � , 1 r- r ,•� to Notified/M � tD Supplemental Information
' TV1? ' OF * v s rte. ', ' FEE*., SCH ; .
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
® Addition /alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
• ;; .CATEGOR . - O P '.CONSTRYJCTION . SFR (1) bath 312.70
❑ 1- and 2- family dwelling ® Commercial /industrial 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: 6713 SW Bonita Road Building C, Suite 2(10 Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18,76
City /State/ZIP: Tigard, OR 97224
/ _ _Footing Footing drain (no. linear ft.: ) Page 2
✓ /b g. /apt. no.: Ow I Project name: PCC Rock Creek Central Manufactured home utilities 50.03
Cross street/directions to job site: Distribution TI Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: I 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
' Clothes washer 25.02
Remove existing mop sink and drinking fountain.
Dishwasher 25.02
Replace existing water closet with ADA water closet. Drinking fountain / 25.02 354'I'
' Ejectors /sump 25.02
❑ PROpERT'Y:.OWNER° ® TENANT Expansion tank 12.51
Name: PCC Rock Creek Central Distribution
Fixture /sewer cap ,P._.. 25.02 ` j2' , a y
Floor drain /floor sink/hub 25.02
Address: 6713 SW Bonita Road Building C, Suite 200
Garbage disposal 25.02
City /State /ZIP: Tigard OR 97224 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
': ®. APPLICANT .❑ CONTACT' PERSON. ' ' Interceptor /grease trap 25.02
Business name: Portland Mechanical Contractors Medical gas (value: $) Page 2
Primer 12.51
Contact name: Brian Schain
Roof drain (commercial) 12.51
Address: 2000 SE Hanna Harvester Drive Sink/basin/lavatory 25.02
City/State /ZIP: Milwaukie OR 97222 Solar units (potable water) / 62.54
Phone: (503) 656 -7400 I Fax: : (503) 655 -0620 Tub /shower /shower pan 12.51
E - mail: bschain @pmc -g.com Urinal 25
t .,
Water closet 1 25 02
. • ° . � ' ,; CO 1VTRACTO'R:
. Water heater 37.52
Business name: Same as above. Water piping/DWV 56.29
Address: Other: I 25.02
City /State /ZIP: Subtotal 75.06
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: 151807 Plumbi g Lic. no.: 3 - 425PB
State surcharge (12% of permit fee) 9.01
Authorized signature: TOTAL PERMIT FEE I 84.07 V
Print name: Brian Schain Date:
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.
1A Building Wermits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB)
07/01/2013 08:59 5036550620 PMC GROUP PAGE 03/04
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Square •Footage. Perait`Fee:,
ty..:: , ,ee(ea ;.: Total
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 - .. ..
Storm & Rain Drain - 1st 100' 62.54 Valuation:; Pet riit Fee:.. : • .,
$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
each additional 100 00 or fraction there
, ... .. :.. Total �al r thereof, to
Hier' YTSp'CietiU 1:9.,.01'° . `ees.,.., Q b : Fee (ea) • 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
Reinspcction Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr 550,001.00 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
lu><r �Re'�ie�- forPlam�ing: Iinstallations
accurately report fixtures could result in increased sewer fees *. Plan review is required for any of the following.
Quantity by (Fixture) Work Performed Please check all that apply.
Fixture Type: Replace
Previous Capped Added Existing ❑ Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath - Tub /Shower engineer.
- Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash -Each Stall as defined in OAR918- 780 -0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher - Commercial ❑ Any complex structure as defined in OAR918 -780 -0040.
- Domestic
Drinking Fountain l Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain /sink - 2"
Isoiiiietric or •Riser: Diagram '
s ❑ Isometric or riser diagram is required for new buildings
- 4 „ g 9
Car Wash Drain that meet the qualifications above.
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice MachJRefrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory _
- Bradley
- Commercial
-Service I *Note: If the fixture work under this permit results in an
Swimming Pool Filter
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
WaterCloset- Toilet 1 plumbing permit can be issued.
Urinal
Other Fixtures:
H:IDepartments\New Div 71 Mech & Plumbing\Projects\Service Managettent Dept 71 Projects1219335 PCC Rockcreek Distribution TIFCity of
Tigard - Plumbing Fixture Units.doc
07/01/2013 08:59 5036550620 PMC GROUP PAGE 01/04
PLUMBING & MECHANICAL CONTRACTORS GROUP
FACSIMILE TRANSMITTAL SHEET
TO: FROM:
Debbie Stephanie Taylor
COMPANY: DATE:
City of Tigard 7/1/13
FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER:
503 -598 -1960 4
PHONE NUMBER: SENDER'S REFERENCE NUMBER:
503 -639 -4171 WO #219335
RE: YOUR REFERENCE NUMBER:
PCC Rockcreek Central Distribution TI
❑ URGENT 0 FOR REVIEW ❑ PLEASE COMMENT 0 PLEASE REPLY ❑ PLEASE RECYCLE
NOTES /COMMENTS:
Attached is a plumbing permit application for PCC Rockcreek Central Distribution TI at
6713 SW Bonita Road, Building C,Suite 200.
Please charge the permit fees to the Mastercard shown on the Credit Card Authorization
form.
Please fax the fee receipt for the permit to me at 503 - 655 - 0620.
If you need additional information or have any questions, please contact me at 503 -479 -3180.
Thank you.
Stephanie
Project Assistant
2000 SE HANNA HARVESTER DRIVE • MILWAUKIE, OREGON 972,22 • PH (503) 656 -7400
FAX (503) 655 -0620
CCD #151807 • WA #CCOI PORTLMCO24KA
IN Accumulative Sewer Tally
O
p , T enant Name: PCC Rock Creek Central Distribution SWR # N/A
I Site Address: 6713 SW Bonita Rd., Bldg C, Suite 200 PLM # 2013 -00224
= Parcel #:' 2S112AA00600
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptisery/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 1 1 0 -1 -1
•
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 I -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:
- I.av /Bar - Non -Food Related 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Com /Sery /Util - Food Related 3 0 1 3 0 -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 0
TOTALS 0 0 2 4 0 0 -2 -4
Current Fixture Value -4 divided by 16 = -0.250 Current EDU 1 EDU = $4,800.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -4 divided by 16 = -0.250 over (under) $ (1,200.00)
Enter EDU Change Here -0.250
Notes: EDU Credits
Authorized Name /Signature:; Dianna Howse Date: 07/02/2013 .
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.
1: \ Building \ Sewer Tally \ Sewer CallySheet_4800._070113.xlsx