Permit (115) 1111 CITY OF TIGARD PLUMBING PERMIT
1111; COMMUNITY DEVELOPMENT *r• +- Permit#: PLM2018-00403
T[GAS D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/03/2018
Parcel: 1 S134BC00200
Jurisdiction: Tigard
Site address: 12160 SW SCHOLLS FERRY RD
Project: Portland Window Coverings Subdivision: None Lot: None
Project Description: Interior plumbing:Capping(3)sinks and(1)water closet;Relocating(2)sinks and(1)water closet. 11/27/18:
REPRINTED permit to correct address.
Contractor: MIKE PATTERSON PLUMBING Owner: ATLAS GREENWAY LLC
15028 S MITCHELL LN 333 NW NINTH AVE, STE 1009
OREGON CITY, OR 97045 PORTLAND, OR 97209
PHONE: 503-632-7374 PHONE:
FAX: 503-632-5647
FEES
Quantity Description Date Amount
4 ea Fixture/Sewer Cap 10/03/2018 $100.08
Specifics: 2 ea Sink 10/03/2018 $50.04
1 ea Water Closet 08/27/2018 $25.02
Type of Use: COM 1 ea Water Heater 08/27/2018 $37.52
Class of Work: ALT 1 12%State Surcharge- 10/03/2018 $25.52
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $238.18
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 503.232.19= . . 2344.
Issued By: / •• ittee Signature: 10/
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.
111 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00403
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/03/2018
c;AR g Parcel: 1S134BC00200
Jurisdiction: Tigard
Site address: 12198 SW SCHOLLS FERRY RD
Project: Spec Space Subdivision: None Lot: None
Project Description: Interior plumbing:Capping(3)sinks and(1)water closet; Relocating(2)sinks and(1)water closet.
Contractor: MIKE PATTERSON PLUMBING Owner: ATLAS GREENWAY LLC
15028 S MITCHELL LN 333 NW NINTH AVE, STE 1009
OREGON CITY, OR 97045 PORTLAND, OR 97209
PHONE: 503-632-7374 PHONE:
FAX: 503-632-5647
FEES
Quantity Description Date Amount
4 ea Fixture/Sewer Cap 10/03/2018 $100.08
Specifics: 2 ea Sink 10/03/2018 $50.04
1 ea Water Closet 08/27/2018 $25.02
Type of Use: COM 1 ea Water Heater 08/27/2018 $37.52
Class of Work: ALT 1 12%State Surcharge- 10/03/2018 $25.52
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $238.18
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. +u may obtai a 'py of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
2/
/
Issued By: - • --Signature:
' v
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 '�t j - .
Building Fixtures ,,, ' FOR OFFICE USE ONLY
" lam
Cityof Tigard
b t Received
131 5 S W Hall Blvd.,Tigard,OR)972 y ii + Date/By: r?�/f,SJ f Permit No.:,/,/„,,,,,,,,r...„,L�v�
l��(6 Plan Review
11 Phone: 503.718.2439 Fax: 503.598.19 (�t t:, l ate/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov ; ..%, %.,,-.'',s„" `i'. Notified/Method: Supplemental Information
TYPE OF WORI� °'IA lill ( l °,31 It'"�F. FEE* SCHEDULE
❑New construction [�Demolition For special information use checklist.
Description Qty. Ea. Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
0 Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: W Scholls Ferry Rd. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
�� SC4.4-4.'' Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:GBC- 111Lbway ADA Bath 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: I Lot no.: Fixture or item:
Tax map/parcel no.: /2 43 t1COt1f,;?Ck) Backflow preventer 31.27
DESCRIPTION OF WORKW = Backwater valve 12.51
Clothes washer 25.02
Install(1)ADA toilet,(1)wall hung sink and(1)point of use water heater. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap Li 25.02 '
Name: J
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
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contactname:
a m
e.
Roof drain(commercial) (;141A 12.51
Address: fib✓
Sink/basin/lavatory i l ii ,,1' 25.02 25.02
City/State/ZIP: Solar units(potable water) j, 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
mittjp .vomUrinal 25.02
E-mail: � Gep ��1fJ`It, Water closet,fDl�'J
1 25.02 25.02
CONTRACTOR
Water heater 1 37.52 37.52
Business name:Mike Patterson Plumbing,Inc. Water piping/DWV 56.29
Address:PO Box 850 Other: 25.02
City/State/ZIP:Gladstone,OR 97027 Subtotal 7-r--7,4
74
Phone:(503)655-4306 Fax:(503)655-4349 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:81746 Plumbing Lic.no.:3-359PB State surcharge(12%of permit fee) sz
.
, ld
Authorized signature:ef:,�i TOTAL PERMIT FEE 24e, 4(e._
e.
To This permit application expires if a permit is not obtained within 180 days
Print name: G Q (��k Date: �p g after it has been accepted as complete.
J *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 Systems:
Site •Utilities Q� Fee(ea) Total Square Footage: Permit Fee:
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: Permit Fee:
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
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
p 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 Type Plan Review for Plumbing Installations
Fixture Type for Replace! Plan review is required for any of the following.
Work Performed: Capped Added Relocate
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 ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 0 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" Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food
0 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 3 A"
-Bradley i
.?
-Commercial-food related Pa 11
-Service
w
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
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:\UsersUennifer\Downloads\PLMF_PermitApp(1).doc 2
Accumulative Sewer Tally
UPI = Tenant Name: SPEC SPACE SWR# N/A
Site Address: 12198 SW SCHOLLS FERRY RD PLM# 2018-00403
TIGARD
Parcel#: 1S134BC00200
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 0 0 0
Sink:
-Lay/Bar-Non-Food Related 2 0 2 4 0 -2 -4
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 1 3 0 -1 -3
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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 13 0 0 -4 -13
Current Fixture Value -13 divided by 16= -0.813 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -13 divided by 16= -0.813 over (under) $ (4,576.50)
Enter EDU Change Here -0.810 *
*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*** 10/3/18:FEES CHANGED FROM ADDING(1)NEW NON-FOOD RELATED SINK AND(1)NEW WATER CLOSET
ON 8/23/18 TO RELOCATED FIXTURES. BT.
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 10/3/2018
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_5500_070117.xlsx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12198 SW SCHOLLS FERRY RD, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00403
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor