Permit (101) n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00095
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/29/2016
Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 440
Project: Spec Space Subdivision: YARNS ACRES Lot: 9
Project Description: Interior plumbing for TI:Capping(1)domestic dishwasher,(1)2"floor drain,(2)sinks,and(1)water closet;
Relocating(1)domestic dishwasher,(1)2"floor drain,and(1)sink;Installing(1)primer and(1)water heater.
Contractor: GRIDLINE PLUMBING Owner: GK TRIANGLE CORPORATE PARK III L
14844 SW 109TH AVE ATTN KBS REALTY ADVISORS
TIGARD, OR 97224 P O BOX 28270
SANTA ANA, CA 92709
PHONE: 971-275-6167 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 02/29/2016 $25.02
Specifics: 5 ea Fixture/Sewer Cap 02/29/2016 $125.10
1 ea Floor Drain/Floor Sink/Hub 02/29/2016 $25.02
Type of Use: COM 1 ea Primer 02/29/2016 $12.51
Class of Work: ALT 1 ea Sink 02/29/2016 $25.02
Type of Const: 1 ea Water Heater 02/29/2016 $37.52
Occupancy Grp: 1 12%State Surcharge- 02/29/2016 $30.02
Stories: Plumbing
Total $280.21
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
issua is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the Opted by the Oregon
ity Notification Ce er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y may obtain copy Of the rules
Lordirections to OUC b ng 503.232.1987 or 1.800.332.2344.
Permittee Signature:
,4
Call 503.639.4175 by 7:00 a.m.for the next available ins pe o at
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 Zl U( Wil 1
Building Fixtures i
Cit of Tigard G Received /� qQ
City g Y3leN Date/By: Permit No.: ^ �16 I" f,,5
� 13125 SW Hall Blvd.,Tigard� 23 �O'�Cj Plan Review 7 Jt714'
Phone: 503.718.2439 Fax: 503.59 0%9 Other Permit No.:
^ Date/By: of 5=
Inspection Line: 503.639.4175 pp �j Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard-ocgov ���ri N Notified/Method: Supplemental Information
TYPE OFVAN
* tax
❑New construction Demolition
For special information use checklist.
Description I Qty. I Ea. Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OFCONSTRUCTION SFR(1)bath 312.70
-and 2-family dwelling Z-Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ElMulti-family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND L ATION Site utilities:
Job site address: / Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: S � t0 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
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear It.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
t f��� Clothes washer 25.02
Dishwasher 25.02
t�K ! Drinking fountain 25.02
. Ejectors/sump 25.02
Q PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT [3:CONTACT PERSON Interceptor/grease trap 25.02
Business name:
Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
AX 5
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR,
" OF I Water heater 37.52
Business name: n C J12 ` Water piping/DWV 56.29
Address: �(SW A9 Other: 25.02
City/State/ZIP: , 277-741 Subtotal
Phone:( ) � Fax:( )
Minimum permit fee: $72.50
CCB Lic.: lumbing Lic.no.: - Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE ,
Print name: Date:';2 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:Building Permits PI.MU-PernutApp.doc 10 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(ell) 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- I st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 10062.54alu400n.
$1.00 to$5,000.00 Minimum fee$72.50
Stonn&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
Other0"0_0 0' "" 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 nonnal 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 90.00/111. $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
Ouantity 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 El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cus idor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic El 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
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
-Bradley
-Com/Sery/Util food related
-Service *Note: If the fixture work under this permit results in an
Swirriining Pool Filter 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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
L•\Building\Pennits\PLMF_PennitApp.doc 08/04/2011 2
Accumulative Sewer Tally
Tenant Name: SPEC SPACE SWR# N/A
Site Address: 13221 SW 68TH PARKWAY SUITES 440&450 PLM# 2016-00095
' Parcel#: 2S101DA00102
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptiscry/Dont 4 0 0 0 0 0
Bath: -"1'ub/Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Czar Wash: -Fach Stall 6 1 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 1 2 0 -1 -2
Drinking Fountain 1 0 0 0 0 0
I"yc Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 1 2 0 -1 -2
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 11P) 16 0 0 0 0 0
Commercial (to 5 1111) 32 0 0 0 0 0
-Industrial(over 5 1-111) 42 0 0 0 0 0
Ice:Machine/Refrigerator Drain 1 0 0 0 0 0
hiving Unit 16 0 0 0 0 0
Oil Se (Gas Station) 6 0 0 0 0 0
Ree 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/liar Non-food Related 2 0 2 4 0 -2 -4
tiradlcv 5 0 0 0 0 0
Com/Scry/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 HAtractor 6 0 0 0 0 0
WaterCloset-Toilet 6 0 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous 1?DU Count 0 0
Capped 1?DU Credit p
T()"1':A I,S 0 1 0 1 5 1 14 1 0 1 0 1 -5 1 -14
Current Fixture Value -14 divided by 16 = -0.875 Current FIDU 1 EDU= $5,100.00
Previous fixture Value 0 divided by 16 = 0.000 Previous FDU
Change -14 divided by 16- -0.875 over (under) S (4,488.00)
Enter EDU Change Mere -0.880
*Round kDUS 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: 'CRI{DIT'**
Authorized Name/Signature•. BRANDI?N TAGGART X2449 Date: 2/29/2016
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:ABuildinf�\Seo-cr']';tllp\Scv CrT1 ilk'Shcct_5100070115els.\
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
13221 SW 68TH PKWY 440, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00095
Don Sylvester
Violation Summary:
Inspector Contractor