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Permit
CITY OF TIGARD PLUMBING PERMIT .14 s COMMUNITY DEVELOPMENT Permit#: PLM2014-00304 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/11/2015 Parcel: 1 S133DA07200 Jurisdiction: Tigard Site address: 11470 SW 130TH AVE Project: Summer Lake Park Restroom Subdivision: AMART SUMMER LAKE Lot: A Project Description: Plumbing fixtures for new restroom:(2)drinking fountains,(3)2"floor drains,(2)hose bibs, (2)lays&(2)water closets. Contractor: JUNCTION CITY ELECTRIC& PLUMBING Owner: TIGARD,CITY OF 5480 SW PHILOMATH BLVD 13125 SW HALL CORVALLIS, OR 97333 TIGARD,OR 97223 PHONE: 541-754-0880 PHONE: 503-639-4171 FAX: FEES Quantity Description Date Amount 2 ea Drinking Fountain 04/01/2015 $50.04 Specifics: 3 ea Floor Drain/Floor Sink/Hub 04/01/2015 $75.06 2 ea Hose Bib 04/01/2015 $50.04 Type of Use: COM 2 ea Lavatories 04/01/2015 $50.04 Class of Work: NEW 2 ea Water Closet 04/01/2015 $50.04 Type of Const: 1 12%State Surcharge- 04/01/2015 $33.03 Occupancy Grp: Plumbing Stories: Total $308.25 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 8y: •ermittee 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 `I FOR OFFICE USE ONLY Received City of Tigard \R 0 Permit N1,- / Q 'j,0 Date/By: 1 �! /f � J /✓,-+``/,.10/Y ,,c).,.1u9 ill • 13125 SW Hall Blvd.,Tigard,OR D Plan Review Phone: 503.718.2439 Fax: 503.598.191 �Q VOW"' Dam/g Other Permit No.:cly..,/J a /c/• LIQ TIGARD Inspection Line: 503.639.4175 ` , Date Read/B Q,. �� 1/L� Juris: ® See Page 2 for Ready/By: / 7 1t.acr/ Internet: www.tigard-or.gov \ — ,' Notified/Method: /� Supplemental Information PE OF WORK \ 'L • ��/ , II /, FEE* SCHEDULE -r' '®New construction El - olition Forslecia!in ormation use checklist. Description • . Ea. Total LIN ❑ Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(l)bath 312.70 Q ❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 1 SFR(3)bath 500.32 ❑ Accessory building ❑Multi-family Each additional bath/kitchen 25.02 d ❑ Master builder El Other: Fire sprinkler(_sq.ft.) Page 2 pv JOB SITE INFORMATION AND LOCATION i,U71 314' Site utilities: Job site address:Summer IA Park V 1 . Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.:N/A Project name:Summer Lk.Park Restroom home utilities 50.03 Cross street/directions to job site:Head westbound on Walnut St from Hwy 99W Head . I• • • 1 . 1 / Head • drain 1 1 Sanitary sewer 11 Storm'P rt)on Winterlake Dr.take imeediate left on Lakeview Terrace. Project site 1 located in Park at terminus of Lakeview 1 '') Subdivision: Tax Fixture or item: • I. I '1 I I I • • preventer 31.27 Backwater valve 12.51 - DESCRIPTION OF WORK ,. Clohthes washer 25.02 Erect pre-engineered modular block Romtec restroom facility ') 25.02 • pvc sanitary 1 facilky Drinking 1 50.04 1 1 1 1 Ejectors/sump 1 0 PROPERTY OWNER 0 TENANT Expansion tanlc 12.51 • Fixture/sewer I I I Name:City of _ 1 Floor drain/floor 1 75.06 Address:13125 SW Hall Blvd gP:Tigard,OR Hose bib 2 25.02 50.04 1 Phone: I (503)624-0752 Ice maker 12.51 C, E APPLICANT ■ / 1 I • g :' 1 1 Business name:City, Contact name:Jeff Peck Primer 1 Tigard Page 2 Roof 1 1 1• I Sink/basin/lavatory 50.04 I' 1 • ' ' Solar (potable . II'hone:(503)718-2466 Fax::(503)624-0752 Tub/shower/showe Urinal E-mail:jeffp@tigard-or.gov 25.02 closet Water ©® 11 'ri CONTRACTOR Water heater• Business name: T,Ne T OIJ Cf T y � £ T',C �Z k#.76,, er PP P�i in WV 56.29 Address: S. ee Ste) /Iv//L 0/ff ' _.1) Other: 25.02 4 City/State/ZIP: cp 2 U g-,_sc e 9 7 3 J Subtotal /) 1 `y--D`�� ( ?// 1' Minimum permit fee: $72.50 Phone: �! O Fax: ) O / Plan review (25%of permit fee) • CCB Lic.: /W 6 19 Plumbing Lic.no.: 3�02 14 State surcharge(12%of permit fee) NW Authorized signature cl...c3Ce TOTAL PERMIT FEE 3i Print name: �`� �„ Date: j• 'f , This permit application expires if a permit is not obtained within 180 days • after it has been accepted as complete. 30$- *Fee methodology set by Tri-County Building Industry Service Board. I.Building'Permits\PLMU-PetmitApp.doc 10/01/09 440.4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Sage 2 - Supplemental Information Fee Schedule: Residential Fire Su ression 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' I 62.54 /'2 54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' I 62.54 62.54 Medical Gas Systems: Water Service-each additional 100' .05 37.52 1 S Valuation: iermit Fee: Storm&Rain main-1st 100' 62.54 $I.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 l� 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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for any of the following.Performed: Capped Added Relocate q y g' Baptistry/Font Please check all that apply. Bath Tub/Shower ❑ Any new commercial building with water service 2"and -Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thm ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain 2 ❑ Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" 3 Submit 2 sets of plans with any of the above. -3,, 4" Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: l:\ENG\1 -Active Projects\92048 Summerlake Restroom\PERMITS\COT.PPLICATIONS\PLMF-PermitApp.doc III Accumulative Sewer Tally I Tenant Name: Summer Lake Park Restroom SWR# 2014-00092 i�_ D Site Address: 11470 SW 130th Ave PLM# 2014-00304 Parcel#: 1 S133DA072000 Fixture \'aloe Previous Previous Credits Capped Fixture Fixture New New # value count capped#s \clue 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 2 2 2 2 Eve Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 3 6 3 6 -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 1-1P) 16 0 0 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 0 2 4 2 4 -Bradley 5 0 0 0 0 0 -Com/Scrv/Util-Food Related 3 0 0 0 0 0 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 2 12 2 12 Urinal 6 0 0 0 0 0 Previous EDU Count 0 (I Capped EDU Credit 0 TOTALS 0 0 0 0 9 24 9 24 Current Fixture Value 24 divided by 16= 1.500 Current EDU 1 EDU= $4,900.00 Previous Fixture Value 0 divided by 16= 0.000 Previous 1?DU Change 24 divided by 16= 1.500 over (under) S 7,350.00 Enter EDU Change Here 1.500 Notes: Authorized Name/Signature: Debbie Adamski Date: 9/9/2014 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. l:\Building\Sewer Tally\Sewer l'allyShcet_49()0._070114.xlsx