Permit (128) 71CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00569
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/22/2016
Parcel: 2S112DA01300
Jurisdiction: Tigard
Site address: 6640 SW REDWOOD LN 300
Project: Portland Clinic Subdivision: 1996-048 PARTITION PLAT Lot: 1
Project Description: Interior plumbing for TI:Capping(7)sinks and(6)water closets;Adding(1)shower stall and(1)water closet;
Relocating(1)water closet. 12/8/16 REPRINTED to add(1)sink&replace(1)water heater.
Contractor: DETEMPLE COMPANY INC Owner: PACIFIC REALTY ASSOCIATES
1951 NW OVERTON ST ATTN: N PIVEN
PORTLAND, OR 97209 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-227-2641 PHONE: 503-624 6300
FAX: 503-274-7686
FEES
Quantity Description Date Amount
13 ea Fixture/Sewer Cap 11/22/2016 $325.26
Specifics:, 1 ea Tub/Shower/Shower Pan 11/22/2016 $12.51
2 ea Water Closet 11/22/2016 $50.04
Type of Use: COM 1 12%State Surcharge- 11/22/2016 $46.54
Class of Work: ALT Plumbing
Type of Const: 1 ea Sink 12/12/2016 $25.02
Occupancy Grp: 1 ea Water Heater 12/12/2016 $37.52
Stories: 8 12%State Surcharge- 12/12/2016 $7.50
Plumbing
45 Misc Administration Fee 12/12/2016 $45.00
0 12%State Surcharge- 12/12/2016 $7.50
Plumbing
Total $556.89
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: ,(arPermittee Signature:
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.
UPI - Accumulative Sewer Tally
it
Tenant Name: PORTLAND CLINIC SWR# N/A
TtGARpSite Address: 6640 SW REDWOOD LN PLM# 2016-00569
Parcel#: 2S 112 DA01300
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 0 0 0
-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 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 1 2 1 2
Sink:
-Lay/Bar-Non-Food Related 2 0 7 14 1 2 -6 -12
-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 1 6 6 36 1 6 -4 -24
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 1 6 13 50 3 10 -9 -34
Current Fixture Value -34 divided by 16= -2.125 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 6 divided by 16= 0.375 Previous EDU
Change -40 divided by 16= -2.500 over (under) $ (13,250.00)
Enter EDU Change Here -2.500
*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: ***CREDIT***Revised 12/8/16 to add(1)sink.
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 11/22/2016
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:ABuilding\Sewer Tally\SewerTallySheet_5300_070116.xlsx
Plumbing Permit Applicat
EIVED
Building Fixtures 1,
City of Tigard Recelve
r� IIIIIMI
Date/By: /y / Permit No.: di i�-6 56 9
111 III • 13125 SW Hall Blvd.,Tigard,OR 97143 C 0 7 2 p 1 6
Pian Review
Phone: 503.718.2439 Fax: 503.598.1960 Date'By: Other Permit No.:
Inspection Line: 503.639.4175C OJ( AltIi n :ll Date Read)By: oris: H See Page 2 for www.tigard-or.gov
Notified/Method: Supplemental information
.z �'xi,: sem.. �:
❑New construction 0 Demolition For special information use checklist
Description I Qty. j Ea. j Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft,for each utility connection)
-! " T CATEGO'4 P,/ , c ON `"'.. 'r,',7,,,,:,.-
r SFR(1)bath 312.70
SFR(2)bath 437.78
❑ 1-and 2-family dwelling 0,Commercial/industrial ,
❑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
v
t ,, JOBS SITZ INFORMATION 7+r VOCATION} ;ry' Site utilities:
Job site address: j SLO /...mCatch basin or area drain 18.76
.,. Drywell,leach line,or trench drain 18.76
City/State/ZIP: ,�c,,.- C)(Z S i 9-(�.iL Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: \ l /-+
Ft`l�ltaf\C� 4.-,\f\\'r Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
�� / Rain drain connector 18.76
/�� 7✓ D ✓7 / 42 Sanitary sewer(no.linear ft.: ) Page 2
P4-41`--1Storm 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..x'3.1'.:1' �A t' io' '4;Y,, ,t g A? Backwater valve 12.51
� Clothes washer 25.02
"E,OC1 S CC'vsn r Dishwasher 25.02
VV--\17C. < -'e. 1. Drinking fountain 25.02
KA c - Ejectors/sump 25.02
PROP a '`; gay :,l Expansion tank 12.51
Fixture/sewer cap 25.02
Name: F(,��\tNr CX C,i r1\t"_.. Floor drain/floor sink/hub 25.02
Address:(L (231::Vt..7C)t,{l I Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker
k 12.51
' APPY.1'C ONl ACT PERSO V Interceptor:grease trap 25.02
Business name: \%�v?moMedical gas(value:$ ) Page 2
Primer
12.51
