Permit , CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit#: PLM2014-00215
T f G A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/30/2014
Parcel: 2S 102AC00500
Jurisdiction: Tigard
Site address: 12492 SW MAIN ST
Project: Spec Space Subdivision: BURNHAM TRACT Lot: 1
Project Description: Capping(1)lay,(1)water closet&(1)urinal,adding(1)2"floor drain,(2)primers&(1)commercial sink,replacing
or relocating(1)2"floor drain,(1)lay,(1)commercial sink&(1)water closets.
Contractor: WESTERN PLUMBING Owner: WOODARD LIVING TRUST
9460 SW TIGARD AVE SUITE 101 PO BOX 23303
TIGARD, OR 97223 TIGARD, OR 97281
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
3 ea Fixture/Sewer Cap 06/30/2014 $75.06
Specifics: 2 ea Floor Drain/Floor Sink/Hub 06/30/2014 $50.04
2 ea Primer 06/30/2014 $25.02
Type of Use: COM 2 ea Sink 06/30/2014 $50.04
Class of Work: ALT 1 ea Lavatories 06/30/2014 $25.02
Type of Const: 1 ea Water Closet 06/30/2014 $25.02
Occupancy Grp: 1 12%State Surcharge- 06/30/2014 $30.02
Stories: Plumbing
Total $280.22
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
Uti j i i Center. Those rules are set forth in OAR 952-001-0010 through OAR 95248 :090. You may obtain a copy of the rules
direct questions to UNC b calling 503.232.1987 50,31.232.1987 or 1.800.332.2344.
Issued By: ,rk I^ A /l; Permittee Signature:
'PINT G -
Call 503.639.4175 by 7:00 a.m.for the next availab, nspection 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.
06/30/2014 12:3@ 5036849015 WESTERN PLUMBING INC PAGE 01
Plumbing Permit AnpliakinTIVEP
Building Fixtures FOR ()Fru:r i ,-,F. 0:■IA
City of Tigard JUN 3 0 2014
ilr‘ITAIM11111211=1.117fell .- Jr/
111.., • 13125 SW Balt Blvd,Tigard,OR 97'223 --
Ptan Review
: . Phone: 503.639.4171 Fimillipig0/4 I GA RD rate/By: other Penns No.4,popa, ....49/i,
*-- Inspection Line: 503.639A173n.
T I s:;\"" Internet: www.t1gartkir.01111 DIN r. !III/SION Date Readyn3y:
Notified/Method, Jack 2r Sot Papp 2 tbr
Supplainadal lesrmation
• ''!::::,..':;'•', . : ."7.: .:' 1: :.°1. /FORK
El NM ocestruction 0 Demedirm. For Vicki,iteentrogen meet:keens&
Description
in AdditionAdrantion/replacesuent 0 Other: New 1-2-Ibmity dwellings(includes 10 l'itt.yfor. each eitELutilitylcenneisT431
• '..•....;.:'''''''....-'''.:-.;.: . , rAnGeirit0.0ittintitaiiiit. .' .... SFR(1)bath 312.70
0 1-and 2- my dwelling 1:.4 Commeiciid/inductrial SFR(2)bath • 437.78
50032
R ) ' --
El Aoceseory building 0 Multi-faraily SF C3 bath
Each additional bath/kitchen 25.02
C]Master builder 0 Other:
are sprinkler( sq.ft.) Page 2
401114litiLlitlit01110i4i0etj .AND LOCAlikt3if Sfte unitieet
Job site address: i 2 4.4 ' a,of) _ , Catch basin cc area drain 10.76
Dryarell,leach line,or trench drain 18.76
City/State/ZIP: ---FC --ci D v__ qg 2.2._?-,
Footing drain(ou.linear St:_) Page 2
Suite/Mg./apt no.: Project name: itligall'01;/A.a_sam art Manufacenred home utilities 50.03 '
