Permit CITY OF TIGARD PLUMBING PERMIT
14 14 8_ COMMUNITY DEVELOPMENT Permit#: PLM2021 00003
Date Issued: 1/6/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD, STE#501
Project: Lithia Driveway Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Capping (1)sink;Replacing(1)sink;Installing(1)water heater.
Contractor: CRAFTWORK PLUMBING INC Owner: LITHIA REAL ESTATE INC
7939 SW CIRRUS DR BLDG 23 ATTN DEBOER, MARK
BEAVERTON, OR 97008 150 N BARTLETT ST
MEDFORD, OR 97501
PHONE: 503-644-8698 PHONE:
FAX: 503-644-5989
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 01/06/2021 $25.02
Specifics: 1 ea Sink 01/06/2021 $25.02
1 ea Water Heater 01/06/2021 $37.52
Type of Use: COM 1 12%State Surcharge- 01/06/2021 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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:C Cam"'
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.
1 ,
Plumbing Permit ApplicatiO1 ECCY�� /e
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Building Fixtures FOR OFFICE; LSl O:vLV
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City of Tigard DEC 3 0 2020 r;atell� / S�o?/ B�- Permit No.: &IVO,, t-/f1(a
• 13125 SW'Hall Blvd. 'Tigard OR 97221 y` '-r v-
t Ilan Review
Phone 503.718 2439 Fax. 503.59R.19fiQ ITY OF TIGAA Other Pemtit No. .,
u p Uate/BY: t o Lrr 7
,16 A R D Inspection Line: 503.639 4175 Date Heady/By. �p�y_- trio I Ed Sec age 2 for
Internet: www.ligdrd-orgov II/ G D(V1SIO Notified/Method. � 'T' J Supplemental Information
2§r tirJ r.c n ,�. ° ;' L".M ! ,#alto%XXX
.pC i�': .e` a'� r.�.3t� t ', � '# x4E'ifn" SCHGllt;LE
❑New Construction 0 Demolition Fo special information use checklist.
Description I Qty. JFa. I Total
(f Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
. . . 3kSl* '4''''' °r'� °' ,..A 3 t7wt.. +2. , „. _.. SFR(I)bath 31270 --
- 1-and 2-family dwelling ®Commercial/industrial
41.131
SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional hath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft) Page 2
�4. :F- � a •' . i + a4/ e ".-* °wY a `y siteuallnea: --
Job site address:q DI 0 ,'LL (J L2 r}I!v k)i V f' 30. R Catch basin or area drain 18.76
Dryweli,leach line,or trench drain 18.76
City/State/ZIP: \ ((:1Nye......0 Q --_ L aA/4 ArfllCr fr,•{,3/ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:5-di I Project name "A r"° ' -- Manufactured home utilities S0.(13
Cross street/directions to job site: `-\1,J.)'( a )❑ 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 II.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: ls/,00 1I ' Back flow prevcntcr 31.27
,,,; K C -r"., 11;t)� r *g,:,* .1 Backwater valve 12.51
- V 4142 Clothes washer 25,02
ilf.Wtove, t( a pAtk. ink... e,ke OFF J)11 ri. Dishwasher 25.02
jZ.C'.(Mtve 8 IelA.51!SLL. V+ft09.{/'S IN(C, 4I30 Drinking fountain 25.02
i� .€- --. Ejectors/sump 25.02
?" "xr "� ....'-• -=r" - ,s, Expansion tank 12.51
... . 1 (� ft.h,tNl
Fixture/sewercap S rank . I 25.02 DS'.01-
Name:
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
r.).4.'7 .-. pv„;T ti ; k t ps Interceptor/grease trap 25.02
Business name:L FZ>�tNL.v._ ,'�, Lk.)ill.cL )0.3 (r _ _T Medical gas(value:$_) Page 2
Primer 12.51
Contact name: fA('ETZc{ K,te.2a Lt.),to S ye. I Roof drain(commercial) 12.51
Address: _ Sink/basin/lavatory I, 25.02 .5,O )-
City/State/ZIP: Solar units(potable water) 62.54
Phone:(gZ1 3)--a.,. g 1 (,,I Fax::( ) Tub/shower/shower pan 12.51
t(^'' � Urinal 25.02
E-mail:T\'--G-r- @ e r'o3't'e+?Ov-'k- \.)-rv.,.l:t m G t9/n^
a - Water closet 25.02
-.- V , - - - Water heater 1 37.52 3 1.s')-
Businessname:( )�py.roOiQ� ?LUV14B.L ) ,� .._`_ Water piping/DWV 56.29
Address: .1 Cl.. c1 G✓' 10 G>,'2162..uSa. '-' ,0_,_,,, Other: 25.02
City/State/ZIP:"?::,�•-" Jv„-ye__-c' - `ya- G`'.--/ p Og Subtotal 4icl,Sla
Phone:( A to y9.- 6r.( g Fax:( -0, t4 4 t.� `B Minimum permit fee: $72.50
b i/ j 01
`'1 8 ? Plan review (25%of permit fee) }!'
CCB Lic.: (O Plumbing Lie.no.:
/ State surcharge(12%of permit fee) � ro
Authorized signature. a y . I/tr/a)'( TOTAL PERMIT FEE �.{�- Ai?ma
Print named)/1 . ,r v i O$ Dater('J, 6 ,a, This permit applicationt hasrbe if a permit is not obtained within ISO days1T74�
J �_"- t after 11 been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service,Board.
l ABuildingW°mtita'PLMU-Pertua pp.dac 10,01/09 440-4616T(twoaCoMJWea(
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Sub ression S stems:
ttless Qty''... Fec tea) Tatar ttv"t`sc a v a �;
Footing drain- I 100` 50.03 0 to 2,000 $121.90
Footing dram-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 IOW 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 #uati0n: Permit Fee:
Storm&Rain Drain-tat ion' 62.54 $a --
$1.00 to S5.000.00 Minimum fee$72.50
Storm&Ruin Drain-each additional 100' 37.52 i $5,001.00 to$10.000.00 $72.50 for the first$5.000.00 and$1.52 for
Other Inspections or Fees` 1sty. ,' Fec('a).: Tula(:' 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 90.00Au $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 -
9uantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Roplacrt Please check all that apply.
Work Performed; Capped Added - Relocate.
RaptisrrylFont El Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool New engineer.
exterior Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
ElCuspidor/water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Cmnmercial ❑ Any multipurpose fire sprinkler system.
-Domestic ElAny complex structure as defined in OAR918-780-0040.
DrEycWashag Fountain Submit 2 sets ofplans with anyof the above.
Eyo
Floor Drain/sink: -2"
Isometric or Riser Diagram
-4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Dram that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice MachiRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
n -Lav ar non-food relate i X
-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-Cloches fees assessed for the sewer increase be paid before the
Water Extractor must
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures;
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
: Accumulative Sewer Tally
lig • Tenant Name: LITHIA DRIVEWAY SWR# N/A
Site Address: 9020 SW WASHINGTON SQUARE RD PLM# 2020-00003
TIGARD
Parcel#: 1 S 126BC01506
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s clue count added# added value total#s total values
Baptistry/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 I IP) 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 1 2 0 -1 -2
-Bradley 5 0 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 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 1 2 0 0 -1 -2
Current Fixture Value -2 divided by 16= -0.125 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -2 divided by 16= -0.125 over (under) $ (754.00)
Enter EDU Change Here -0.130 *
*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: BRANDFN TAGGART X2449 Date: 1/5/2021
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_5800_070119.xlsx