Contact name: ?' \ v,
k..\-N / iNvi\as\ckj.....„
lam m Roof drain(commercial) 12.51
Address: 6 CD-71_4, �q____. ��c, C._. .\,1/4
Sink/basin/lavatory I 25.02
City/State1ZIP:V �.\\-„ 01(2........ (Art�(3 Solar units(potable water) 62.54
Phone:( 1 t ';L}.,--1-1 to e�6, Fax::((\' 4 ) Tub/shower'shower. pan 12.51
Urinal 25.02
E-mail R C ANSi_'Z.ra.gyN)N OA € ' to L _t>ry,
vg3 Q Water closet 25.02CORCTOR 0
t 3,',`, Water heater
37.52
Business name:
�✓if;lk.Y11•.0- C:k.„. C�C3 LA.„Q Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 1D,-'�j\0 Plumbing Lic.no.:g(- '��
Plan review (25%of pennit fee)
Authorized signature: �_��L 4 /10.-j------- State surchargeTTO(1TAL
ofRM T fee) */./5:
o
TOTAL PERMIT FEE �7l f,j. /
Print name: \�.1i\ \\-01•.\-\\ Date: 1 i�j 17 i it, 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 PLMU-PermitApp.doc 10.01'09 440-0616T(1602('OM'WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
�Qt3 n FeeY )' y.;
Footing drain l°100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $12
3,601 to 7,200 $23333.200
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' b2.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 'ee
u0 ..,, CI'lllty
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
1fTee(ee) Total
each additional$100.00 or fraction thereof,to
Other IpspeCtlops or Fees Q� 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$120 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*. r Gln °e `�.EOrPlunibingnStllati�>s�-
Quakily by Fixture Type - Plan review is required for any of the following.
Fixture Type:for Reptscx/ Please check all that apply.
Wort performed: .; Capped Added S Rcl;.eate ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cusp;dor;'Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
❑ Any multipurpose fire sprinkler system.
Dishwasher -Commercial
Domestic 0 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"
-4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Conunercial food related
-Industrial food related
Ice MachlRefrig.Drains
Commentsppl regardingfixture work:
Oil Separator(Gas Station) ttt ii I 11S b C\r,
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay.Bar non-food related ,
-Bradley
-Com/Sery.'Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming 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 \n^�
Other Fixtures: \y\1 0, x lq l
C:\Users'achezem.DTML\Desktop\PLM Permit Portland Clinic B.doc 08!04/201 I
CITY OF TIGARD PLUMBING PERMIT
# COMMUNITY DEVELOPMENT Permit#: PLM2016-00569
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/22/2016
T[c: + I<'.[=y g Parcel: 2S112DA01300
Jurisdiction: Tigard
Site address: 6640 SW REDWOOD LN 300
Project: Portland Clinic Subdivision: 1996-048 PARTITION PLAT Lot: 1
Project Description: Interior plumbing for TI:Capping(7)sinks and(6)water closets;Adding(1)shower stall and(1)water closet;
Relocating(1)water closet.
Contractor: DETEMPLE COMPANY INC Owner: PACIFIC REALTY ASSOCIATES
1951 NW OVERTON ST ATTN: N PIVEN
PORTLAND, OR 97209 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-624-6300
PHONE: 503-227-2641
FAX: 503-274-7686
FEES
Quantity Description Date Amount
13 ea Fixture/Sewer Cap 11/22/2016 $325.26
Specifics: 1 ea Tub/Shower/Shower Pan 11/22/2016 $12.51
2 ea Water Closet 11/22/2016 $50.04
Type of Use: COM 1 12%State Surcharge- 11/22/2016 $46.54
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $434.35
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct s io o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Sign. ure:
Call 503.639.4175 by 7:00 a.m.for the next available inspe, on date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
11/17/2016 11 : 03 Frei I I1 2. 7§ DeTemple Co Inc Page : 1/1
Plumbing Permit Application ff)I't i 3c D
OOoBuilding Fixtures NOV 1 7 2( 1 FR FFICt SE ri
City 0f Tigard , I r Received // �7 /6 � Permit No.: /Le"rt;o!
a r r �) Date/By,vie
I1/41 � 33125 S W Hall Blvd,Tigard OfF�.9�+�2.3' '� �� f Pian Review
Phone: 503.718.2439 Fax t5Q3a5fii T14 i'`y+A ,' Date/By. Other Permit No, -A
Inspection Line: 503.639 41750:°.%-.....->' t : `,E Dale Read/B huh: 8f See Page z fur _�
TICAI D, Y Y g
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
die 'i e l '1 ` 0 'WOkK is ' :'FEE* SCUEiii'LC.