Cross street/directions to job site:
kP e_ 5PA-c t_ • Manholes 13.76
Rain drain connector 1L76
sanitary sewer(no.linear ft.: ) Page 2
r
Storm mass(tio.linear ft.!_) Page 2
Water=vice( o.linear IL:_) Page 2
Subdivision: Lot no.: Roans or gage _
Tax insp/Parceln0.: A6 I 6 9-AC. CO 500 Backflow preventer
31.27 I
. , . . . . .„
'' " " " Backwater valve 1251
pllijellilililiOrMrAVOli11!"*:' '
Clothes washer 2102
Dishwasher 25.02
Drinking fountain 25.02
EircsorainasT 25.02
7"".....-.. "4kiiiiilliVir'.4{illtlilit2. ,...' .'rl'iitiNT . ....'e.....:'-''' Expansion tank 12.31
Ns= .. la gi. !' _ A ikAto Fixture/sewo cap 3 25.02 7 5-.040
Flow drain/floor andrJhub 91 25.02 50 iO4/
Addict's: Veng \I \AJOI3a ______ ___,.. \ Garbage disposal 25.02
City/State/ZIP: .-----a 6 1rd Dt6ct'-'1"2,•?-,-.-12 Hoes has 23.02
Phone:6):)r tol y ii t d Fax ( ) loe tinker 12.51
0..*IPialtAillY rtr Otirg00:ttglisoll. . Interceptongree.se trap 23.02
, -
Business name: Medical pa(value:$ ) Page 2
Primer 2.,, 12.$1 .p5.44
Contact name:
Roof drain(oonutiostial) 12.51 '40
Address:
Sink/baseintlavaiary '_ _ 3
_ .
Cy/State/ZIP: Solar units(potable wider) ' 62.54
Phone:( ) Fax:( ) 'TulliehowerIshovear pan 12.51
E-mail: Urinal ' 25.02
Water closet I 25.02
Water heater 37.52
Business ittfullei:Western Plumbing,Iii.. Water Water piping/DWV 56.29
Address;9460 SW Tigard Avenue Suite 101 Other 25.02 9,....- ;2-
City/State/Z1P:Tigard,OR 91223 Subtotal _ALA:ni
Phone:(503)639-6296 FLUE(603)6114,9015 Miainams permit fee: $72.50
r Plan review (25%of permit fee)
CCB Lic.:2439 Numbing Lie.no.:34-29PB
A Stag gilrghlitge(12%orpormit fee) '2 _. o
Authorized siguanne la ,
TOTAL PERMIT FEE V.4..fr-L
4 ■
Print name Dan - _...p"
This permit application...pima Ifs pet is net oilialued within 180 cis)
: a Jensen Date: , Mal
after it has base acteptad is couplets.
ttop..m....),nried.vve..41,7••Tri_revmn.Plvileliv.14..,s,v Ro•rvi,..Pl....rel
06/30/2014 12:30 5036849015 WESTERN PLUMBING INC PAGE 02
Plumbing Permit Application - City of Tigard
Page 2- Supplemental Information
Fee Schedule: Residential Fire Su ress�
_ �•:. .. stems:
n s m
r,sttrs, Fee .* ' ' LL.5 as f't10 - P
Footing drain-1 100' 50.03 - 0 to 2,000 -` l'�.
_ 3111.90 _
Footing drain-each additional 100' 37.52 2.001 to 3,600 5169.69
Sewer-1st 100' 62.54 - X601 to 7,200 w$?33.20
Sewer-each addiSonal 100' 37
7,201 and greater $32754
37.52
Water Service-1st 100' 62.54
Water Service-each additional 100' 3732 Medical Gas Systems:
Storm&RAM Dram- at 100' r
•-• 62.54 + '
$1.0010 S5,000.00
Storm�Rain Dray-each additi 00' _ � - fee 377-SO
on:4 l 3732 r o$10,0 M$72.50 fo
�y ,001.0010$10,000.00 $72.50 for the first$5.000-00 and$1.52 for
�U' " "or F° '"`•:.1 " r4". :' each addkioml$100.00 or fraction thcre04 to
Inspection of existing plumbing or for"—"'r _�"`-.-�•. ' and roan ,$10 000.00.
