Permit 1 — ,t CITY OF TIGARD PLUMBING PERMIT
11 s COMMUNITY DEVELOPMENT Permit#: PLM2015-00248
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/03/2015
Parcel: 25101 DB01000
Jurisdiction: Tigard
Site address: 7080 SW FIR LP 110
Project: Shroyer Office Subdivision: 72ND BUSINESS CENTER Lot: 12
Project Description: Plumbing fixtures for new tenant dental office: ADD(1)lay,(1)break room sink,(1)dental service sink,and(1)
water closet. Capping(1)domestic garbage disposal.
Contractor: WESTERN PLUMBING Owner: SHROYER FARMS INC
9460 SW TIGARD AVE SUITE 101 PO BOX 789
TIGARD, OR 97223 PHILOMATH,OR 97370
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
2 ea Sink 08/03/2015 $50.04
Specifics: 1 ea Lavatories 08/03/2015 $25.02
1 ea Water Closet 08/03/2015 $25.02
Type of Use: COM 1 12%State Surcharge- 08/03/2015 $12.01
Class of Work: ALT Plumbing
Type of Const: 1 ea Fixture/Sewer Cap 08/03/2015 $25.02
Occupancy Grp: 0 12%State Surcharge- 08/03/2015 $3.00
Stories: Plumbing
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: , Permittee Signature: ` t
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.
07/29/2015 07:27 5036849015 WESTERN PLUMBING INC PAGE 01/03
Plumbing Permit Applica ECEIVED
Building Fixtures . -In t,i : It i. I •1 ,
City of Tigard J U L 3 0 2015 ���� 17!�r a,;tID��y �..,���y�
13125 SW Hall Blvd.,Tigard,0 -9
Phone: 503 718.2439 Fax; 503-498... F TIGARD oo+erPermitNoS2diega/SQpp,'(�
DasKty:Inspection Line: 503.639.41743ILDING DIVISION Doe Ready/By: rune a See Pap zfor
Internet: www.tigard-or.gov No ed4Meehod: 8a••emental information
i . : ,, �V}a 7} n t., u r 7, ..._. 7--, p' "rr i[ I i -. - -----",--7- ,i E lilt i;uk ,
C 1:+:+ �' ,,.)�.�" 4z f'.� v } - ,._ a i 1 n 14..j,1 tY+ �.,1 .. .,
❑New construction 0 Dexaalitlon For epeeist liefli seadi►wawchecklst
Descri•don e j. Ea Total
1"l Addition/alteration/replacement ❑Other: New 1-2-familydwelh. (includes 100 ft.for each utility connection)
�" 312.70
�`�i���i�..n�`-�.�� �•:;T� . .. ..- .,ice:-� _ , .-.. "'t.i..1iY• �`,-:■,?;a'I,I'.' ,..t.i
0 1-and 2-family dwelling Li Commerciallindustrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building El Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other
Fire sprinkler( _sq.ft.) Page 2
'14 1, � G� d^6.■`,T61';',.:,., ..a--4y r..o..6....:I ■∎'.;1,41 T Site utilities:
Job site address: 1 1�
'AMC) •- r, - 1 Catch basin or area drain 18.76
1-1
Dr'ywell,leach line,or trench drain
City/State/ZIP:7164�(i ( cvi. � _� 2
6 �-', .. . . :: • Page z
Suite/bldg./apL no.. ( i 1 Project name: .,40 " 1111 Si; u Manufactured home utilities 50.03
Cross street/directions to job site: / ► 0 Sr2- , Manholes ■ 18.76
Rain a
drain connector 1
S -ani tary sewer(nu.linear ft.:__J IIIIIIIIEM
Storm sewer(no.linear n.:_„_) Page 2
Water service(no.linear R: ) Page 2
Subdivision: [ Lot no.: Fixture or item:
Tax map/parcel no.; Backftow preventer 31.27
tar{'Yyvy��uu�1 Iyy��� �' I 7. -. i i ,4 1!;)+ 4ii/ r t-1l J• Backwater valve 12.51
M,. ,ytt ,{�jt,$::.t IY'.I_I Y:.A!�,.^1,» .•1._n I . ,34. I' Ji..., S /t/.t.A::$L/. 41 5..f.N .,.0 w-•: Clothes washer 25.02
j�S'lel.Q0 rvt.e3 L )e.i LV 1 r k - n Dishwasher 25.02 -
Oms&Q alnk.i Drinking fountain 25.02 -
t c tjectors/stmtp 25.02.11 ill/ ., eey w rc ,v ,.w:,, ,a ,, t I .. '.? ' i Expansion tank 12.51
Name: , y Fixture/sewer cap 25-02 Illa/t - •� l� ! .' f Floor drain/floor sink/hub 25.02 M .
1
Address: ill" 5 .i , Garbage disposal 25-02
City/State/ZIP: NOW bib 25.02
Phone: ,y ) , ,to _ e r Fax:( ) ice maker ■ 12.51
Interceptor/grease trap 25.02 7.
Business name: Medical gas(value:S ) Page 2
Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02 ,
City/State/ZIP: Solar units(potable water) 62.54
I Phone;( )
Fax::( ) Tub/shower/shower pan 25 02
1 E-mail nn _
n1Rr ' ,
_ ,. c ,I
, Water clot 25.02 AMII
t tip..,! ;; .