+.a�3�� Y .i s. ..� .��',�� r �'�.k.k ..,J ei., ...' Y ...u1. .1 t . .,. -., ..,.... .,. r... ..... � e .... _
0 New construction 0 Demolition
For special information use checklist
Description I Qty. I Ea. 1 Total
/ Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes I00 ft.for each utility connection)
CA'TECQR'Y O CON$''R>JCT1OI ..,i, SFR(1)bath 312.70
❑ 1-and 2-family dwelling Z Commercial/industrial SYR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
:1OB SITE INFORMATION-AND LOCATIO1+ Site utilities;
Job site address:6640 SW Redwood Ln Catch basin or area drain I8.76
-_... Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Portland Clinic Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18,76
Sanitary sewer(no.linear ft.:T) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no,linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
IFW j Backwater valve 12.51
1DPCRYPlON OOR�z
Clothes washer 25.02
u •'' �`a't �""`� 41 : Dishwasher 25.02
S(13)64,1--,A-...,, `\ ‘1,......„ Df_.ux4''
Drinking fountain _, r 25,02
4� -- t\ �� Ejectors/sump 1-ilii 25.02
_ e3 ROPERT Fd"1+E ,, ❑ TEI�IAlV1 ExpansionF, / 12.51
� tank
Name:Portland ClinicFixture/sewer cap /3 25.02 3d,- ,-. v .,
Floor drain/floor sink/hub 25.02
Address:6640 SW Redwood Ln
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone ( ) Fax ( ) Ice maker 12.51
❑ AF.I'LICANT CON.RACI P.EiLSON • Interceptor/grease trap 25.02
Business name:DeTemple Medical gas(value:S�) Page 2
Primer 12.51
°
Contact name:Phil Huth �.,L 7 c` ` Roof drain(cormnercial) 12.51
Address:5636 NE Hassalo St Sink/basin/lavatory 25.02
City/State/ZIP:Portland,OR 97213 j Solar units(potable water) 62.54 j
Phone:(503)274-7686 Fax::( ) Tub/shower/shower pan l 12.53 bo?5-1 !
E-mail bedsra�?detemplc com Urinal 25.02 i
Water closet25.02 S'(e --1:l.t'l
CON I It.Af.TOR • •
,�. W ater heater37.52
Business name:Same as above / 1
Water piping/DWV 6/_' 56.29 f
Address: Other: `P 25.02 ?
City/State/ZIP: Subtotal 1
Minimum permit fee: 572.50 „�LRA:KS'r
Phone:( ) Fax:( ) � � 7,
CCB Lia: t� Plumbing Lie.no.: Plan review (25%of permit fee) -----Cr
J` t9,(v...... 5??,) State surcharge(12%of permit fee) ,-I-1 Lit)..51
Authorized signature: n t /FAfes, TOTAL PERMIT FEE ,„.1.1.2t111.641,35'
This permit application expires if a permit is not obtained within 180 days
Print name. , 'Q �.� ff y+.� Date: after it has been accepted in complete.
*Fee methodology set by Tri-County Building Industry Service Board.
C Buiidtng.nermitsPLMU-PennitApp$ec IO,CI'09 440,46IOT(1O'0'_'COVPWEB)
11/17/2016 10 : 53 From : 5032747686 DeTemple Co Inc Page : 1/2
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site 'iflMes r ,.} ,.> .?. , i>dee cea)t ;£vtst S(l t ;l a; toga,ge`t, ';.r3.'r F emit; 'ee:
Footing drain-I"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,00I 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-€st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-Ist 100' S2.54
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 55,001.00 to$10,000.00 £72.50 for the first$5,000.00 and$1.52 for
�� IlspectIOIi�S or ees Qty Tec(es) "..;dotal 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--I/2 hour) and including$25,000.00. 1
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 5379.50 for the first$25,000.00 and 51.45 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 550,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum char_e-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 Type: ;( Plain Re civ f4?r P umbudg Y$1Sta1l* IQu5
Frxture hype tot Replace/ plan review is required for anyof the following.
Work lsertornied:i . Capped Added, tteRacat®. 9 $•
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 Thin ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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"
Car Wash Drain
Isometric or Riser thagra�in
Garbage Domestic-non-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 1
Sink/lav -Non-food related 7
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EIDUs,a sewer permit will be issued and
Water Closet-Toilet 6 1 l fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\aehezem.DTML\Desktop\Portland Clinielumbing Fixtures Apticatirn.doc
Accumulative Sewer Tally
vil ..a
Tenant Name: PORTLAND CLINIC SWR# N/A
Site Address: 6640 SW REDWOOD LN PLM# 2016-00569
TIGARD
Parcel#: 2S112DA01300
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 0 0 0
-3inch 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 1 2 1 2
Sink:
-Lay/Bar-Non-Food Related 2 0 7 14 0 -7 -14
-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 1 6 6 36 1 6 -4 -24
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 1 6 13 50 2 8 -10 -36
Current Fixture Value -36 divided by 16= -2.250 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 6 divided by 16= 0.375 Previous EDU
Change -42 divided by 16= -2.625 over (under) $ (13,939.00)
Enter EDU Change Here -2.630 *
*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: ***CREDIT***
Authorized Name/Signature:BRANDEN TAGGART X2449 Date: 11/22/2016
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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
6640 SW REDWOOD LN 300, TIGARD, OR, March 8, 2017 at 11 :16:24 AM
97224
Record Type: Record ID:
Commercial - Plumbing PLM2016-00569
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Corrections are complete - plumbing final approved
Violation Summary:
Inspector Contractor