Permit (66) CITY OF TIGARD PLUMBING PERMIT
$111 • COMMUNITY DEVELOPMENT Permit#: PLM2016-00225
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/25/2016
Parcel: 2S101AA03800
Jurisdiction: Tigard
Site address: 12259 SW 69TH AVE
Project: Consumer Cellular Subdivision: WEST PORTLAND HEIGHTS Lot: B
Project Description: Capping(1)dishwasher, (5)2"floor drains,(4)3"floor drains and(2)lays. Adding(1)dishwasher, (2)2"floor
drains, (2)ice maker drains,(3)break room sinks, (2)lays&(2)water closets.
Contractor: WEST COAST CENTRAL PLUMBING LLC Owner: SDC TIGARD CORPORATE CENTER INC
12714 SE MAJESTIC LN ATTN: ANDREW HARPER
HAPPY VALLEY, OR 97086 101 CALIFORNIA ST, 26TH FLOOR
SAN FRANCISCO, CA 94111
PHONE: 503-298-0435 PHONE:
FAX: 503-855-3264
FEES
Quantity Description Date Amount
1 ea Dishwasher 04/25/2016 $25.02
Specifics: 12 ea Fixture/Sewer Cap 04/25/2016 $300.24
2 ea Floor Drain/Floor Sink/Hub 04/25/2016 $50.04
Type of Use: COM 2 ea Ice Maker 04/25/2016 $25.02
Class of Work: ALT 3 ea Sink 04/25/2016 $75.06
Type of Const: 2 ea Lavatories 04/25/2016 $50.04
Occupancy Grp: 2 ea Water Closet 04/25/2016 $50.04
Stories: 1 12%State Surcharge- 04/25/2016 $69.06
Plumbing
Total $644.52
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 Not' • - • -r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir— questions to OUN • g 503.232.1987 or 1.800.332.2344.
Is•ued By: / Permittee Signa re:
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.
Accumulative Sewer Tally
111111 s " Tenant Name: Consumer Cellular SWR# N/A
Site Address: 12259 SW 69th Ave PLM# 2016-00225
TIGARI)
Parcel#: 2S1 01 AA03800
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 1 4 1 4 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 5 10 2 4 -3 -6
-3 inch 5 0 4 20 0 -4 -20
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 IIP) 16 0 0 0 0 0
-Commercial(to 5 IIP) 32 0 0 0 0 0
-Industrial(over 5 IIP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 2 2 2 2
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 2 4 5 10 3 6
-Bradley 5 0 0 0 0 0
-Com/Serv/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 0
Capped EDU Credit 0
TOTALS 0 0 12 38 12 32 0 -6
Current Fixture Value -6 divided by 16= -0.375 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -6 divided by 16= -0.375 over (under) $ (1,938.00)
Enter EDU Change Here -0.380 *
*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: ***CREDITS***
Authorized Name/Signature: Debbie Adamski Date: 4/25/2016
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:\Building\Sewer Tally\Sewer CallyShect_5110_070115.xlsx
Plumbing PermitApplicati�C������
Site Utilities I i t m ()mil ( ,,i 0.1 1
City of ard /(
13 t S W Hall Blvd.,Tigard,()R 97223 APR 2 o 2 016 Received Date/By: T S /6, I ` -
`~ Plan Review I
Phone: 503.7182439 Fax: 5037r(�l�rZ� DateBv: Other Pennit No.:
) I \It I 1 Inspection Line: 503.639.4175$UI��(pp���-+ r(�pt,t!�+ Date Ready/By; runs. Pi See Page 2 for
Internet: www.tigard,or,gov 1VG U�VlL7��N Notified/Method: Su .1ensentel Information
TYPE OF WORK FEE* SCH DOLE
For special information use checklist
❑13cw construction r
•` Description 1 Qty. I Fa. 7 •foist I
" - OtherNew 5-2-family dwellings(includes 100 0.for each utili connoction)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑1-and 2-family dwelling `®Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Master builderEach additional bath/kitchen 25,02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB 811E INFORMATION AND LOCATION Site adlldes:
Catch Job site address: i�„i s S tr.) 1
to -W
' ' MOE]
City/Statc/ZIP: T i7e Cs.- cGil 21,3 En 18.76
Suite/bldg./apt.no.: t I Project name: C4w4,))me"( Ce Uqt� Fooling
Manufactured homc utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear It.: ) Page 2
Storm sewer(no.linear ft.:_,) Page 2
Water service(no.linear ft.:,,,__) Page 2
Subdivision: ILot no.:
Fixture or Item:
Tax map/parcel no.: 2 5 1 Ol i A,0 3$e>0 l3ackflow preventer 31,27
kwater valve DESCRIPTION OF WORK t'Clothes washer � 2
"1.-- 4s-\ Z b ‘ , akt NNO a LOAc� 4 0 t_d a
2 Mel
pk ties Drinking
t
U PROPERTY OWNER 0 TENANT Expansion tank 12.51Pixture/sewer cap "i__ 25.02 Ott,Floor drain/floor sink/hub ,-- 25.02
Garbage disposal 25.02Hose bit) t
h.
