Permit CITY OF TIGARD PLUMBING PERMIT
`'�! COMMUNITY DEVELOPMENT Permit#: PLM2015 00045
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/18/2015
Parcel: 2S 101 AA08200
Jurisdiction: Tigard
Site address: 12455 SW 68TH AVE
Project: McGee Wealth Management Subdivision: WEST PORTLAND HEIGHTS Lot: 8
Project Description: Relocate(1)sink,and the water supply lines for the icemaker and coffee. Cap(1)bar sink and(1)clothes washer.
Contractor: CUSTOM PLUMBING&CONSTRUCTION LLC Owner: MCGEE DEFOE FAMILY TRUST
PO BOX 1051 BY MCGEE, JUDITH A TR
CANBY,OR 97013 12455 SW 68TH AVE
PORTLAND, OR 97223
PHONE: 503-266-1212 PHONE:
FAX: 503-266-4391
FEES
Quantity Description Date Amount
2 ea Fixture/Sewer Cap 02/18/2015 $50.04
Specifics: 1 12%State Surcharge- 02/18/2015 $15.01
Plumbing
Type of Use: COM 1 ea Sink 02/18/2015 $25.02
Class of Work: ALT 50 Misc Other Fee 02/18/2015 $50.04
Type of Const:
Occupancy Grp:
Stories:
Total $140.11
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(----����l��(�l 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.
02/12/2015 3:35PM FAX 5032661212 CUSTOM PLUMBING & CONST 1210001/0001
Plumbing Permit Applica& +lCEIVEL)
Building Fixtures FOR OFFICE USE ()NI v
FEB 12 2015 Rea:dyed
City of Tigard Date Ry: a/ /A /s AP j- Permit No.: ' , /1-1160 S
a 13125 SW Hall Blvd.,Tigard,OrtA7723 -Olin Review
C • Phone: 503.718.2439 Fax: 9113i5B1l1 1'1GARD Daie/Fi ; OtherPennil Nn.: Aub s fr
inspection line: 503.639.41 _
T[GAR1� ,as. DIVISION DmrReady/B : ]urix 121 See Supplemental lntcrnct: www.ligard or.go 1!1 VV 7l 1� N titled/Method Supplemental Information
0
. •TYPF.-OF'AVOW .. 143E*.!SCHED(IT.F;,• •
❑New construction -. ❑Demolition Far special information use checklist:
Description I Qty. I Ea. Total
'Addition/alteration/replacement ❑Other: New I.2-family dwellings(includes 100 ft.for each utility connection)
. CATF`.;GORY•OF CON&`1 RUCTION "l SFR(1)bath 312.70
' • ❑ 1-and 2-family dwelling - ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500,32
CI
builder Each additional bath kitchen _ 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB'Mg INI?ORll
IATION AND LO X IiON Site utilitie :
.. C
Job site address: -r
}'Z, t 5 € A C.A J Catch basin or area drain 18.76
te
Drywall,leach lino,or trend)drain 1R.7G
City/State/ZIP: `-?Or4w�.a -
Footing drain(no.linear ft,;, ) Page 2
Suite/bldg./apt.no. Project Hamm: _ Manufactured home utilities 50.03
Cross street/directions to jah site; Manholes 18.76
Rain drain connector 18.76
- Sanitary sewer(no.linear fi.: ) Pagc 7.
Storm sewer(no.linear ft.; ) Page 2
- _Water service(no.linear R.: ) Page 2
I
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.; d3/0/j g 44 0 Bucktlow preventer 31.27
DESCRIPTION OF'WORK ;.:F Backwater valve 12.51
�1_ Clothes washer 25.02
'iL_ 61 t 1 LPxY1P k t°�►r ` GOr- - - Dishwasher '25.02
V�Gyv. Y1 P___ Jpp l i e S ._( P 0 4- 3-150,- , i� 1)tinking fountain 25.02
p i (�C - Ejectors/sump 25.02 -•[] PROPERTY OWNER I 0 TENANT Expansion tank 12.5] of
Name: Fixture/sewer cap 2. • 25.02 6,91*iP",
-- Floor drain/floor sink/hub 25.02
Address: -
City/State/ZIP: Garbage disposal 25.02
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51_1
. ❑ APPLICANT .. ❑:EONTACC ?FgSON , . •• _Interce tor/Srcasc trap 75.02
--
Business name: C Gce� `/}1Qvta Qe k^r Primer Medical l gas(value,S ) Page 2
Contact name: �;vi t' 11e.tL1-cyxtt I� - 12.51
-�1 Roof drain(commercial) 12.51
Address: 1 a 4.th1 1 pCiJA , .- _Sink/basin/lavatory e' 25.02 ,>6";e'--)"
City/State/71P: `pct e d a/LD G727,3 Solar units(potable water) 62.54
Phone:(1t:U3) 1'.. 222 ., Fax::(i J0 �iy q 8.of Tub/shower/shower pan 12.51 -
E-mail ail @ N.c4Pe.w-� . /+�� / Urinal 2542
�° 1 Water closet 25.02
( Water heater 37.52
Business name• - rn lk_l WAl� q Cam- �` L,U_f Water piping/Dwv 56.29
Address: P d .QJX 1 t�. 7 t Other: j�Prrf�64-e Y 1:c2 a 25.02 �•O fZ`
City/State/ZIP: ca 4 , Oa_ G1O 13 (C f HAM. 4 (_' 'Grit NttC/Fit- . Subtntal `A
Phone:( h.--3) 7,C.e4 , 12t Fax:(G565) •,(Q(, -.43(i ) Minimum permit fee: 572.50 -
CCD l.ic.: 1 q`"t / Plumbing Lie..no.: t W ` 3.-Ns, Plan review (25"/o of permit fee} cf
State surcharge(12%of permit fee) l�•
Authorized signature: '�' t
�.-4S �La • - s--� TOTAL PERMIT FEE
Print name: mod;- w This permit application expire«if n permit is not obtained within 180 x
, s1i�1 .i Date: fl �j/I�� after It has been IICCCptCd as complete. n
"Fee meilmdnInly set by Tri-Coway Huitding Industry Service d. / tV
1:1Buildin en5,MU-PwmilApp.doc 10/0006/n,� r ( .. .tee aZ Il-es
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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
❑ 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
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
4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the ualifcations above.
Garbage -Domestic non-food q
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 Filer 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 P
WaterCloset-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
Tenant Name: McGee Wealth Management **CRI FITS*** SWR# N/A
Site Address: 12455 SW 68th .\ve PLM# 2015-00045
Parcel#: 2S101AA08200
Fixture \.iluc Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s \due 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 U
-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 3/4 111') 16 0 0 i 0 0 0
-Commercial(to 5 I-IP) 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 1 2 0 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 1 6 0 -1 -6
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
1'(Yl'.11.S 0 0 2 8 0 0 -2 _ -8
Current Fixture Value -8 divided by 16= -0.500 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -8 divided by 16= -0.500 over (under) $ (2,450.00)
Enter EDU Change Here -0.500
Notes: ***CREDITS***
Authorized Name/Signature: Debbie Adamski Date: 2/12/2015
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
•ubnutted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\Sewer 1'allySheet_4900._070114.xlsx