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Permit CITY OF TIGARD PLUMBING PERMIT • s. COMMUNITY DEVELOPMENT Permit#: PLM2014-00058 T I C;A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/05/2014 Parcel: 2S102DA00701 Jurisdiction: Tigard Site address: 13405 SW HALL BLVD Project: Tigard Christian Church Subdivision: BARNUM PARK Lot: 9 Project Description: Adding(1)hand sink to kitchen Contractor: RAYBORN'S PLUMBING INC Owner: TIGARD CHRISTIAN CHURCH 19990 SW CIPOLE RD 13405 SW HALL BLVD TUALATIN, OR 97062 TIGARD, OR 97223 PHONE: 503-692-4139 PHONE: FAX: 503-691-2328 FEES Quantity Description Date Amount 1 ea Sink 03/05/2014 $25.02 Specifics: 1 12%State Surcharge- 03/05/2014 $8.70 Plumbing Type of Use COM 47 ea Minimum Fee Adjustment- 03/05/2014 $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 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. Issued 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. CITY OF TIGARD SEWER CONNECTION PERMIT 1,1 .4 = COMMUNITY DEVELOPMENT Permit#: SWR2014-00016 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/05/2014 Parcel: 2S102DA00701 Jurisdiction: Tigard Site address: 13405 SW HALL BLVD Project: Tigard Christian Church Subdivision: BARNUM PARK Lot: 9 Project Description: .19 EDU increase Contractor: Owner: TIGARD CHRISTIAN CHURCH 13405 SW HALL BLVD TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Description Date Amount . Specifics:, Sewer Connection Fee 03/05/2014 $912.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: .19 Total $912.00 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. Issued By: `. ittee Signature: /•'■Idrie�■ Call 5 An:=" 7 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. 02-27-14;07:36 ;Rayboltj�R nb i n ;5036912328 # 1/ 2 pJulmbing Permit A,pplica , ' {' ED Building Fixtures 1 OR OH It 1 t "1 011 N City of Tigard FEB 2 7 2014 ved _C Permit No•: ) A/e/, + t 3125 550 1.611.4171,T pq,9 i`C Plan Review Phone: 503.639.4171 �j 'SA3�5 ARD Date/13 ! der Permit Na..�, ,/y 4 71 '"ri intern ton w n r.so �DIN�DIVI N[ifeNMeth d: See Pare 2 for TYPE . 1 �UPnlementel Intiorn1 j ❑ New construction ❑Demolition _ For s,eciall alMalion age clreckllsx • �Addilion/alteration/rcplaccmcnt ❑Other Now X y—frmlly dwellings(includes 100{t.for each uefyty coon `-''. _ CATEGORY OF CONSTRUCTION -- SFR. < ,' 11 312.70 1-and 2-family dwelling fri Commercial/industrial SFR C ] I=Pd `❑ Accessory building ❑Multi-family Ich �dtiti1� tchen 500.32 El Master builder ❑Other: Fire 3e( s9'ft) 25.02 ETU - JOB SITE INFORMATION AND LOCATION .. -- . Site in ta11>t•Ticx 1 Job site address: 1 3 L/p 5" .5 1i) 1-�A�� !1 _ �� Dryv►,EU� Icach line,or trench drain City/State/ZIP: 'T > 4. 17,2_L3 Foot-iti a in(no.linear ft:____) IIIIIII Suite/bldg./apt.no.: Project name: —7: "Pt C04 (! 1 Ma i i ffl s*-r� me utilities 50.03 Cross street/directions to job site: Ma i1iOlcs emmeerzoiral Sa.rsiutrY s'ewer(no•linear ft.:_ ) iiii---.1 Storm s.wer (m.linear ft,_____) MEM Subdivision: Lot no.: Fixture or Item. Tax map/parcel no.: 61 51 Q), b' 0,070 sscie�ow p voter ' DESCRIPTION OF WORK ancicwate.,„sive ADD �AIt L �L1V1,K 4Q �1.` Dishwasher 25.02 uniair 25.02 to Drinking to um 25.02 Ejectors/sump 25,02 Expansion tank ��. ❑ PROPERTY OWNER ❑ TENANT 25.02 Name: T qa �itnt sd! ti -iii J! Floor drain/floor 25.02 Address: V ..