which ti fee is specifically indicated f 90.00/hr
10,001.00#0 225,000.00 $145.50 forthe first$10,000.00 and 134 for
(minimum oharpe-1/l hair) each additional$100.00 faction thereof 10
1nsQcdiona outside of normal business 9000J1w agd inchr.: 525,000.00.
boas(minimwn _ 2 horns) $25,001.0o to 510,000,00 5379.50 fortlte feat$23,000. 0 and S1.45 for
Reinapedioa Fees 90 � each additional$100.00 or fraction t ern to
and including 550,000.00.
Additional plan review for revisions 90,E $10,001.00 and tip $742.00 for the first$50,000.00 and$1.20 for
( im charge-1/2 hour) each
additional$100.00 or fraction thereof
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes", ,.•:.. ..,
piesse Indicate work performed by fixture. Failure to eviewu or any Plan review is required for airy of the following.
ccurately report fixtures could remit in Increased sewer fees*. Please check all that apply.
ype .;;- ',bY Olit#T Ji Wutlt. _erforined ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
- /Font - ❑ New exterior any complex-Tub/Shower
plumbing site utilities for an c lex structure
,faaa¢a/whirlpoot as defined in OAR 91&780,0040.
Car Wash Each Stall CI Medical gas and vacuum systems for health care facilities.
-Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator Any complex structure as defined in OAR918-780-0040-
—
Dishwasher - onniicrcaal
-Domestic "' Submit 2 sets of plans with any of the above.
• Faintain —
Eye Wash L
Float Drain/sink 2" — 1 1 1 .::U is nc.r` et Di gr tin ,
-3� Isometric riser diagrams iS requi ed for new buildings
_4• that meet the qualifications above.
car Wash Drain '"�
Garbage -Domestic
Disposal -Commercial
-1 - . Comments regarding fixture work:
Ice Mach./Redlig.Drains
Oil Separator(Gas Station)
Rec.Vchicie Dump Station
Shower -Gang
-Stall _
Sink -Ber/Lavatory N__., t T
-Bradley
-Commercial t 1 1 _ "Note: If the fixture work under this permit results in an
-Service \ increase of sewer EDUs,a sewer permit will be issued and
r Swimming Pool Filter
Washer-Clothed fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Wrier Closet-Toilet Q - 1 1
Urinal I j -
Other fixtures:
IN Accumulative Sewer Tally
Tenant Name: Spec Space ***CRl?DI'l�'*'* SWR# N/A
ii;, \cn
Site Address: 12492 SW Main St PLM# 2014-00215
Parcel#: 2S1 02AC00500
Fixture \.ilu,• Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s \clue 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 1 2 1 2
-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 3/41IP) 16 0 0 0 0 0
-Commercial(to 5 III') 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
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:
-Lay/Bar-Non-Food Related 2 0 I 2 0 -1 -2
-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 II
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 1 6 0 -1 -6
Urinal 6 0 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
'I'OT:V.S u 0 3 _ 14 2 5 -1 -9
Current Fixture Value -9 divided by 16= -0.563 Current EI)l 1 EDU = $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -9 divided by 16= -0.563 over (under) S (2,688.00)
Enter EDU Change Here -0.560
Notes: ***CREDITS***
Authorized Name/Signature: Debbie Adamski Date: 6/30/2014
Building Division
ote: The property owner shall retain the ORIGIN.\I.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.
r
I:\Building\Sewer Tally\Sever 1'allySheet_4800._070113.xlsx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12492 SW MAIN ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
October 28, 2015 at 10:09:18
AM
PLM2014-00215
Don Sylvester
Violation Summary:
Inspector Contractor