Permit (24) CITY OF TIGARD PLUMBING PERMIT
III 2 ' ' COMMUNITY DEVELOPMENT
Permit#: PLM2017-00143
Date Issued: 04/24/2017
-f E C A kt D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12262 SW SCHOLLS FERRY RD
Project: Advantis Greenway Subdivision: None Lot: None
Project Description: Add(1)mop sink,relocate/replace(1)break room sink&(1)water heater,cap(2)clothes washers.
Contractor: COLUMBIA CONSTRUCTION INC Owner: FW OR-GREENWAY TOWN CENTER LLC
28170 BOBERG RD PO BOX 790830
WILSONVILLE, OR 97070 SAN ANTONIO, TX 78279
PHONE:
PHONE: 503-427-0304
FAX:
FEES
Quantity Description Date Amount
2 ea Fixture/Sewer Cap 04/24/2017 $50.04
Specifics: 2 ea Sink 04/24/2017 $50.04
1 ea Water Heater 04/24/2017 $37.52
Type of Use: COM 1 12%State Surcharge- 04/24/2017 $16.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $154.11
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 N. - .. --- -r. Those rules are set forth in OAR 952-001-0010 through •,. ' :' -0090. You may obtain a copy of the rules
or d. ct questions to OUN bik..4 , calling 503.232.1987 or 1.800.332.2344.
ssued By: � �A Permittee •ignature:
/
Call 503.639.4175 by 7:00 a.m.for the next availabl•.' spection 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 RECEIVED FOR OFFICE USE ONLI'
City of Tigard Received /R / 7 i ft PermitNo.: &H -OI1 OC/ 3
a 13125 SW Hall Blvd.,Tigard,OR 97 Date/By:
F ' � 2 4 2 017 Plan Review /��t,., e rle��
Phone: 503.718.2439 Fax: 503.598. Dale/By: Other Permit No.:f�/"o[/f T Gl/Y(i[.y
TI GAR D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: furls: la See Page 2 for
Internet: www.tigard-or.gov Notified/Method: II „// Supplemental Information
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0 New construction El Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
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ii,1}i.:IT I,�,E11 .._...a-...dXTEe A_,--,� Plpgg@I @.._y�i,.�"� 31.€1814111111111i� '" 1..111 LI SFR(1)bath 312.70
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-,,T--,git< __
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
El Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
El Master builder ❑Other: Fire sprinlder( sq.ft.) Page 2
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:ri�l`iM '€Eidg P �OBI1TE INFORM.aSON t W-1 A1'1'IO 'P 1@ I - Site utilities:
�. .P°9X.11..E@f9El 3e I@d;Y.iPetP...�._a.w.�..Vse Si :�� .__.a.stt_Ae.o.. i.^'1-r.'".".T �a. P End,O.S.. ,t s
Job site address:12262 SW Scholls Ferry Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Beaverton
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:Advantis Greenway 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: p Lot no.: Fixture or item:
G�
Tax map/parcel no.: /5/341 !O'2c.,c) Backflow preventer 31.27
m 9ig oot..4 : i< � @ " �_-.-....TP p
Backwater Valva 12.51
-�.---- ,?g. ..a` ilhiS , �q h .OA\ NEA@ M '2 r 9@Willi .§ 1T@ -NClothes
washer 25.02
Plumb for a mop basin water heater breakroom sink Dishwasher 25.02
Replace toilet and lavatory(no permit needed) Drinking fountain 25.02
Ejectors/sump 25.02
r,l�g�i @d❑aPR_e ftol: IIIIW'^ `" l? -��I. :� -4 lr!1d TE Tiiii Expansion tank 12.51
-mplesName: Fixture/sewer cap g. 25.02
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
Rk"lCAr F --.,j-__. . @.. , 0 CONi`AC YERSOl , L Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 2 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
__..__..� 1 1 ,.s�.. 0 ,'@ Waterer closet 25.02
1 f /iN/R � 1g +o
.n1i1 p,gli O,„..., l' 1v .. ; 1d gR. Ks water heater
1
37.52
Business name:Columbia Const.Inc. Water piping/DWV 56.29
Address:PO Box 621 Other: 25.02
City/State/ZIP:Donald,OR 97020 Subtotal
Phone:(503)427-0304 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:199903 Plumbing Lic.no.:PB-1400
n , 1 State surcharge(12%of permit fee)
Authorized signature: V .,,,11 1 TOTAL PERMIT FEE 1/6LI.«
Print name:Darren Placek ���M�'�`���NNN+++ Date:04-24-2017 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(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
4> .� t,C ,4.�.4�.-x o¢f
Footing dram-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-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 ""tl!NN€t;fg€, x, t°`
Storm&Rain Drain-1st 100' 62.54
l {+ ,+4'PP�€ ra j
$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
'g� Mss g s�+sly ng 3tefgi ffagy 3f t vg,sgt a7 each additional$100.00 or fraction thereof,to
G...;. e ' K fs i7 t1:1 P i +'s i"g's€lIsis€ fS .: 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*.
AgM °I+lfg
Qua fity by Fixture Type ]an . A G ,for pilimlllgnstR $ lrC
tuYe Type for Is14P.5-0444:r
eellocate Plan review is required for any of the following.
,o '-Perforkned ,piled . Added Rocate, Please check all that apply.
Baptistry/Font
Bath Tub/Shower CI 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 ❑ 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 ❑ 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" p
4"
Car Wash Drain ❑ 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./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/lav -Non-food related
-Bradley
-Commercial-food related
-Service 1
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes 2
Water Extractor 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:
C:\Users\Darren\AppData\Local\Temp\PLMF_PermitApp.doc 2
•
1111 C Tenant Name: Advantis Green
wayAccumulative Sewer Tally SWR# N/A
Site Address: 12262 SW Scholls Ferry Rd PLM# 2017-00143
T I G A R D
Parcel#: 1S 134BC00300
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
-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 1 2 1 2
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 2 12 0 -2 -12
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 2 12 2 5 0 -7
Current Fixture Value -7 divided by 16= -0.438 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -7 divided by 16= -0.438 over (under) $ (2,332.00)
Enter EDU Change Here -0.440 *
*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: 4/24/2017
Building Division
IN
ote: 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