Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00393
T I c;A P:t) 13125 SW Hall Blvd.,Tigard OR 97223 503 718.2439 Date Issued: 9/22/2021
Parcel: 1 S 126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 250
Project: Lithia Driveway Subdivision: None Lot: None
Project Description: Interior plumbing: CAP(1)breakroom sink and water heater;replace(1)sink,drinking fountain and water supply
line for refrigerator and coffee maker.
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 Drinking Fountain 09/20/2021 $25.02
Specifics: 1 ea Fixture/Sewer Cap 09/20/2021 $25.02
1 ea Ice Maker 09/20/2021 $12.51
Type of Use: COM 1 ea Sink 09/20/2021 $25 02
Class of Work: ALT 25 Misc Other Fee 09/20/2021 $25.02
Type of Const: 1 12%State Surcharge- 09/20/2021 $13.51
Occupancy Grp: Plumbing
Stories:
Total $126.10
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: Ha{.I,y Van. Wege Permittee Signature: O yV
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 ApplicatioECEIVED
Building Fixtures I I ll: /t, II( I , 11.1 ,
SEP 9 2021 Received 9/�fP�2 •cQ0
City of Tigard Daly: Pemtd'Pt-/1 201i-00 3
II • 13125 SW Hall Blvd.,Tigard,OR 9722�+IT Plan Review
n Phone: 503.718.2439 Fax: 503.598.f960 Y OF TIGARD Daly: Other Permit No.:
I s I A I;it Inspection Line: 503.639.4175 DUI LDING DIVISION! Datc ReadyBy: p ® See Page 2 far
Internet: www.tigard-or.gov Notified/Method: I/� '/2� �� Sappkmental Information
: OF WORK :111/1 ;P" 11 FEE SCHEDULE
❑New construction ❑Demolition rspecial information use checklist.
Description I Qty. I Ea. I Total
�p
(P'Addition/aheration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
.ram 4NSTR - .. SFR(I)bath 312.70
❑ I-and 2-family dwelling atCottunercial/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
4;;d11'A 11kw.1 lift''. Site utilities:
lob site address.oao IS\,, Li M rk 11VV 1 SD i 0Catch basin or area drain 18.76
V Drywell,leach line,or trench drain 18.76
City/State/ZIP:1'T,V,A,L O O 1(L a 11 z 3
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: g so Project x°Ira Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
aF QO4 t/) j'1(1/1n -_ C� Rain drain connector 18.76
L ,1A�( 1\!11a).)ALr Sanitary sewer(no.linear ft.:_) Page 2
��1 n Storm sewer(no.linear ft.:_) Page 2
CO F1=1 C E yQ F,r Y Ja Del-- Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or Item:
Tax map/parcel no.: Backfow preventer 31.27
Backwater valve 12.51
_ - - - Clothes washer 25.02
0 pYIC F te.Ill�( f7E.3--- C�P 6Fe t.SIn� _ Dishwasher 25.02
FAO(€T, l\'0 \\ Pt 1tYt 1 Rct 1-1 \ 5�\iO^t--ii ;NA)Ct+ Drinking fountain 1 25.02
Z( )\-o- "Dr:AY-- rNTa3 . (ftrWJ{ Yt?f cc, , LtS Ejectors/sump 25.02
,QMINFRTv OWNER •Lt -ep ,. Expansion tank 12.51
Fixture/sewer cap I 25.02
Name
Floor drain/floor sink/hub 25.02
Address: ~
_ __ _ Garbage disposal 25.02
City/State/ZIP: _ Hose bib 25.02
Phone:( ) I Fax:( 1 Ice maker- I 12.51
[] CONTACT. PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51 I
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory I 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(S03 1 . ') 3 - /34 i Fax::( I Tub/shower/shower pan 12.51
Urinal 25.02
E-mail. /1r AHret,f el 4.--vel �15 fe JO 4.eyay
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: 141TF-.-ni o,�iV- W P f�;�� - Water pm WV - 56.29
irt
Address: -79 3c vA) S 1:::)xt Other: Cpccte d veY ±f 1 25.02
�p ^2 off! Subtotal i,/a,s
City/StatelZlP�t Ole_. Q ( tJ V `� Minimum permit fcc: $72.50
Phone:(�3 b 9 A Fax _ . _ Plan review (25%of permit fee)
CCB Lie.: 76 6 Plumbing/ Lie.no. 0-1 8�'t(� State surcharge(12%of permit fee) 15 ,s
I ll-tw.u�`✓S&d.
Authorized signature. r 't2„t,,e,,_ TOTAL PERMIT FEE 124,, lc
_
Print name: f.`'1{U. . Date: cjI a/ This permit application expires if a permit le not obtained within 180 days
a�-y k sk after It has been steepled as complete.
f 'Fee methodology set brFrilcoility-&tilllitQ'industry Service Board.
I:tBuildinpPernutiNLMU-PermitApp.d°c 10701109 440-4616T11 a/OLLUM/WEB)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Su t t ression Sy stems:
•
it Fee:
Footing drain-l°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 S stems:
Water Service-each additional 100' 37.52
F �
Storm&Rain Drain-1st 100' 62.54 $I.00 to$5,000.00 Minimum fee S72.50
Storm&Rain Drain-each additional 100' 37.52 S5,001.00 to$10,000.00 S72.50 for the first$5,000.00 and$1.52 for
each additional S 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 S25,001.00 to S50,000.00 S379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspectian Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr S50,001.00 and up S742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional S100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
x .:
accurately report fixtures could result in increased sewer fees*. ate ±
Quantity by Fixture Typ!"' ' 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
BapiislryiFont greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thnr
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic l CI Any complex structure as defined in OAR918-780-0040.
Drinking Fountain > 1 Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
El 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./Rcfrig.Drains 1 Comments regarding fixture work: (`
Oil Separator(Gas Station) S iti- G C
Rec.Vehicle Dump Station 1�f�S Ci h D . 1
Shower: -Gang
5/
-Stall fl�G.
Sink: -LavBar non-food related 1
-Bradley
ofFtce,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: rof��r imimLF).-
l:.Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2
lative Sewer Tally
Tenant Name: Lithia Driveway SWR# N/A
Site Address: 9020 SW Washington Square Rd,250 PLM# 2021-00393
Parcel#: 1 S 126 BC01506
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s %slue 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 I) 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
-4inch 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 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:
-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 Il 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 (1 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDIT Credit 0
TOTALS 0 0 1 2 0 0 -1 -2
Current Fixture Value -2 divided by 16= -0.125 Current EDU 1 EDIT_ $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -2 divided by 16= -0.125 over (under) $ (791.05)
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: ***EDU CREDITS***
Authorized Name/Signature: Dianna Umclas Date: 9/16/2021
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\SewerTallyShec t_6085_070121.x lsx