Permit IIa
CITY OF TIGARD SEWER CONNECTION PERMIT
I ' COMMUNITY DEVELOPMENT Permit#: SWR2015-00092
T 1GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/21/2015
Parcel: 2S112DA01000
Jurisdiction: Tigard
Site address: 6610 SW CARDINAL LN
Project: Umpqua Bank Subdivision: 1995-098 PARTITION PLAT Lot: 1
Project Description: .5 EDU increase
Contractor: Owner: PACIFIC REALTY ASSOCIATES
ATTN: N PIVEN
15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: PHONE: 503-624-6300
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/21/2015 $2,550.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .5
Total $2,550.00
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. se rules ar- et forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OUN by calling 503.232.1* .r 8 0.332.2344.
Iss ed By: ' Permittee Signature: �`y---.
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 RtILIVEP FOR OFFICE USE ONLY
City of Tigard Received 7I JAI // 5 j�k� Permit No..i-U / 8 3/83/
14 w 13125 SW Hall Blvd.,Tigard,O�I�72 � 2015
Plan Review p
s Phone: 503.718.2439 Fax: 5>3} 8. Other Permit No.:a 5- � 7a
Date/By:
Inspection Line: 503.639.4174 y Date Ready/By: fur is H See Page 2 for
I IGAItll Internet: www.tigard-or.got,ITV OF f (3AR1 Supplemental Notitied/Method: Su lementallnformation
TYPROKSWIC DIVISION FEE* SCHEDULE
❑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)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32 Vt
❑Accessory building ❑Multi-family 1
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 0,
JOB SITE INFORMATION AND LOCATION Site utilities: .�
Job site address:6610 SW Cardinal Lane Catch basin or area drain 18.76 �-
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR,97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Fars emodel culpeiUAt- Manufactured home utilities - 50.03
Cross street/directions to job site: P2091")/1"-• Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) 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.: a 6//3---)D A 6/000 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Add new restroom and relocate breakroom sink. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER l ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 1 12.51 /a `J
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business gas(value:$ ) Page 2
usiness name:Alliant Systems
Primer 12.51
Contact name: David Russell
Roof drain(commercial) 12.51
Address:1600 NW 167th Place,Suite 330 Sink/basin/lavatory 2 25.02 b,oy
City/State/ZIP: Beaverton,OR 97006 Solar units(potable water) 62.54
Phone:(503)572-7761 Fax::(503)230-9238 Tub/shower/shower pan 12.51
E-mail:d.russell @alliant-stsems.com Urinal 25.02
CONTRACTOR Water closet 1 25.02 25.62-
Water heater 37.52
Business name:Alliant Systems Water P�P �I in WV 56.29
Address: 1600 NW 167th Place,Suite 330 Other: 25.02
City/State/ZIP:Beaverton,OR 97006 Subtotal 3-2, 5-7
Phone:(503)572-7761 Fax:(503)230-9238 Minimum permit fee: $72.50
Plan review (25%of permit fee) '
CCB Lic.: 153420 Plumbing Lic.no.:3-487PB
State surcharge(12%of permit fee) I /v 5
Authorized signature: TOTAL PERMIT FEE ggr
Print name:David Russell Date:07/20/15 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc I0/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Tom 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 Fee(ea) Total each additional$100.00 or fraction thereof,to
P 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.
Work Performed: Capped Added Relocate
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 Thru ❑ 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 ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram dia is required for new buildings
Garbage -Domestic-non-food g q g
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 I j
-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:
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