Permit (173) u CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00016
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/14/2016
Parcel: 2S113AA00100
Jurisdiction: Tigard
Site address: 16342 SW 72ND AVE
Project: Bridgeport Distribution Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS A,B
Project Description: Interior Plumbing:Adding(2)lavatories, (2)water closets, (1)2"floor drain,(1)water heater,(1)primer,and(1)
expansion tank.
Contractor: DEAN WARREN PLUMBING& REMODELING INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE 503-236-4152 PHONE'
FAX 503-296-2218
FEES
Quantity Description Date Amount
1 ea Expansion Tank 01/14/2016 $12.51
Specifics: 1 ea Floor Drain/Floor Sink/Hub 01/14/2016 $25.02
1 ea Primer 01/14/2016 $12.51
Type of Use: COM 2 ea Sink 01/14/2016 $50.04
Class of work: ALT 2 ea Water Closet 01/14/2016 $50.04
Type of Const: 1 ea Water Heater 01/14/2016 $37.52
Occupancy Grp: 1 12%Slate Surcharge- 01/14/2016 $22.52
Stories: Plumbing
Total $210.16
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale 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
Issued By: ttee Sio nature:
Call 503.639.4175 by 7:00 a.m.for the next available ins a tion 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 (1 i
Building Fixtures CEIVEP
Received % / p
City of Tigard Pennil No.: AM '
m 13125 SW Hall Blvd.,Tigard,OR 9(/R2� Date/By:
. Plan Review
dau
Phone: 503.718.2439 Fax 503.598.196 ¢ Date/By: Other Permit No.: 4(/f' O ��
Inspection Line: 503.639.4175 + +L Date Ready/By: IZ See Page 2 for
Internet: www.tigard-or.gov 1.11 y(A 11 Notified/Method: Supplemental Information
�. 01
❑New construction ❑Demolition For special information use checklist
Description I QtY. I Ea. I Total
4JZLAddition/alteratiori/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
❑ I-and 2-family dwelling .ommercial/industrial SFR(2)bath 437.78
❑ Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath kitchen 25.02
❑ Master builder ❑Other Fire sprinkler(_sq.ft) Page 2
-- '� ' 4013 $ +IkOR1lfA`IT0N AND LUCA19ON. Site utilities:
Job site address: 33a Catch basin or area drain 18.76
City/State/ZIP: l9AfLO Drywell,leach line,of trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:,WLAO Project name: R IC>GF P�l�-
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
ry Storm sewer(no,linear ft.:_) Page 2
Water service(no.linear ft.:_) Page
V Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
4aON OT WO87C Backwater valve 12.51
,.stirr
F Clothes washer 25.02
Dishwasher 25.02
' H PKI I t X U71O� Drinking fountain 25.02
x) -t- y.�,G. FOQ- N Oft NI, Ejectors/sump 25.02
t r �.g y Expansion tank 12.51
Name '--- Fixture/sewercap 25.02
Address: Floor drain,Nloor sink/hub 25.02 r `�
2- City/State/ZIP: Garbage disposal 25.02
Hose bib 25.02
e Phone:( ) Fax:( ) Ice maker 12.51
y ,p I
, h za Interceptor/grease trap 25.02
�`:
Business name: Medical gas(value:$_) Page 2
Primer I 12.51
Contac[name:
Roof drain(commercial) 12.51
Address: Sink'basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
1 Water closet 25.02 ode
R. d� ' Water heater 37.52 7 51
Business name: E�F� ��- l�`' ) Water piping/DWV 56.29
Address: NWA-rPp OL-Y, y Q Other: 25.02
City/State/ZIP: f3D act Subtotal i . 61
Phone:(5-311M 1 Fax:( ) Minimum permit fee: $72.50 1
CCB Lic.: ( ��� Plumbing Lic.no.: a - Plan review (25%ofpermit fee)
State surcharge(12%ofpennit fee) �,}�
Authorized signature: TOTAL PERMITFE lo.t
Print name: (qM t Dale: ;- �� -t� This permit application expires if a permit is not obtained within 180 days
after It has been accepted as complete.
