Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00440
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/4/2021
Parcel: 2S 101 AA08700
Jurisdiction: Tigard
Site address: 12511 SW 68TH AVE 150
Project: Dr Snip Subdivision: WEST PORTLAND HEIGHTS
Lot: 34
Project Description: Interior plumbing for TI:Adding(3)sinks.
Contractor: DP PLUMBING INC Owner: TIGARD TRIANGLE PROPERTIES LLC
15825 NE SPRINGBROOK 3232 SW FAIRMOUNT BLVD
NEWBERG, OR 97132 PORTLAND,OR 97239
PHONE: 503-537-9492 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Sink 10/28/2021 $75.06
Specifics: 1 12%State Surcharge- 10/28/2021 $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
Issued By: F loU y yaw Wegi: Permittee Signature: Ow Ap-p- '
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.
RECEIVE
Plumbing Permit Application ,�`.1aut-, 7 &UP 2021-ootao 10
Building Fixtures OCT 15 Z021 I(112 (1141( I.: 1 ST OM 1
City of Tigard UITY OF TIGARD Received
DowDy la/ f/0)' , -�- Permit No.. �v��y I
?J (rk 1. f)
13125 SW Hall Blvd.,Tig 1 n plan Review
Phone: 503.718.2439 Fax: 503:
ard,OR I>7DING DIVISIOf 1 Date/By //A Other Permit No Q ,mod I /l[)i qO
TIGARD
Inspection Line: 503.639.4175 Date Reedy By: /�,�r ® Ste Pa et
2 for
Internet: www.tigard-or.gov NotiliedMethod .i /t ^^ 8
11�f�i '' C,c, Supplemental Information
1 TYPE OF WORK (� i FEE* SCHEDULEVV
For special information use checklist.
❑New construction ❑Demolition
Addition/alteration/replacementDescription I Qty. I Ea. Total
0 Other: New 1-2-family dwelling
s gs(includes 100 tt.for each utility connection)
CATEGORY OF CONSTRUCTION f STR(1)bath I 312.70
El 1-and 2-family dwelling 14 Commercial.%industrial ! SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additions bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(„___sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1,Z.s it s w 6 8'kt A.A. Catch basin or area drain 18.76
Drywell,leach line,or trench dram 18.76
City/State/ZIP:
ec Footing drain(to.linear ft.: ) Page 2
Suite/bldg./apt.no.. t I Project name: Dr. c&ti fa Manufactured dome utilities 50.03
Cross street/directions to job site: Manholes 1 18.76
Rain drain connector
18.76
Sanitary sewer(no.linear ft.:_) Page 2
•
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear fL: ) Page 2
Subdivision: I Lot al: Fixture or non:
Tax map/parcel no.: /d 1,44-0r7o I3ackflow prev;nter 31.27
DESCRIPTION OF WORK Backwater vale 12.51
Clothes washer 25.02
d 3 ShJS 1 I was /1417 bud- ihaf-lwt-d pt. Dishwasher 25.02
Drinking fountain 25,02
Ejectors/sump 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: 1 irNct 1 r'i,lj(C rorceiias
e Fixture/sewereap 25.02
J ��++ n / Floor drain/floor sink/hub 25.02
Address: 3 Z S Z Sw YOJ U 11..0011 /3(vt Garbage disposal 25.02
City/State/ZIP: 0e> td 6 DR tt ill 9 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT POISON interceptor/grease trap 25.02 1
Business name: Medical gas(valuo:$_) Page 2
Contact name:
Primer 12.51
Roof drain(commercial) 12.51
Address:
I Sink/basin/lavatory 3 25.02 '75.Ow
City/State/ZIP: Solar units(po,able water) 62.54
Phone:( ) Fax: ( ) Tub/shower/shower pan 12.51
E;mail. d Pl l n uv ^ I Urinal 25.02
rv�� 9 N 7 CT Water closet 25.02
~• �/ CONTRACTOR
Water heater 37.52
Business name: d P /-lubnitM �itC. Water piping/DWV 56.29
Address: I�-A k/�s 1 �4 25.02
•'D nV Sri tW Other:
City/State/ZIP A+{to 6ie� 1 en I Z Subtotal •"7Ss�*
Phone:(�k)Siq.7v4g Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 2?�l t D/,a Plumbing i,ic.no.: LL7t Plan review (25°ro of permit fee)
State surcharge(12%of permit fee) 4,d i
Authorized signature: ( 7
� P � 'f0'1'AL.PERMIT N'1;1��.0
Print name: ���, J! i This permit application expires ifs permit is not obtained within 180 days
4U'i�l VL pate. 1b� / S/Zi after it has been accepted as complete.
