Permit CITY OF TIGARD PLUMBING PERMIT
11
''1 = COMMUNITY DEVELOPMENT Permit#: PLM2021-00253
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/18/2021
T f[ R T3 g Parcel: 2S113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 150
Project: Oregon State Bar Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: Interior plumbing:Capping(1)dishwasher,(1)sink,and(1)coffee pipe in breakroom.
Contractor: A ABSOLUTE COMFORT HEATING&COOLING INC Owner: OREGON STATE BAR,THE
15886 PARK PLACE CT 16037 SW UPPER BOONES FERRY RD
OREGON CITY, OR 97045 PO BOX 231935
TIGARD, OR 97224
PHONE: 503-513-4795 PHONE:
FAX: 503-513-0797
FEES
Quantity Description Date Amount
3 ea Fixture/Sewer Cap 06/16/2021 $75.06
Specifics: 1 12%State Surcharge- 06/16/2021 $9.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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 tto� �/2.OUNC by calling 503.232.1987 or 1.800.332.2344.
—l_
Issued By: . j'/ /�_ / Permittee Signature: e� ��/ 7�
�, 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 6 -
Building Fixtures FOR OFFICE, usr ONLY
City of Tigard eceived Permit No.:
II n 13125 SW Hail Blvd.,Tigard,OR 97 EC E IV E gate/By: /Ihs/ .I7�•-•' /�N�t a�'
F tan Review _/
Phone', 503.718.2439 fax: 503.598.19 0 Date/By: /A_/ Other Permit No.:
T IGARD Inspection Line: 503.639.4175 i `' q q Date Ready/By: _tuts. Sea Page 2 far
Internet: ww .tigard-or.gov JUK 40L� tJotificdJVtetlto l; e'�y ' Sapplementnl InformnHon
TYPE OF WORK CITY OF TIGARD f'� �rr-r�
TEE' SCHEDULE
❑New construction �.rA.�m 4t° ��De" ' For specialIstJarrnadon use checklist
;U1LDNG DIVISION Description Qty. I Ea. 1 Total
❑Addition/alteration/replacement 0 • ter: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling mmercial/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:
/� y7 „� f area 18.76
Job site address: �� were � rae�,", {`rP-�' �wf
j
l DCatchry4vebasinll,leachor line,or trenchdrain drain 18.76
City/State/ZIP: 1.4 �, . , a Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt,no.:`I ikrb , {Project name: e; 1/:140r3 <,4 Me 1.-''r . . Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
`4,/'/ Rain drain connector 18.76
,NA l 7FG 1� j�JCT ` �n �' �"� Sanitary sewer(no,linear ft Page2.:�)
if3 . 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.: ?s/B 3cie) Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK 25.02
Clothes washer
k t4,,, - (1\ �e 6,44 fit,. I `°LC, Dishwasher 25.02
j'ie4' t.J)_ _ (W_•._eiy,'1 4/I(�� j, Drinking fountain 25.02
"�v/ Ejectors/sump 25.02
0 PROPERTY OWNER I El TENANT Expansion tank 12,51
Fixture/sewer cap 3 25.02 �5,(40
Name:
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/Z1P: _ Hose bib._.___-__ . __._ -_25.02_
Phone:( ) Fax:( ) Ice maker
12.51
'APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25,02
�..-�./ ,, ,
Business name:A(T C 44,6` af4,/,, eap,,c it i 0,+Mdbal gas(value:$--) • Page 2
:,f� / Primer 1 12.51
Contact name iA�/r Roof drain(commercial) 12.51
Address: / kl6r 4m1dr" .' 0414v' / Sink/basin/lavatory 25.02
City/State/ZIP: tOit,t° d.. ' 4A iiie / *-'"')t `)i.) Solar units(potable water) 62,54
r L, �+- p Tub/shower/shower pan 12.51
Phone:(, �dfi) " , r ��) Fax:.($"t�) .`�,J 22.51
.� �� Urinal
E-mail: D1/4i'L( A-.4 j3,°5 t 1., 41.411 °' r Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: F /1 1()Ile, Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 75'.
ap
Minimum permit fee: $72,50
Phone:( ) Fax:( )
`� J Plan review (25%of permit fee)
CCB Lic,: j 7 d I Plumbi g Lic,no.: P6 6,3
3 ? State surcharge(12%of permit fee) q-.d I
_ �I
Authorized sii e• _ . TOTAL PERMIT FEES ,V 7
r This permit application aspires if n permit Is not obtained within 180 days
Print „tt'/ DatC'J c+'0'1 after It has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I,1Buitding/Permits\i'LMU-PecmitAPP.doc 1.0/01/09 440-4616T(10/02/COM1/NEB)
61✓iVo S DC. S `O 66e.e- APe
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-1"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
Qty. • Fee(ea) ; Totsd. each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof.
(minimum charge—1/2 hour)
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 ❑ New exterior plumbing site utilities for any complex structure •
Car Wash: -Each Stall as defined in OARS 18-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
❑—Any.complex structure.as-defined nOAR9 8-.. .....
-Domestic j
_Drinkin Fountain Submit 2 sets of plans with any of the above.
EyeWash - . ... ..._.. — --....__._...
Floor Drain/sink: 2"
Isometric or Riser Diagram
0 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 Comments regarding fixture work:
Ice Mech./Rang,Drains _
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Scrv/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 plumbing permit can be issued.
Water Closet-Toilet
Urinal {
Other Fixtures: A'F'f , k 1P 1'"(`/ i
I:1Building\Permits\PLMF_PermitApp,doc 08/04/2011 2
taY 9
Accumulative Sewer Tally
111 •
_ Tenant Name: OREGON STATE BAR SWR# N/A
Site Address: 16037 SW UPPER BOONES FERRY RD 150 PLM# 2021-00253
TIGARD
Parcel#: 2S 113AB00300
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 1 2 0 -1 -2
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 1 2 0 -1 -2
-Bradley 5 0 0 0 0 0
1 -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
i Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOE 0 0 2 4 0 0 -2 -4
I
Current Fixture Value -4 divided by 16= -0.250 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -4 divided by 16= -0.250 over (under) $ (1,450.00)
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:***CREDIT***CAPPED COFFEE PIPE DOES NOT HAVE SEWER CREDITS SINCE IT WAS NOT CONNECTED TO SEWER.
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 6/16/2021
Building Division
ote: 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