'Fee inethodology set by Iri-County Building Industry Service Board.
IrBulldiag Permits PI MU-Pen.uAPPdoc 10 01 09 440-46161}1002 COM wI'm
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
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 1 $327.54
Sewer-each additional 100' 37.52
Water Service- 1st 100' 62.54 Medical Gas Systems
Water Service-each additional 100' 37.52 f
Sk
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
Jtiy�, f n^' a each additional S 100.00 or fraction thereof,totiu ,QrtYes eee7i} 'g' `v; and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 5148.50 for are first SI0,000.00 and$1.54 for
which no fee is specifically indicated 90.001hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.001hr 525,001.00 to$50.000.00 $379.50 f'or 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 I and including$50,000.00.
Additional plan review for revisions 90.00,hr $50,001.00 and up $742.00 for the first 550,000.00 and$1.20 for
(minimum charge-I2 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.
aantity 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 Relecah PP y'
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirl ool engineer.
ElCar Wash: -Each Stall New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thou
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-
VU
-4* ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refri .Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related Z
-Bradley
-Com/Serv'Util food related
-Service *Note: If the fixture work under this permit results in an
Swinaning Pool Filter increase of sewer EDUs,a sewer permit will be issued and
washer-Clothes
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-'toile Z plumbing permit can be issued.
Urinal
Other Fixtures:
1:ABuildingVPermitsVPLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
'1'cnant e.NamBR1DGb;POR"1'DIS"I'RIBU'L1ON SWR# N/A
Sitc:Address: 16342 SW 72ND AVG PLM# 2016-00016
It
6
Parcel#: 2S113AA00100
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Battiscry/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
- acuzzi/Wind ool 4 0 0 0 0 0
Czar Wash: -Each Stall 6 0 0 0 0 0
-Dnve through 16 0 0 0 1 0 0
Cus idor/W'atcr:As irator 1 0 0 0 0 0
Di-shwasher. -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eyc 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
-CarWash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 1111) 16 0 0 0 0 0
-Commercial(to 5 I11)) 32 0 0 0 0 0
- Industrial (over 5 1IP) 42 0 0 0 0 0
Ice Nluchinc/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sc (Gas Station) 6 0 0 0 0 0
Rcc. Vehicle Dump station 16 00 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
- Bradlev 5 0 0 0 0 0
-Com/Scrv/Ril- Food Related 3 0 0 0 0 0
Swimming Poul Plter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water I(xtractor 6 0 0 0 0 0
Witter Oosct-Toilet 6 0 0 2 12 2 12
Urinal 6 0 0 0 0 0
Previous FDU Count 0 0
Capped IA)U Credit 2 32
'1'0'1:ALS 0 0 0 0 4 16 4 -16
Current Fixturc Value -16 divided by 16= -1.000 Current GDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous IiDU
Change -16 divided by 16= -1-000 over (under) S (5,100-00)
Enter EDU Change Ilere -1.000 '
*Round FDD,to the ncarest I/100th a count ending in-005 shall be rounded up to 01,and a count ending in.014 or Tess shall be rounded down to.01.
Notes, *"*CCREDI'I'**` 2" FLOO 2 DRAIN ISA I IUB DRAIN FOR AVA t FIZ I F ATIiR OVERFLOW, NO MU'S FOR 2" FLOOR DRAIN. 2.0 F:DU
CRI(DfI;C FROM 1'1,612000-00096. 1 ISDU CRI?DI'1'APPLIED'1O PIA12016-00016 FRO61 PI-612000-00096.
Authorized Name/Signature BRr\NUIiN 7'AGGARI'X2449 Date: 1/14/2016
Building Division
Note the property owner shall renin the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted ut the City of"I igard Building Division to redeem credits towards future system development charges.
I.AHuilding\5 yvcr'I'nllyASc�cur'1'ally5hcct_S IUU_ii7u115.Jss
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
16342 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
Scheduled
PLM2016-00016
Don Sylvester
1. Corrections are complete - plumb. Final ok.
Violation Summary:
Inspector Contractor