/ 'Fee methadology set by Tri-County Building Industry Service Board.
IaBuildiatlPermits1PLMU•PermitApp.doe 10/01'09 440-4016T(10/021COM!WEB)
,,
ei Aoi, ,h h� _ /3i,„--- Ld
____,
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fir Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-f" 100' 50.03 0 to 2.000 $121.90
2.001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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) Total 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 A0 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 S100.00 or fraction thereof.to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00hr $25.001.00 to$50,000.00 $379.50 for the first$25.000.00 and$1.45 for
thereof,to
charge 2 hours
each additional$10
0.00 or fraction
hours(minimum
)
(.DO!Inr and including$50,000.00.0.00.
Reinspection Fees
9) g
Additional plan review for revisions 90,00/hr $50,001.00 and up $74each a 0 for the first$50,000.00orfraction
and$1.20 for
each additional$100.00 or fra 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.
-.1acu-r.7.i/Whirlpool
❑ New exterior p umbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR9 18-780-0040.
-Drive limn
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
shwash : -Commercial
t ❑ Any multipurpose fire sprinkler system.
DDomestic 0 Any complex s ntcture as defined in GAR918-780.0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain'sink: -2"
3., Isometric or Riser Diagram
4" ❑ isometric or r ser 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/Serv/Util food related 3
-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 yPLMF PermitApp.doc 08/04/2011 2
Branden Taggart
From: #Building Permit Technicians
Sent: Thursday, October 21, 2021 7:01 PM
To: Darren Placek
Subject: RE: Plumbing permit: PLM2021-00440 & SWR2021-00273 - 12511 SW 68th Ave 150
Attachments: Dr. Snip App.pdf; Plumbing Permit Invoice.pdf; Sewer Permit Invoice.pdf; Sewer Tally.pdf
Hey Darren,
The Plumbing and Sewer permits for Dr. Snip are ready to issue now. I have attached invoices above for you to
reference, and the fees due are as follows:
Dr. Snip
Permit# Fees Due
PLM2021-00440 $ 84.07
SWR2021-00273 $ 3,407.60
Total: $ 3,491.67
The above fees can be paid online through our website: https://aca.accela.com/TIGARD/Default.aspx. From there, click
on the Building tab, enter the permit numbers in the Record Number field, and click Search. Once paid, please notify us
at tigardbuildingpermits(a?tigard-or.Rov so that we may issue these permits and email the paperwork to
you. Furthermore, the permit fees for both permits will need to be paid before we can issue either of them. Please let
me know if you have questions.
Thank you,
FriBranden Taggart
City of Tigard
Senior Permit Technician
Community Development
}
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or.gov
From: Darren Placek<dplumbingguy@gmail.com>
Sent: Friday, October 15, 2021 7:30 AM
To: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Plumbing permit
Caution!This message was sent from outside your organization.
Please receive and process as necessary.
Thank you.
1
€k:
I
Accumulative Sewer Tally
' Tenant Name: DR SNIP SWR# 2021-00273
s' I it,AF I)
Site Address: 12511 SW 68'1'I I AVE 150 PLM# 2021-00440
Parcel#: 2 S 101 AA08700
Fixture Value Previous Previous Credits (;aphcd Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
I
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
1a
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
t
Cuspidor/Water Aspirator 1 0 0 0 0 0
(I 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
I
-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 O 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/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 3 9 3 9
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 _ 0 0 3 9 3 9
Current Fixture Value 9 divided by 16= 0.563 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 9 divided by 16= 0.563 over (under) $ 3,407.60
Enter EDU Change Here 0.560 *
*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: BRANDEN TAGGART X2449 Date: 10/21/2021
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.xlsx