Permit (101) CITY OF TIGARD PLUMBING PERMIT
•' COMMUNITY DEVELOPMENT Permit#: PLM2018-00284
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/11/2018
Tac,r4 I<.C� g Parcel: 1S136CD01501
Jurisdiction: Tigard
Site address: 7600 SW ATLANTA ST
Project: Tigard Self Storage Subdivision: None Lot: None
Project Description: Site utilities for a new 5-story self-storage facility.
Contractor: UEB BUILDERS INC Owner: TRAILBLAZER DEVELOPMENT LLC
6750 E CAMELBACK RD#103 BY CPS ASSET MANAGEMENT LLC
SCOTTSDALE,AZ 85251 333 S STATE ST STE V-144
LAKE OSWEGO, OR 97034
PHONE: 221136 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 10/05/2018 $62.54
Specifics: 485 If Storm Sewer 10/05/2018 $212.62
95 If Water Service 10/05/2018 $62.54
Type of Use: COM 1 ea Backflow Preventer 10/05/2018 $31.27
Class of Work: ALT 1 Plan Review 10/05/2018 $111.00
Type of Const: 1 12%State Surcharge- 10/05/2018 $53.28
Occupancy Grp: Plumbing
Stories: 2 ea Catch Basin or Area Drain 10/05/2018 $37.52
2 ea Manholes 10/05/2018 $37.52
Total $608.29
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:
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.
Piumbing Permit Application
Site Utilities FOR OFFICE USE ONLY
Received Co 2.1` q
City of Tigard Date/By: CI 1 f ,;> f� PennitNo.:�J Cif ',r � )y
v 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 1 G`✓w0
_. Phone: 503.718.2439 Fax: 503.598.1q�ppp1 2018 p Other Permit No.: -->_.
Ins action Line: 503.639.4175 J V!� `' (3 Date Ready/By:
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TIGARD PDate Read B : Juris. IEI See 2 for
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b g Notified/Method: l9 �� /3 7 �L Supplemental Information
;, ' TYPE,OF W �(�swt id.,+��ivGr't*+s FEE's SCIIEDIILE -�
02 New construction t �D Forspecial iu or»aatiorr use checklist.
Description Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
;;'CATEGORY O CONSTRUCTION ; , Y SFR(1)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION-AND LOCATION Site utilities:
Job site address:7600 SW Atlanta Street Catch basin or area drain 2 18.76 37.52 1
Drywell,leach line,or trench drain 0 18.76 0
City/State/ZIP:Tigard,OR,97223
Footing drain(no.linear ft.:_) 0 Page 2 0
Suite/bldg./apt.no.: I Project name:Tigard Self Storage Manufactured home utilities 0 50.03 0
Cross street/directions to job site:SW Dartmouth Street,south of OR 99W Manholes 2 18.76 37.52.-
Rain drain connector 18.76
Sanitary sewer(no.linear ft 1(0 1 Page 2 t4,5-4
Storm sewer(no.linear ft t Page 2 a/ ,‘..,„4. -
Water service(no.linear ft.:95) 1 Page 2 ‘,).; S4II
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.:TLID 1S136CD01501 Backflow preventer 1 31.27 3t,a 11
DESCRIPTION OP WORK Backwater valve 12.51 NA
Clothes washer 25.02 NA
Install private storm water,water,fire water, sanitary sewer
Dishwasher 25.02 NA
Infrastructure for new storage facility and parking lot Drinking fountain 25.02 NA
Ejectors/sump 25.02 NA
® PROPERTY OWNER 0 TENANT Expansion tank 12.51 NA
Name:Trailblazer Development,LLC Fixture/sewer cap 25.02 NA
Floor drain/floor sink/hub 25.02 NA
Address:333 S State St.,Suite V-144
Garbage disposal 25.02 NA
City/State/ZIP:Lake Oswego,OR 97034 Hose bib 25.02 NA
Phone:(866)930-9390 x11 Fax:( ) Ice maker 12.51 NA
;0 APPLICANT = . fa CONTACT PERSON Interceptor/grease trap 25.02 NA
Business name:Otak,Inc Medical gas(value:$_) Page 2 NA
Primer 12.51 NA
Contact name: Kyle Childers
Roof drain(commercial) 12.51 NA
Address:808 SW Third Ave Suite 300 Sink/basin/lavatory 25.02 NA
City/State/ZIP:Portland,OR Solar units(potable water) 62.54 NA
Phone:(503)287-6825 Fax::( ) Tub/shower/shower pan 12.51 NA
E-mail:kyle.childers@otak.com Urinal 25.02 NA
CONTRACTOR Water closet 25.02 NA
Water heater 37.52 NA
Business name:UEB(General Contractor) Water piping/DWV 56.29 NA
Address:9236 SE Woodstock Blvd Other: 25.02 NA
City/state/ZiP:Portland,OR 97266 Subtotal 444,
Phone:(206)718-4217 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 221136 Plumbing Lic.no.: Plan review (25%of permit fee) f/.,3('
State surcharge(12%of permit fee) -3 , s
Authorized signature: I G /� •TOTAL PERMIT FEE g'Of. l
/ This permit application expires if a permit is not obtained within; 1
Print name:Trailblazer Development LLC by Azam Qayum,its ManagerDate: 6/6/18 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:UBuilding\Pernuts\PLMU-PermiiApp.doc 10/01/09 440-4616T(10/02/COMAVEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
-S to Uti ities Qiy Fee.(ea) Tota[ Square Footage Permit Fee:
Footing drain-1"100' 0 50.03 0 0 to 2,000 $121.90
Footing drain-each additional 100' 0 37.52 0 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' off. 62.54 fa.si4ie 7,201 and greater $327.54
Sewer-each additional 100' 0 37.52 0
Water Service-1st 100' 95 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' 0 37.52 0 YaluafIop :<-. Permit Fee:
Storm&Rain Drain-1st 100' ` 62.54 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 4 37.52 f" yC�� $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
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:.1(j
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/
Work Performed: Capped Added . Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ 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"
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food El 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 Fixture work to be submitted with
Shower -Gang
Stall building plans and not included in this
Sink/Lav -Non-food related application.
-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 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:
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