` . s I INZMIZIMII City/State/ZIP: Lf 4-9/1- 1702.13 blase bib• 25.02 25,02 Phone:( ) Fax:( ) ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease tap EMI Medical gas(valucS 25.02 ) Business name: Page 2 Prin►er all Contact name: Roc f drain(commearial) 12,51 Address: sink/basin/lavatory 111Eall 25.02 t. solar (Potable Phone:( ) Fax::( ) fub/shower/showcrpR Urinal 25,02 Ilinn E-mail: Water closet 25.02 — CONTRACTOR Water heater Business name: r : �� i `, Water piPin€D �� 66,29 Address: °s 01_ s 0 - Other: NMI MIME City/State/ZIP: w, d #r ,., _ Subtotal Phone:(St') � —L j j p 7 Fax:(�`31 (, ..a_.3�/ $ Minimum pettrrit fee: S72,S0 • t Plan review (25%ofpennit fee CCB Lic.: r �S` // � � Plumbing Lic o.: � - _ � State surcha ) Authorized signature: A=Jr.�( � tgc(129'0 ofpermit fro) - 70 ��-�► I i I� TOT ALPERMfT r ��-,�;,�,,�; Y-hfa permu apaneva•neaPlrey lra �E aZ,O rah Date:,, / after N Jrpr t tM�uneombtalned Within 180 days 'Fee methodology sdby rri,Couary Building InduuntrY Service Board. t;1BUUdlat\PeamhPLMU.PmmitApp.dot 10101/09 6taTtiao?JCOhvwEa) 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-I"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 ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure Each 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 4 ❑ 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 -Bradley -Com/Serv/Util food related j -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 increase be paid before the Water Extractor e sewer ncrease must p WaterCloset-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 N--- " Accumulative Sewer Tally Tenant Name:Tigard Christian Church - SWR# 2014-00016 Site Address: 13405 SW Hall Blvd PLM# 2014-00058 t r t Parcel#: 2S102DA00701 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 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 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 HP) 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 Living Unit 16 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 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 0 TOTALS 0 0 0 0 1 3 1 3 Current Fixture Value 3 divided by 16= 0.188 Current EDU 1 EDU = $4,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 3 divided by 16= 0.188 over (under) S 912.00 Enter EDU Change Here 0.190 Notes: Authorized Name/Signature: Debbie Adamski Date: 3/4/2014 Building Division rote: 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\SewerTallySheet_4800._070113.xlsx 111 -- Accumulative Sewer Tally Tenant Name: Tigard Christian Church SWR# 2014-00016 Site Address: 13405 SW Hall Blvd PLM# 2014-00058 Parcel#: 2S102DA00701 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 1 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 I1P) 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 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Station) 6 0 0 0 0 Il 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 11 Sink: -Lav/Bar-Non-Food Related 2 0 0 0 0 O -Bradley 5 0 0 0 0 0 -Com/Sery/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 0 TOTALS 0 0 _ 0 0 I 3 1 3 Current Fixture Value 3 divided by 16= 0.188 Current EDU 1 EDU= $4,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 3 divided by 16= 0.188 over (under) $ 912.00 Enter EDU Change Here 0.190 Notes: Authorized Name/Signature: Debbie Adamski Date: 3/4/2014 Building Division rote: The property owner shall retain the ORIGINAL,sewer tally record. If credits exist,this document will serve as a voucher which must be ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges. I:\Building\Sewer Tally\SewerTallyShcet_48(K1._070113.xlsx Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 13405 SW HALL BLVD, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal 2014-03-24 00:00:00 PLM2014-00058 PASS - No C of O NOTE provide caulking around sink Violation Summary: Inspector Contractor