Permit CITY OF TIGARD PLUMBING PERMIT
: COMMUNITY DEVELOPMENT Permit#: PLM2021-00422
Date Issued: 10/25/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AB01607
Jurisdiction: Tigard
Site address: 7540 SW HERMOSO WAY
Project: Luby Professional Building Subdivision: HERMOSO PARK Lot: 9
Project Description: Interior plumbing for TI:ADDING(1)bar sink;REPLACING(1)dishwasher,(1)ice maker,and(1)sink.
Contractor: THE PLUMBERS INC. Owner: 7540 HERMOSO LLC
11420 SW PACIFIC HWY 7540 SW HERMOSO WAY
TIGARD,OR 97223 TIGARD,OR 97223
PHONE: 503-519-6644 PHONE:
FAX: 503-684-1202
FEES
Quantity Description Date Amount
1 ea Dishwasher 10/15/2021 $25.02
Specifics: 1 ea Ice Maker 10/15/2021 $12.51
2 ea Sink 10/15/2021 $50.04
Type of Use: COM 1 12%State Surcharge- 10/15/2021 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.08
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: HoU y Vaw eg2 Permittee Signature:
•C-N. Odic 1 CC(1117'1
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.
D
Plumbing Permit Applicat9FCEIVE ‘' SGt/1 0(:),/` tg ..F
Building Fixtures SEP 2 7 2D21 rill' oli1uI Fs': u\I 1
City of Tigard CITY OF TIGARD Received Date/By: `O/1.Z- / )44---- /' i"'f / V O ,
111 II 13125 SW Hall Bhd.,Tigard,OR 7 Plan Review
Phone: 503.718.2439 Fax: 503.5�3 I�IG DIVISIOP� Plate!Review
--O01.. 7
Inspection Line: 503.639.4175 Date Rcady'By: 0See Page 2 for
T I GAIt U Internet: ww'w'.ligard-or.gov Notified/ ethod:/07111/2)i/ 5 Supplemental Information
TYPE OF WORK L �q%'�""�/ FEE* SCHEDULE
Demolition For special information use checklist.
Er New construction __ _- Description [ Qty. I Ea. 1 Total
Addition/alteration replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70437.78
SFR(2)bath
❑ 1-and 2-family dwelling XCommercial/industrial
500.32
SFR(3)bath
❑Accessory building ❑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:
�L� G , , Catch basin or area drain 18.76
Job site address: 'VjL t // Wei.� Drywell,leach line,or trench drain 18.76
City/State/ZIP: -F, e- 1 1O\ �(r (/2 J Footing drain(no.linear fi.: ) Page 2
Suite/bldg./apt.no.: Project name:site: I te`La !�(Ovx,a/ Manufactured home utilities 50.03
Cross street/directions to jobYJ//f,[/u/[('ly Manholes 18.76
t/ .. .�wa-m`w.t tea, Rain drain connector 18.76
et.,..; i s'r1��1N' t‘w tSI tip' ' Page 2
Sanitary sewer(no.linear ft.: ) B
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or Item:
Backflow preventer 31.27
Tax map/parcel no.: Backwater valve 12.51
DESCRIPTION OF WORK Clothes washer 25.02
1 ishwashel 25.02
C\ e1 -'{C..,--- Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY. OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( )
Fax:( ) Ice maker ( 12.51
0 APPLICANT ElCONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 2,, 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( )
Tub/shower/shower pan 12.51 Urinal 25.02
-- -
E-mail' Water closet 25.02
CONTRACTOR Water heater 37.52
Business nameTk /I1tii f J _f S fig-, Water piping/DWV 56.29
Address: 1 1 2, C�j a(�{�-'((_ ✓J Other: 25.02
Subtotal
City/State/ZIP:
Minimum permit fee: $72.50
Phone: � �� 'V ) Fax:( )
Plan review (25%of permit fee)
CCB Lie.: tPlumbing Lic.no.: vfy.47State surcharge(12%of permit fee)
Authorized signature: {� r��1 /// TOTAL PERMIT FEE
�y y i J/J/1z/ This permit application expires if a permit is not obtained within 180 days
Print name: Date. /G`t// f after it has been accepted as complete.
I *Fee methodology set by Tri-County Building Industry Service Board.
I tBuilding'8crmios'.PI.MV-PermitAPP.doc 10/01/09 440.46161 I0021'OM'w'EB)
111.7
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Residential Firepp Suression Systems.
Fee Schedule: Qty. Fee(ea) Total Squ FPermit Fee:
Site Utilities o to 2,000 $121.90
50.03 $169.69
Footing drain-1"](x]' 3,601 to 7,200
37.52 3,601 to 7,200 $233.20
Footing drain-each additional 100' 5327.54
Sewer-1st 100'
62.54 7,201 end rcatcr
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-Ist 100'
62.54 $1.00 to S5,000.00 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
each additional$100.00 or fraction thereof,to
Other Ins ections or Fees
Qty. Fee(ea) Total and includin $10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 S 148.50 for the first S10,000.00 and$1.54 for
90.00tr each additional$100.00 or fraction thereof,to
which no fee is specifically indicated and includin $25,000.00.
Inspections
(minimum char is-1/2 hour) 90.00/hr $25.001.00 to$50,000.00 $379.50 for the first 525,000,00 and$1.45 for
ecdonn tis outside of normal business each additional$100.00 or fraction thereof,to
hours(minimum char c-2 hours 90.00/hr and including$50_01)D.lxl.
Re
Additional
colon plan review $50.001.00 and up $742.00 for the first$50,000.00 and S1.20 for
Additional for revisions
90.009u each additional$100.00 or fraction thereof.
(minimum char ie-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 Plumbin;Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for
Replace/ Please check all that apply.
Capped Added RelocateWork Performed: ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Showcr engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Watcr Aspirator I 0 Any multipurpose fire sprinkler system.
Dishwasher: - ommercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain
Ey Submit 2 sets of plans with any of the above.
Eyc Wash
Floor Drain/sink -2" Isometric or Riser Diagram
3"
. Isometric or riser diagram is requiired for new buildings
-Car Wash Drain that meet the •ualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-industrial food related 1 ___ Comments regarding fixture work:
lcc Mach./Rcfrid.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Laa/Bar non-food related i
-Bradley r
-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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
1:U3uilding\Pernut5\iLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
■ us Tenant Name: LUBY PROFESSIONAL BUILDING SWR# SWR2021-00268
TI GARD Site Address: 7540 SW HERMOSO WAY PLM# PLM2021-00422
Parcel#: 2S101AB01607
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
-3inch 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:
-Lay/Bar-Non-Food Related 2 0 0 1 2 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 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 1 2 1 2
Current Fixture Value 2 divided by 16= 0.125 Current EDU 1 EDU= $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:
Authorized Name/Signature: JULIE DRINKWATER X2804 Date: 10/12/2021
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