Permit CITY OF TIGARD PLUMBING PERMIT
1111
COMMUNITY DEVELOPMENT Permit it: PLM2021-00335
T f C;A K f) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 8/12/2021
Parcel: 1 S 135 BA00102
Jurisdiction: Tigard
Site address: 10120 SW WASHINGTON SQUARE RD
Project: Sim Golf -TI Subdivision: OAKBURG
Lot: 9
Project Description: Interior plumbing for TI:Capping(10)3"floor sinks and(9)sinks;Adding(1)dishwasher, (2)2"floor drains/sinks,
(1)ice machine,and(7)sinks; Replacing(2)sinks,(3)water closets,and(1)urinal.
Contractor: PERFECT FLUSH PLUMBING Owner: PPR SQUARE TOO LLC
24023 NE SHEA LANE SUITE 107 BY MACERICH RET
WOOD VILLAGE, OR 97060 PO BOX 4085
SANTA MONICA, CA 90411
PHONE: 503-985-9461 PHONE:
FAX:
FEES
Quantity Description Date Amount
ea Dishwasher 08/11/2021 $25.02
Specifics: 1 ea Fixture/Sewer Cap 08/11/2021 $25.02
2 ea Floor Drain/Floor Sink/Hub 08/11/2021 $50.04
Type of Use: COM 1 ea Ice Maker 08/11/2021 $12.51
Class of Work: ALT g ea Sink 08/11/2021 $225.18
Type of Const: 1 ea Urinal 08/11/2021 $25.02
Occupancy Grp: 3 ea Water Closet 08/11/2021 $75.06
Stories:
1 12%State Surcharge- 08/11/2021 $52.54
Plumbing
Total $490.39
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: fl,.,77'"'`"'ll''„VavvDe,WPC Permittee Signature:
"' 0 vv AppLi:ca tGan
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.
s __ .............._.........._._
1
Plumbing Permit Application 'Al/2/. -I I
Building Fixtures ` :: '{
RECEIVE
-74-7 City of Tigard dyed „l-
oco* l P rw.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 _ I - AM ��/IS 3 'a
Pion Review n
Phone: 503.718.2439 Fax: 503.598.1960 AUG 2021 Datertty: Ain.
.eiOther Permit No"r14/9g1.�j•LL 1 a)ix
TIGA U Inspection Line: 503.639.4175 Date Ready/By: Sale fa See Page tine
Internet; w'ww.tigardor.gov CITY (IF TI( ARI.Not{0ndlMcthod: 't/I LP Art" -?'rr: Supplemental Information
TYPE OF WORK W '`/ FEE• SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description ( Qty. I Ea. I Total
KAddRtion/alteration/replacement CI Other: New 1-2-family dwellings(includes 100 R.for each utili connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling XCommercial/industrial SFR(2)bath 437.78
❑AccessorybuildingSFR(3)bath 500.32
0 Multi-family
{ � �� Each additionalbath/kitchen 25.02
❑Master builder 1 u p11 ,❑Other; Fire sprinkler( sq.ft.) Page 2
/ly 1J06 SITE TNFORICiA`,T�I`ON AND LOCATION f Site utilities: _
Job site address: Y V, .Vi) ji ik I e. M Catch basin or area drain 18.76
DiyCity/State/ZIP: 2.ryC1, f\(].. I� Footing or
Page1g2
�-�J -1 (f 1L- 6 /� �f�f,�( Footing drain(no.linear R:_, 2
Suitelbldg./apt,no.: Project name: cirri �ol4•T`t l/v' Manufactured home utilities 50.03
Cross street/directions to job site: J Manholes 18.76
SVI fee,h 10U VA Rain drain connector 18.76
Sanitary sewer(no.linear R.:, ) Page 2
Storm sewer(no.linear ft.: I Page 2 I
Water service(no.linear A,:_) Page 2
I
Subdivision: I Lot no.: Fixture or Item: f
Tax map/parcel no.: Backtlowpreventer 3127
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
IT(WOU' , Cl/ N19r V\um VI in el4C-47rhDishwasher I 25.02 :? ti
"{ \ ,/-Iti 1 s.6r'dt- b1A -I' _h 1L, ,(r I. Drinking fountain 25.02
Oa - (/.(m�e ` Ot HIi-F. ✓rl Ir.{ Ejectors/sump 25.02
❑l PR,OPERTY OWNER, 'j1 /,�TENAN///T""" """( Expansion tank 12.5I 1
Name: ++cyl 4101-c s IFixture/sewer cap 25.02 .�j„(}� !
i ` A' ` "'� / Floor drain/floor sinle/bub 25.02 ,_� .tIy •
Address: \n 12 r-, V Na� [?- Garbage disposal 25.02 I
City/State/ZIP: poy---�rt 'i 'v1 O�i:,,," Cr Hose bib 25.02
��tVVY"'LLLJJJ "` "�"
Phone:( ) Fax:( ) Ice maker ( 12.51 / ,57
'KZ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: 40 li( �[ �,�f/t01. Medical gas(value:S ) Paget
'-+L���� s t{, h. Primer 12.51
Contact name: 1LuV�7f lr
{--7 Roof drain(commercial) 12.Si �
Address: �� .� �� 0 /t�- / Sink/basin/lavatory .�. 25.02 2 ;IS
City/State/ZIP: j( UI Ib M(�(n Solar units(potable water) 62.54
Phone: ((-1 '7 i D Fax:::(( ) vv-' Tub/shower/shower pan 12.51
E-mai1: I!Midn yre `k 1 i'y/ 0 Urinal I 25.02 p2y.4:.
p�v' Water closet • rm 25.02 7y.