V 12.51
F. APPLICANT El CONTACT PERSON25.02
Page 2
•, MIN12.51
Roof drain(commercial) EMI
S 25,02 ,1D
& 'F" A. 62.34
Phone:(S c3]) -1,11) 0 -3,% Fax::( ) 12.51
E-mail: l►JGC,•1a1w.Wil& 5,�pAt►C.Z) Urinal 25.02 NMI
CONTRACTORWater closet 0,b�
Water heater 37,52
Business name: . ..2.4 • ..4 1 1/t,,t%1P1 s Wateriping/DW V 58.29
Address: kiii9sv. 1 la\� ,c, �vx Other: INN 25.02
City/State/ZIP: , , , Llk I _ di Subtotal 6441
Phone:(S+3) •Litt (, 3sFax:(,S4$ )01 ra—" Li(o,� Minimum permit fee: $72.50 i�
CCB Lic.: I BZ,.1$D Plumbing Lie.no.: pe t51Plan review {25%of permit fee) /4 ob
State surcharge(12%of permit fee) ip.&riev
Authorized signature: fols10.
TOTAL PERMIT FEL? 'mss
Print name: 16/4 S „-"'11 art Z✓ Date: -11- (o Thh permit application expires ire permit h not obtained within 180 days a�
atter It has been accepted a,complete. f/ /i�•
*Fe:methodology set by 11E-County Building Industry Service hoard. 10 '
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
..Site Utilities Qty. Fee(est) Total Square Footage: Permit Fee:
Footing drain-1"I W' 50.03 0 to 2,000 _5121,90
Footing drain-each additional 100' 37.52 2,001 to 3.600 5169,69
- -- 3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 end 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 Qty. RFee(ea) Total each additional$100.00 or fraction thereof,to
and including 510,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000,00 $148.50 for the first 510,000.00 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 550,000.00 $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
Reinspeotinn Funs 90.00/hrand incliding$50,000.00.
Additional plan review for revisions + 90.00/hr $50,001.00 and up 5742,00 for the first$50,000.00 and S1.20 fbr
(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*.
oaaatlty by Fixture Type . Plan Review for Plumbing Installations
Fixture Type for Replace
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
'Bath -Tub/Shower 0 Any new commercial building with water service 2"and
BJacur�i/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Bach Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cusnidor/Water Aspirator as defined in OAR91 X-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities,
-Domestic 1 1 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in 0A0 I R-750-0040.
-
Eye Wash
Moor Drain/sink -2" �+� _ °,, Submit 2 sets of plans with any of the above.
�'C
-4" _ Isometric or Riser Diagram
Car Wash Drain 0 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./Refri,.Drains
Oil Separator(Gas Station) - , Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Clang
-Stall ✓
Sink/Lay -Non-food related 1
-Bradley .
-Commercial-food related
-Service •
Swimming Fool Filter . *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor v.- 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: ,-,_
Macintosh I ID:Uscrs:WCCPlumbing:Downloads:PT.M11_PcrmitApp-4.act
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