Permit (197) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00439
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/20/2018
Parcel: 1 S 134AD06200
Jurisdiction: Tigard
Site address: 10565 SW NIMBUS AVE 100
Project: Progressive Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: A
Project Description: Interior plumbing for TI:Capping(5)tub/showers,(2)drinking fountains,(1)3"floor drain,(1)ice machine,and(4)
sinks;Relocating(1)drinking fountain,(1)3"floor drain,(1)ice machine,and(2)sinks.
Contractor: GRIDLINE PLUMBING Owner: DIETRICH, NANCY BISHOP
14844 SW 109TH AVE ROBINSON, JERRY CHRISTOPHER TRUST
TIGARD, OR 97224 ROBINSON, LYNN ET AL
9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: 971-275-6167 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 09/20/2018 $25.02
Specifics: 13 ea Fixture/Sewer Cap 09/20/2018 $325.26
1 ea Floor Drain/Floor Sink/Hub 09/20/2018 $25.02
Type of Use: COM 1 ea Ice Maker 09/20/2018 $12.51
Class of Work: ALT 1 ea Primer 09/20/2018 $12.51
Type of Const: 2 ea Sink 09/20/2018 $50.04
Occupancy Grp: 1 12%State Surcharge- 09/20/2018 $54.04
Stories: Plumbing
Total $504.40
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 fo • the ru adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obt.in a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: -rmitteeSignature: ', y fJ
fi
Call 503.639.4175 by7:00 a.m.for the next available i f. �.
r�,.
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 FOR OFFICE USE ONL\'
City of Tigard j °. Received
Date/By: � L 6 Permit No.:
ill 13125 SW Hall Blvd.,Tigard,OR 97 3 Plan Review ��� �� � 1
= Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: 1 )
Inspection Line: 503.639.4175 SEP 1 8 2018
1 �>�X
T I G A R D Date Ready/By: Juris: RI See age 2 for
Internet: www.tigard-or.gov ` t p Notified/Method: '.-- --1, Supplemental Information
,' 'TYPE-OF WORQ1TY(W'l�I.� R ,` . ;:y FEE*. CHEDUL'E%'
0 New construction al DJi DIVISIONFor special information use checklistµ
Description 1 Qty. Ea. Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
rx CATEGORY,.OF CONSTRUCTION '* • ,: SFR(1)bath 312.70
❑ 1-and 2-family dwelling Commercial/industrial i SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
0 Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
�-���-- � J ` �� Drywell,leach line,or trench drain 18.76
City/State/ZIP: /( 6 ate CI /62-& 2727-3
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: !OD I Project name: C7, 55/1,2 72 Manufactured home utilities 50.03
Cross street/directions to job site: / Manholes 18.76
5i//7----e-- /0e) ,/iP5 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: /3 i 3,.j,4 J1 6� , Lot no.: Fixture or item:
Tax map/parcel no.: `/ Backflow preventer 31.27' Backwater valve 12.51
4'. " 'ill'''''''''-''''
ESCRIPT10 {' F Y R :;.n
E'� y tet'` Clothes washer 25.02
(JJ YntU ' /7 - Dishwasher
25.02c
e_ Q C t -!-1e- Sy-x)77 ,, i5
. Drinking fountain ✓7 1 / 25.02 ;:Z.5.--,(),,
Ejectors/sump 25.02
❑ i opj 6,,,,NER s, a y bx.-„,-2, : z.'� � Expansion tank 12.51
Name: Fixture/sewer cap ✓ 25.02 tj,(j
Floor drain/floor sink/hub ,,,r' / 25.02 Address:
- 2
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax ( ) Ice maker f --{
Y 12.51 i J -
g [O..'PL i =00 5 ( Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 7') / 12.51 / i
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory -,,,- a 25.02 ')?),�11
City/State/ZIP: Solar units(potable water) 62.54
Phone:( )� pp �) Fax::( ) Tub/shower/shower pan 12.51
rLE-mailQjr'jdltj /L7b'% ra /(" /�1CC< Urinal 25.02
�! .: ;; .,, �; ,. Water closet 25.02
. _ )NTR OR r. %
'''''1" Water heater 37.52
Business name: I'- /� 4,e m /4 9
/Zj Water i m/
DWV 56.29
Address: //41( C� I1J / 7 ii Other: 25.02 t
City/State/ZIP: x ofe ? 7zzA4 Subtota a 30
/
Phone:(g 7 ) ).
4/' 7 Fax:( ) Minimum permit fee: $72.50
Plan review25%of permit fee)
CCB Lic.: i//0..5'. Plumbing Lic.no. --f/1 7,,e review (
State surcharge(12%of permit fee) 541,01'1
Authorized signature: SU 'iC)
f
4. cul 1......-t-,1......-t-,-..-` ' TOTAL PERMIT FEE k T
Print name: �t. t/1•.1 &z v l Date:y-if-/g?� 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:\BuildiogTermits\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 Systems:
. . 4. i dee( �; Total otage: Pei�l�it4-ee; ;: �
,,,,,Site ItlLtte . Square Fo
Footing drain-151 100' 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
Valuation: ` 'ems. Fee: : tt :,,
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 •
T6taI each additional$100.00 or fraction thereof,to
$,Ot leer Inspect ns I�e� y" ' :wit": � 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
u �:
accurately report fixtures could result in increased sewer fees*. t n i w § n
Plan Revlev'tor Pi' mh lg in lia s
-',Quantity by.Fixture' pe Plan review is required for any of the following.
Fixture Type for r" Replace/ Please check all that apply.
Work Performed: tiliped,, Added elocate:":
. �R0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower X ) ""a- engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thiu
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
al 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain X 2-. X
r Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" Ag ; an:
3" / )C / .4" r :Isometric orser lagra i 1'; ,..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 ,7
-Commercial food related t -r-t( 'i/t'f/I l ,5 "J
-Industrial food related 3 C t
Ice Mach./Refrig.Drains `i Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related "X 4 X 2--
-Bradley-Bradley
-Com/Serv/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
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
71 Accumulative Sewer Tally
I Tenant Name: PROGRESSIVE SWR# N/A
T t G A R D Site Address: 10565 SW NIMBUS AVE SUITE 100,105 PLM# 2018-00439
Parcel#: 1S 134AD06200
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 5 20 0 -5 -20
-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 2 2 0 -2 -2
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3 inch 5 0 1 5 0 -1 -5
-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 1 1 0 -1 -1
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 4 8 0 -4 -8
-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 13 36 0 0 -13 -36
Current Fixture Value -36 divided by 16= -2.250 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -36 divided by 16= -2.250 over (under) $ (12,712.50)
Enter EDU Change Here -2.250 *
*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: ***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 9/19/2018
Building Division
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_5500_070117.xlsx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10565 SW NIMBUS AVE 100, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00439
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor