Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016 00461
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/12/2016
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 400
Project: Everest Institute Subdivision: ASHBROOK FARM Lot: 5
Project Description: Vacuum air only
Contractor: COLUMBIA CONSTRUCTION INC Owner: PLAZA WEST OWNER LLC
28170 BOBERG RD BY CHIEF FINANCIAL OFFICER
WILSONVILLE, OR 97070 680 FIFTH AVE 20TH FL
NEW YORK, NY 10019
PHONE: 503-427-0304 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Medical Gas 09/12/2016 $72.50
Specifics: 1 12%State Surcharge- 09/12/2016 $8.70
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81,20
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 1.80.
Issued By: Permittee Signature: h'
of, A j4itivjVekeue/
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
City of Tigard Received 2, permit No.:
;1 - RI 13125 SW Hall Blvd.,Tigard,OR 144 3 1. 2_()A Date/By: d �(o ,�,,d0j [,�/av�'lo-GYM lv�
Plan Review a
Phone: 503.718.2439 Fax: 503. 1960 _ -,i -N Date/By: 4// (D5 - Other Permit No.:
Inspection lane: 503.639.4175 ti-- l it,,d:tA
T I G A R D r �"' Date Read/B p Juris: ® See Page 2 for r
Internet: www.tigard-or.gov V1 1' !VISION y y 1 ��( g
I Notified/Method lP
�-y� )�1 Supplemental Information
4 47-','''. -- '�F�.,S'a)./,44 9 t- �" 1 ' ,t.2 ,, ��,i ce *44,41J LLE --- §&
'i New construction ❑Demolitio / For special information use checklist
Description Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
---44.:,,,,-n.€ g hawk Pooboz.:Im-1/0 , . SFR(1)bath 312.70
❑ 1-and 2-family dwelling N Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
, b `. +?� 1$i' iIja Xell, ti It kIf(0 T � E-i3-mow Site utilities:
Job site address: 16S Catch basin or area drain :
�, _( poa Drywell,leach line,or trench drain 18 76
-y104
City/State/ZIP: 1 ®K Q'?223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: TOO It Project name: „prp i4 Manufactured home utilities 50.03
Cross street/directions to job sie: / / 4/77a r f- 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.: Backflow preventer 31.27
,, :±;-,,,I) (t)ir(PP``� .- '1 ,
Backwater valve 12.51
_,,' , 1111141111MlianinaVirClothes washer25.02
l r ii 1 Dishwasher 1
`, " .1
1- (t -. i . . i' :" I140114/44.c-712+41- Drinking fountain 25 1
.--- ... 0, NL_ Ejectors/sump 1
4 ` ° (e i 1 -f ,`t It r-4 o-i. - ); Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 1
Address:
Garbage disposal 1
City/State/ZIP: Hose bib 1
Phone:( ) Fax:( ) Ice maker 12.51
a r "sE 4 ' 0 6 Interceptor/grease tra
Business name: Medical gas(value:$JAM I 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
Phone:( ) I Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 1
0 € ® = Water closet 1
_ . ,;, Water heater 37.52
Business name: ��h ta, C14 TI Water tin DWV 56.29
-�`�'r PP P>/
Address: ?MI S,, a ot, ,j /N-�d^ Other: 25.02
City/State/ZIP: Cit / S(7 h f I N 6 i k et-76'70� Subtotal
Phone:(�a ) (,12`7 „ d 0 v Fax:( ) Minimum permit fee: $72.50 7p3.`��
j a e t n ' Q� Plan review (25%of pertnit fee)
CCB Lic.: 6 I PlumbingLic.no.: (S
State surcharge(12%of permit fee) 70
Authorized signature: , dioitd,._ TOTALPERMIT FEE gt, x)
Print name: O ��� n r�C Date: This permit application expires if a permit is not obtained within 180 days
Net after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pernuts\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
111 1 41
Tenant Name: Everest Institute
A-DentalccumuLlatiabve Sewer Tally SWR# 2016-00299
r i c n Et o Site Address: 9600 SW Oak St,Suite 400 PLM# 2016-00460
Parcel#: 1 S 135BD00100
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 1 0 0 0 0 0
Eye Wash 1 0 0 0 0
0
Floor Drain/Sink: -2 inch 2 0 0 2 4 2 4
-3inch 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 0 0 0 0
-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 8 16 8 16
-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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 10 20 10 20
Current Fixture Value 20 divided by 16= 1.250 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 20 divided by 16= 1.250 over (under) $ 6,625.00
Enter EDU Change Here 1.250 *
*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:
Authorized Name/Signature: Debbie Adamski Date: 8/31/2016
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\SewerTallySheet_5300_070116.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
9600 SW OAK ST 400, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00461
Don Sylvester
Violation Summary:
Inspector Contractor