Permit (69) CITY OF TIGARD PLUMBING PERMIT
IN-. • COMMUNITY DEVELOPMENT Permit#: PLM2016-00548
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/02/2016
R.I� 9 Parcel: 2S112DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKWY 190
Project: Pahlisch Homes Subdivision: PACIFIC CORPORATE CENTER Lot: 3
Project Description: Add(1)break room sink&(1)dishwasher.
Contractor: LIPPOLD PLUMBING&HEATING INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 895 ATTN: N PIVEN
BORING, OR 97009 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 971-404-7012 PHONE: 503 624-6300
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 11/01/2016 $25.02
Specifics: 1 ea Sink 11/01/2016 $25.02
1 12%State Surcharge- 11/01/2016 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 11/01/2016 $22.46
Type of Const: Plumbing
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 1.800.332.2344.
Issued By: Permittee Signature: .A01*
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 "F, +�
� ,
City of Tigard Received Obs>/
I/ / /b PermitNo.: LITlaoll�' y g
11 _ i 13125 SW Hall Blvd.,Tigard,OR 97 Plan RevDate/ByReview
Phone: 503.718.2439 Fax: 503.59 . (i0 1 2016 Date/By: Other Permit No.n jlQ,ap/(p-p034,5"
T'1 G A R n Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov 15' ( t^ S 1 Notified/Method: SupplementalInformation
�j,�ia it.i al�x�3� „;F�
❑New construction 0 Demolition For special information use checklist rDescription Qty. Ea. Total
k Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
(Atio- Y .. etto,siiii& SFR(1)bath 312.70
„ SFR(2)bath 437.78
❑ 1-and 2-family dwelling ®Commercial/industrial
SFR(3)bath 500.32
❑Accessorybuilding 0 Multi-famil
Y Each additional bath/kitchen 25.02
❑Master builder 0 OtherFire sprinkler( sq.ft.) Page 2Ot
Jt1* J� �)O ATK)Ai Site utilities: o
Job site address:15333 SW Sequoia Pkwy Suite 190 Catch basin or area drain 18.76
City/State/ZIP:Portland,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:190 I Project name: No E u se_i,(- go H�h 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 ft.: ) Page 2
Subdivision: 4 I Lot no.: Fixture or item:
Tax map/parcel no.: 02 5 tigDpor 0 C 7 CJ G Backflow preventer 31.27
1 1 als WO' Backwater valve 12.51
I(
Clothes washer 25.02
Add Kitchen Sink&Dishwasher Dishwasher 25.02 j o�'
Drinking fountain 25.02
Ejectors/sump 25.02
„ r 12.51, ❑ �R3 �1 RC IsExpansion tank
q ; ± L
Name:Pacific Realty Associates LP ATTN:N Piven Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:15350 SW Sequoia Pkwy#300
Garbage disposal 25.02
City/State/ZIP:Portland,OR 97224 Hose bib 25.02
Phone:(503)624-6300 Fax:( ) Ice maker 12.51
PI,1G'Aisi ❑ C P> N Interceptor/grease trap 25.02
Business name:Lippold Plumbing&Heating,Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Dallas Lippold
Roof drain(commercial) 12.51
Address:PO BOX 895 Sink/basin/lavatory // 25.02 9,5.o2-
City/State/ZIP:Boring,OR 97009 Solar units(potable water) 62.54
Phone:(971)404-7012 Fax::(NA) Tub/shower/shower pan 12.51
E-mail:dallas@lippoldinc.com Urinal 25.02
Water closet 25.02
Water heater 37.52
Business name:Lippold Plumbing&Heating,Inc. Water piping/DWV 56.29
Address:PO BOX 895 Other: 25.02
City/State/ZIP:Boring,OR 97009 Subtotal
Phone:(971)404-7012 Fax:(NA) Minimum permit fee: $72.50 7a...5-0
Plan review (25%of permit fee)
CCB Lic.:201597 /A/A3 7/7 Plumbing Lic.no.:PB1417 i 11 1 11
State surcharge(12%of permit fee) .7e
Authorized signature: TOTAL PERMIT FEE 8(.AO
Print name:Dallas Lippold Date:11/1/2016 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.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(]0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems
Footing drain-l'`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-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 d uatiom
$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
llis Col .fi a . .:„. i 7 vital
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 normal 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/hr $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*.
Quantity by Fixture Typel d tib' . IlEl n
Fixture'ltiype for Replace Plan
t.
Work]Performed, Capped Added -Relocate-1 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
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4„ Is or er ra
Car Wash Drain
Garbage Domestic-
0 food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related r
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http://www.tigard-or.gov/document center/Building/PLMF PermitApp.4
1111 s
Tenant Name: Pahlisch HomesAccumulative Sewer Tally SWR# 2016-00365
Site Address: 15333 SW Sequoia Pkwy#190 PLM# 2016-00548
TIGARD
Parcel#: 2S112 DA00700
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 1 2 1 2
Drinking Fountain 1 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
-4inch 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 1 2 1 2
-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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 2 4 2 4
Current Fixture Value 4 divided by 16= 0.250 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 4 divided by 16= 0.250 over (under) $ 1,325.00
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:
Authorized Name/Signature: Debbie Adamski Date: 11/1/2016
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.
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