Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00358
Date Issued: 8/24/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AB02000
Jurisdiction: Tigard
Site address: 7175 SW BEVELAND RD 105
Project: Karon Subdivision: BEVELAND Lot: 4
Project Description: Add(1)clothes washer.
Contractor: WOLCOTT PLUMBING Owner: BERMAN, JOHN M &
1075 W HISTORIC COLUMBIA RIVER HWY SUMMERS, MICHAEL L
TROUTDALE, OR 97060 7175 SW BEVELAND RD#210
TIGARD, OR 97223
PHONE: 503-667-1781 PHONE:
FAX: 503-667-9891
FEES
Quantity Description Date Amount
1 ea Clothes Washer 08/24/2021 $25.02
Specifics: 1 12%State Surcharge- 08/24/2021 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 08/24/2021 $47.48
Class of Work: ALT Plumbing
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
Issued By: p
'/ ✓cam— Permittee Signature: '/V //'"/ L./C-97'7e/j
,00k.V,
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 Applica CENED
Building Fixtures AUG 1 8 2021 FOR OFFICE: USE ONLY
City of Tigard Received
Y OF TIGARD Date By: Permit Nu O
• 131?5 SW'tall Blvd.,Tigard,ORReviewf �L� �l~oQ��Q
IIIPlan �
I Phone: 503.718.2439 Fax: so ll►.48dNG DIVISION Da:c'lh, Other Permit ( e 2,1_Q0 22ii
T!GAR U Inspection I.ine: 503.639 4175 Date Ready'1t / Juris H See Page 2 for
Internet: vivss ttg:uJ-Or;_'0' Non tiedM' ethod: ' 24 A i Supplemental Information
TYPE. OF WORE �% j } '-A/ '"FEE'' SCHEDULE
CI New construction ❑Demolition For special information use checklist
Description I Qty, 1 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
❑ I-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 ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:71 c, /�7 o, Sf •#/��' Catch basin or area drain 18.7G
�I` llV' t Drywell,leach line,or trench drain 18.76
Cite/Slate/J.I I': C'
Tani�i I 71�Z Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:v) Project name: A/55CO V Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 1 ti.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: ( I-ot no.: Fixture or item:
Tax map/parcel no. Backflow preventer 31.27
Backwater valve 12.51
DESC:RII f ION OF WORK
• `
/f 1!! J�c..-t�-% Clothes washer I 25.02 Z Z 1
�.-( i/ i t 4 ‘ . Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
•0 PROPE " Y OWNER I 0 TENANT Expansion tank 12.51
Name: �/(� Fixture/sewer cap 25.02
�'�h� `Y�1� y (� Floor drain/tltxir sink/hub 25.02
Address:`717.. V'UI J3'ke `, °� CS% t /
Garbage disposal 25.02
City/State//I P: t. 7 2 2-.3 Hose bib 25.02
Phone:( ) ( £ Ax iN I,l.r)"l lr`re.,.C.1 I A f e . ( etipilker 12.51
0 APPI.IC.INi" 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:S_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::I ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
J f e-'l t f cc l v-(':, ,.._ L' B _t" �i p'C° Water closet 25.02
? CONTRACTOR
Water heater 37.52
Business name:/� r i L'�C�irI4C'/46 Water piping/DWV 56.29
Address:r� `b, 7 T it. //1 0 1. II ,i / Other 25.02
City/State/ZIP: (T^ -}c Ida(�� CR Crap 4 Subtotal
,`t`1 I -`l V f Minimum permit fee: $72.50
Phone: Fax:( 1
CCB Lic.:/i2Z20 :Plumbing Lie.no.: BZCkPt3 Plan review (25%ofpermit fee)
State surcharge(12%of permit fee)
Authorized sign, � TOTAL J PERMIT FEE / '24
Print Ham': �'err • t l Date:a/l(e/2( This permit application expires if a permit is not obtained isithin 180 days
uu ,� after it has been accepted as complete,
'Tee methodology set by'I'n-Cowry Building Industry Service Board.
i Building.PermnsiPLMU.PermitApp doe 10 r01 i09 440.46167110/Qa/COM/WEDI
r
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems
:Stfe';Utd�t�es_ . ci_� »a:to),.
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' 37.52fiVAI, !!1�,�t S i
jaini Fa*
Storm&Rain Drain-1st 100' 62.54 - L• �t
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 55,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
.. ! sN, t to r Total; i each additional$100.00 or fraction thereof,to
,
Ofher.;Inpel+�1Ms Oil' 'CCS_ , i 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-I/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 S50,000.00 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
�l�3:clfii n a� �.. c,.;, ���! i
accurately report fixtures could result in increased sewer fees* t'/n ogX1t1) g1Ohn `i
• Quantity by Fiztttre Type Plan review is required for any of the following.
Fixture Type for • • tPl> ''' Please check all that apply.
Work Performed: CaPPed !►dam
0 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
Each ❑ New exterior plumbing site utilities for any complex structure
Car Wash: as defined in OAR918-780-0040.
-Drive Stall
ElCuspidor/Water Aspirator 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 OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
4' ❑ 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: -Lav/Bar non-food related
-Bradley
-Com/ServlUtil 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:
1:\Building\Permits\PLMF_PennitApp.doc 08/04/2011 2
.
Accumulative Sewer Tally
R
I-� Tenant Name: Dr.Jennifer Karon SW # 2021-00224
�'1 Site Address: 7175 SW Beveland Rd,105 PLM# 2021-00358
TIGARD
Parcel#: 2S 101 AB02000
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 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 III') 32 0 0 0 0 0
-Industrial(over 5 1 IP) 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:
-l,av/Bar-Non-Food Related 2 0 0 0 0 0
-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 1 6 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 0 0 1 6 1 6
Current Fixture Value 6 divided by 16= 0.375 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 6 divided by 16= 0.375 over (under) $ 2,312.30
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 in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: Dianna Ornelas Date: 8/24/2021
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:A Building\Sewer'rally\Sewer PallyShcet_6085_070121.xlsx