,: : ,., .,..4 ,, a'..,,, f.:fi .....? Water heater 37.52
Business name:Western Plumbing,Inc. Water piping)WV 1111 56.29
Address:9460 SW Tigard Street,Suite 101 Other: 25.02
City/State/ZIP:Tigard,OR 97223 Subtotal ,..;;v
Phone:(503)639-5296 Fax:(503)6844015 Minimum permit fix: $72.50 .--_I
CCB Lic.:2439 Plumbing Lic.no.:3429PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) 1 A
Authorized signature: _/1��. //.I :,4.w /1 TOTAL PERMIT FEE_..�1 '�
�w�- This permit application expires if a permit b not obtained within Jw/)JL
Date: complete
"Fee methodology set by In-County Building Industry Service
t llattilding1PermitaLM U•Perm itArodoc 10/01/09 440.4616T(10/02/COM/WEB)
1
fat/a.! di
07/29/2015 07:27 5036849015 WESTERN PLUMBING INC PAGE 02/0:3
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su I 1 ression S stems:
,., r ., .'X 4 KJ: ,.: ?..._,. 7 1:71: .i 5' -rµ°"..Y _ "..' TM.'C.... :7.7 .,r-7.�t-7 r.i
j . 1 t r i s :..11'x6',.»s Sa a�, �i .r i t `.. 4.61
°i,�;. .'��.,.,M,. . ,. _ . d• � �,..w�. ��.,�q.:fiM�:t�`k�:,: ..�,.�,�� ,«.,..,.,. w�-�.�..,f.�z.�„, ..�.....«.....�z.,,� ± . .._,.r
Footing drain-1'r 100' 50.03 0 to 2,000 . $121.90 _____.1
Footing drain-each additional 100' 37.52 2,001 to 3,600 i 69$169.
Sewer-1st 100' 62.54 3.601 7,201 and rid d,grater _j $327 54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 1 37.52 , rrir?}q gay 0 ;r , ti
Storm Rain Drain 1st 100' - 62.54 .,tt . ., .,.,-,4, �.�..7. :�,*>k . . . 1,
$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
w. ,,xi1 W3.;at•F ti. } 5i 77t 7 r72T, ,^"�1;,;, rte' ,r'A 'r each additional$100.00 or fraction thereof"to
, • ;.4,.,"�- -,.n., .«.( .,,.-.- a ,,.»`•I`^r, r;31.Ai 'w , t .1(.(.:,<0 and includin_ $10 000,00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 , $148 50 for the first$10,000.00 and$)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 525,001.00 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
Rcinspcction Fees 90.00/hr and includi g$30.000.00.
Additional plan review for revisions 90.00/hr 550,001 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; -~T-~
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*.
1 t 4. ,',ii;,:-.. .... , ∎9:71: sR p ..r r it 1 n i ny. F /. Ni aril JF.. {
� "' ` 4 N ,i.,...ax .,, ; wr hJPtan review is required for any of the following. rh v1 -
�� ' Please check all that apply.
Baptistry/Font
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.
-Dove Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator -ii, 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 acts of plans with any of the above.
3"
Car Wash Drain _w:: ,.,.,,cy w , h►` a: 4a,.�:v,....,a k hr
�h' ❑ Isometric or nser diagram is required for new buildings
Garbage -Domestic-non-food ��. 1. t that meet the •ualifications above.
Disposal -Domestic-food related a,>L` 1 �
-Commercial-food related ! ' . . l
-Industrial-food related ea, iQ
Ice Mach./Refrig.Drains Q`
Oil Separator(Gas Station)_ _ 1 Comments regarding fixture work:
Rec Vehicle Dump Station - _
Shower -Gang
-Stall
5ink/Lav -Non-food related 1,1f1r i
^ -Bradley - __
--Service ‘ _ ,
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer Clothes J increase of sewer Elltis,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet t fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures.
http /www.tigard-or.gov/city_ha11/departments/cd/docs/PI,MF-PermitAp9doc
Y
IIIIII Accumulative Sewer Tally
Tenant Name: Shroyer Office SWR# 2015-00096
-rtc;AtcI)
Site Address: 7080 SW Fir 1,p,110 PLM# 2015-00248
Parcel#: 2S101 DB01000
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 I 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 HP) 16 0 1 16 0 -1 -16
-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 3 6 3 6
-Bradley 5 0 0 0 0 0
-Com/Sery/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 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTAIS 0 0 1 _ 16 4 _ 12 3 -4
Current Fixture Value -4 divided by 16= -0.250 Current Fl)U 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -4 divided by 16= -0.250 over (under) S (1,275.00)
Enter EDU Change Here -0.250 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: ***CREDIT*** 8/3/15:Rex Shroyer added(1)capped domestic garbage disposal to give him a.25 credit. B.T.
Authorized Name/Signature: Dianna Howse Date: 7/30/2015
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.
I:\Building\Sewer Tally\Sewer Tall yShec t_5100_0701 15.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
7080 SW FIR LP 110, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00248
Chip Barnett
Violation Summary:
Inspector Contractor