Permit1.
CITY OF TIGARD PLUMBING PERMIT
14---
_ ' COMMUNITY DEVELOPMENT Permit#: PLM2021-00301
Date Issued: 7/28/2021
T I G ARC) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 200
Project: CNA Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Plumbing for new tenant: CAP(1)sink,ADD(1)2"floor drain,(2)sinks,(1)expansion tank,(2)ice makers,(1)
primer,(1)water heater and(1)coffee line.
Contractor: POWER PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES
PO BOX 19418 ATTN: N PIVEN
PORTLAND, OR 97280 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE:
PHONE: 503-244-1900
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Expansion Tank 07/14/2021 $12.51
Specifics: 1 ea Fixture/Sewer Cap 07/14/2021 $25.02
1 ea Floor Drain/Floor Sink/Hub 07/14/2021 $25.02
Type of Use: COM 2 ea Ice Maker 07/14/2021 $25.02
Class of Work: ALT 1 ea Primer 07/14/2021 $12.51
Type of Const: 2 ea Sink 07/14/2021 $50.04
Occupancy Grp: 1 ea Water Heater 07/14/2021 $37.52
Stories: 25 Misc Other Fee 07/14/2021 $25.02
1 12%State Surcharge- 07/14/2021 $25.52
Plumbing
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
Issued By: }{oUy Vc 'iiVe/VU2Ve Permittee Signature: OwAppILOG.tiovt
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 Applicatidn`ECEIVED E 7 2
Building Fixtures JUL 0 2 2021 FOR OFFICE USE ONL 2l d
Cityof Tigard pgCITY OF TIGARD Rcccisxd hzrmii
131 SW Hall Blvd..Tigard,OR 9,I,�I DING DIVISION Plane Reads. J�/L� f' 1 20Z1-M361
Phone: 503.718.2439 Fax: 503 5 Date'By: other Permit SEA) g 20 21-00/93
Inspection Line: 503.639 4175 Date Rcadg Dp // ` hula See Page 2 for
Internet w't6lv.tigard•or.gov tiotified\lelhod�1�Y/2� �(/ la. See Information
TYPE OF WORK 6CTt. -r .. 14/24.S17C-- FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description I GET. I Ea. 1 Total
®Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR 131 bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 12909 SW 68TH PKWY Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
� �iR /State(ZIP:TIGARD, OR 97223 y� Footing drain(no.linear ft.: ) Page 2
V/ A.
Suite/bldg/apt.no.:200 I Project name:21-433 C/4 ' { 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 setter(no.linear ft.:_) Page 2
Water service(no linear ft:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no. Backllose preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
TENANT IMPROVEMENT, CONTINENTAL CASUALTY Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 1 12.51
Fixture/sewer cap 1 25.02 SINK
Name:
Floor drain/floor sink/hub 1 25.02
Address: Garbage disposal 25.02
City/StateJZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 2 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO. Medical gas(value.$_) Page 2
Primer 1 12.51
Contact name: MIKE WARREN Roof drain(commercial) 12.51
Address: P.O. BOX 19418 Sink/basin/lavatory 2 25.02
CityiState/ZIP: PORTLAND, OR 97280-9418 Solar units(potable water) 62.54
Phone:( 503-244-1900 Fax::( 503i-244-8825 Tub/shower/shower pan 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 1 37.52
Business name:POWER PLUMBING CO. Water piping/DWV 56.29
Address:6611 SW MULTNOMAH BLVD Other: 1 25.02 COFFEE
City/State/ZIP.PORTLAND, OR 97223 Subtotal , 2,(o4e
Phone:( 503-244-1900 Fax:( 5031-244-8825 Minimum permit fee S72.50
52378 34 150P6 Plan review (25%of permit fee)
CCB Lie PlumbingLic.no.:
'eviA.,`7 State surcharge(12%of permit fee) S
Authorized signature: l� hi? . cy,ei TOTAL PERMIT FEE .23P /p
Print name:KRISTIE BRAMWELL Date:7-2-21 This permit application expires if a permit is not obtained vi thin 180 days
after it has been accepted as complete.
`Fee methodology set by Tri-County Building Industry Service Board.
I,BuildmgPermas':PLMt:-PetmlApp doe 1001.09 440-4616TI10r02'COM.WEBI
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
Seger-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-Ist 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$7250
Storm&Rain Drain-each additional 100' 37.52 $5.001.00 to$I0A00.00 $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 4148.50 for the first$10,000 00 and$1.54 for
which no fee is specifically indicated 90.00/hr
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
and including$
2525,000.00.
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 of 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
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car wash Each Stall 0 New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidodwater Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial 0 Any multipurpose fire sprinkler system.
-Domestic 0 Any complex structure as defined in OAR9 18-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" t
3,. Isometric or Riser Diagram
4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
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 PLEASE CALL MIKE WARREN WITH QUESTIONS 503-936-5929
Shower: -Gang
Stall i�
Sink: -Lev/Bar non-food related � 2
/l\/�
-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 7
III ■ Accumulative Sewer Tally
Tenant Name: CAN SWR# 2021-00193 Site Address: 12909 SW 68th Pkwy,200 PLM# 2021-00301
i c'n R D Parcel#: 2S101AD03200
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 1 2 1 2
-3 inch 5 0 0 0 0 0
-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 IIP) 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:
Lac/Bar-Non-Food Related 2
0 1 2 2 4 1 2
-Bradley 5 0 0 0 0 0
-Com/Sere/Util-Food Related 3 0 0 0 0 0
i 0 0 0 0 0
Swimming Pool filter
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
0
Capped EDU Credit
TOTALS 0 0 1 2 3 6 2 4
Current Fixture Value 4 divided by 16= 0.250 Current EDU 1 EDU= S6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 4 divided by 16= 0.250 over (under) $ 1,521.25
Enter EDU Change Here 0.250
*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:
Authorized Name/Signature: Dianna Omelas Date: 7/14/2021
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_6085_070121.x1sx