Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit#: PLM2020-00329
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/27/2020
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15495 SW SEQUOIA PKWY 150
Project: Spec Space Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: CAP(1)clothes washer.
Contractor: ALWAYS FAITHFUL PLUMBING LLC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 757 ATTN: N PIVEN
WILSONVILLE, OR 97070 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-780-9486 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 08/21/2020 $25.02
Specifics: 1 12%State Surcharge- 08/21/2020 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 08/21/2020 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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: r' Permittee Signature: �. 7 ��/�� J�,
• �.-yam t „O lJ l / % c /
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 AnP1icati0 ECEI Ii ED-
Building Fixtures FOR OFFICE USE ONLY
AUG 1 2 2020
Date/By: O/2920 0eC.' Pem a NoirV 20,0037 /
City of Tigard
'7 • 13125 SW Hall Blvd.,Tigard,OR 97LiTY OF TIGARD Plan Review ,
e Phone: 503.718.2439 Fax: 503.5§XMOING DIVISION DateBy: Other Permit No.:
T I G A R D Inspection!Inc: 503.639.4175 Date ReadyBy: luris: ® See Page 2 for
Internet: www.tigard-or.gov Notified./Methodt Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑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)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 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: 15495 sw Sequoia Pky Catch basin or area drain 18.76
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.: 150 I Project name: pcc225-150 spec 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.5I
Clothes washer 25.02
demo and cap washer hookups
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Pacific Realty Fixture/sewer cap 1 25.02
Floor drain/floor sink/hub 25.02
Address: 6650 SW Redwood Ln Ste 290
Garbage disposal 25.02
City/State/Z1P: Portland/ OR/ 97224 Hose bib 25.02
Phone:( 503) 624-6300 Fax:( ) Ice maker 12.51
IN APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name:Always Faithful Plumbing
Primer 12.51
Contact name: Corey Chamberlain
Roof drain(commercial) 12.51
Address: PO Box 757 Sink/basin/lavatory 25.02
City/State/ZIP:Wilsonville OR 97070 Solar units(potable water) 62.54
Phone:(503)780-9486 Fax::( ) Tub/shower/shower pan 12.51
E-mail:alwaysfaithfulplumbing@yahoo.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Always Faithful Plumbing Water piping/DWV 56.29
Address: PO Box 757 Other: 25.02
City/State/ZIP: Wilsonville, OR 97070 Subtotal
Phone:(503)780-9486 Fax:( ) Minimum permit fee: $72.50 72r SO
CCB Lie.: 217284 Plumbing Lic.no.:PB1940 y
Plan review (25%of permit fee)
/// ///��� / State surcharge(12%of permit fee) O ' 7 a
Authorized signature: � C • TOTAL PERMIT FEE i/, 2,0
Print name:Corey Chamberlain Date:8/11/2 02 0 This permit application expires if a permit is not obtained within IRO days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry'Service Board.
IN:Wilding\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10.f02/COMhvEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-I' 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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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 tea) 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ 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
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
❑
Cuspidor Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic El 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"
3" Isometric or Riser Diagram
❑ 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
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related
-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 1 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
Accumulative Sewer Tally
IIII Tenant Name: Spec Space SWR# N/A
Site Address: 15495 SW Sequoia Pkwy,Suite 150 PLM# 2020-00329
TIGARD
Parcel#: 2S103CD02600
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptiscry/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:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 11 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 1 6 0 -1 -6
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 1 6 0 0 -1 -6
Current Fixture Value -6 divided by 16= -0.375 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -6 divided by 16= -0.375 over (under) $ (2,204.00)
Enter EDU Change Here -0.380 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending i1 .014 or less shall be rounded down to.01.
Notes: .38 EDU CREDITS towards future fixtures added.
Authorized Name/Signature: Dianna Ornelas Date: 8/21/2020
Building Division
Note: The property owner shall retain the ORIGINA1.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_5800_070119.xls x