CONTRACTOR'--l Water healer 37.52
Business name: C 1'Ce � ' L6h WaterpipioglDWV 56.29
�Address: J I h V 1 i le s�/IO7 Other. 25.02
City/State/Z[P: i ( �j{ � fl( Subtotal Li 1 5-`i
Phone:(Cr,1) ?1O 3, ?, Fax: ) Minimum permit fee: S72.50
CCB Lie.: 211,10 ( Iumbing Lie,no.: 2 ).,,,, Plan review (25°/s of permit fee)
State surcharge(12%of permit fee) S:,i 5:j
Authorized signature: n,�/ TOTAL PERMIT FEE glad., (
��tea4A-Lc r /i,7/L' This permit imptkatlon expim If a permit h not obtained whits lle days
Print name: Date: after 1l Was been accepted as complete.
LI Fee oa hodelegy set by Tii.Couaty Building ladusrry Service Boyd
INNI14.1inglhroilisTLICU-PcnuliAn.doc I5VI.V9 4404616T(IOU2C0a4WEB)
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 SI69.69
Sewer1st 100' 62.54 3,601 to 7,200 $23320
7,201 and greater 532754
Sewn-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
62.54
smmt$Raim Drain-lot IOWValuation: Permit Fee:
51.00 to S5,000.00 Minimum fee S7230
Storm&Rain Drain•each additional 100' 37.52
$5,001.00 to$10,000.00 $7230 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional S100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for
which no fee is specifically indicated 90.00/ttt $10,001.00 to$25,000.00 S 14g30 for thea first$10,000.00 and$154 for
each additional S 100.00 oror fraction thereof,to
(minimum charge-1/2 hour)
Inspections outside of normal business 40.06/hr and including0ort a first
250.
boon(minimum charge-2 hours) f25,001.00 to$50,000.00 each a 0 for the fins 525,000.00 and$1.45 for
Reins(mini n Fees 90.00/hr each additional$100.130 or fraction thereof,to
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 Replan/ Please check all that apply.
Work Performed: Capped Added Relocate
Haptisay/Foot 0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engin
-Jacuzzi/Whirlpooleer'
0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: .Commercial 1 ❑ Any multipurpose fire sprinkler system.
-Domestic ElAny complex structure as defined in OAR91S-780-0040.
Drinking Fountain Submit 2 sets ofplans with anyof the above.
Eye Wash
Floor Drain/sink: -2" '2--
-3^ i Q Isometric or Riser Diagram
•4^ 0 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 MachiRefrig.Drains 1 Comments regarding�� / ` fixture work:a -(& y
Oil Separator(Gas Station) Cg.QPl b mV l 1pk Ivle3
Rec.Vehicle Dump Station On e.�Cy1� �1 i fyf
Shower: g —/"—-Stall --4-/^d' 'O-✓l / 71,e .S/ _l
Sink: -IavBar non-food related 2 �t;a1,1'/ ,W 1i ,1i1�f� � ISO r Al
-Bradley /.tl, ll rA1 4' ei v&4.si r — 'The- 1,
-Com/Serv/ltil food related G 'J Q f �.y / t
77
-Service , *Note: If the fixture work u er is permit sul fan
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
washes-Clotho fees assessed for the sewer increase must be paid before the
Water Extractor
plumbing permit can be issued.
Water Closet-Toilet 3 P gP
Urinal 1
Other Futuna:
f:\Building\Permits\?LMF_'emiltApp.doc 08/04/2011 2
Accumulative Sewer Tally
II ` SWR# N/A
S Tenant Name: SIM GOLF
Site Address: 10120 SW WASHINGTON SQUARE RD PLM# 2021-00335
TIGAI D
Parcel#: 1S135BA00102
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Pont 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 1 4 1 4
-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 2 4 2 4
-3 inch 5 0 10 50 0 -10 -50
-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 1 1 1 1
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:
-Lay/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 7 21 7 21
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 10 50 11 30 1 -20
Current Fixture Value -20 divided by 16= -1.250 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -20 divided by 16= -1.250 over (under) $ (7,606.25)
Enter EDU Change Here -1.250 *
*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***(9)CAPPED SINKS DRAIN TO(10)CAPPED 3"FLOOR SINKS. THE(10)FLOOR SINKS ONLY RECEIVE CREDITS
AS THEY HAVE A HIGHER FIXTURE VALUE.
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 8/11/2021
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\Sewer 1'allySheet_6085_070121.xlsx