Permit CITY OF TIGARD PLUMBING PERMIT
_ COMMUNITY DEVELOPMENT Permit#: PLM2021-00344
Date Issued: 11/17/2021
T f G A R T) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S102CB02300
Jurisdiction: Tigard
Site address: 13240 SW PACIFIC HWY
Project: Westside Surgery Center Subdivision: FREWING'S ORCHARD TRACTS Lot: 8
Project Description: Interior plumbing for new tenant:Capping(4)sinks and(1)water closet;Adding(1)eye wash, (1)2"floor sink, (1)
4"floor sink,(1)garbage disposal,(1)shower stall,(10)sinks,and(2)water closets; Installing(1)expansion
tank,medical gas, (1)water heater,and(2)pumps.
Contractor: AMERICAN HEATING INC Owner: WESTSIDE BUILDING PROPERTIES LLC
5035 SE 24TH AVE BY VALLABHANATH, PRASHANTH
PORTLAND, OR 97202-4765 11086 SE OAK ST
MILWAUKIE, OR 97222
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Quantity Description Date Amount
2 ea Ejectors/Sump 11/04/2021 $50.04
Specifics: 1 ea Expansion Tank 11/04/2021 $12.51
5 ea Fixture/Sewer Cap 11/04/2021 $125.10
Type of Use: COM 2 ea Floor Drain/Floor Sink/Hub 11/04/2021 $50.04
Class of Work: ALT 1 ea Garbage Disposal 11/04/2021 $25.02
Type of Const: 10 ea Sink 11/04/2021 $250.20
Occupancy Grp: 1 ea Tub/Shower/Shower Pan 11/04/2021 $12.51
Stories: 2 ea Water Closet 11/04/2021 $50.04
1 ea Water Heater 11/04/2021 $37.52
1 ea Medical Gas 11/04/2021 $151.58
1 Plan Review 11/04/2021 $191.14
1 12%State Surcharge- 11/04/2021 $91.75
Plumbing
Total $1,047.45
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: Permittee Signature:
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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 Applications ECE\JE® - f//z 21
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Building Fixtures FOR OFFICE ( SE ONLv�
City of Tigard p�UG 1 `� 202_� Received C/
`� g Date/By: 0/f V 4e Permit NoPGM ZO J i 003 /Iy
, Illw Phone:13125 S 03.W 718l B439 lvd.,TrFax'S03:si DF TIGA�u,N Plan Review Other Permit No.: !//Inspection Line: 503.639.4175 BUILDINGp1VISIQ Date By: �bgja 1 ,4Glny. � )CX�I�b
T I GARD Date Ready/By: funs: 63 See age 2 for
Internet www.tigard-or.gov Notified/Method. x� .7" Supplemental Information
F . . ,. „ ,6 • '' ," ry [~� 1j YEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description Qty. Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) _
. CATEGORY OP CONSTRUCt1ON f; SFR(1)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial
SFR(2)bath 437.78
❑Accessory building --- SFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB'SITE 1NFORM,4T1ON,AN ,LOCA.TION Site utilities:
Job site address:13240 SW Pacific Highway Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Westside Surgery I,2 inedtl (,,,U r Manufactured home utilities 50.03
Cross street/directions to job site:Pacific Highway and SW Park Street Manholes 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 ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: /6016./� 0�
Backflow preventer 31.27
" v Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Interior demo of existing plumbing fixtures and piping and buildout of new
_ Dishwasher 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 1 12.51 12.51
Name:Westside Surgery Center,LLC. Fixture/sewer cap 5 25.02 /��j',I u
Floor drain/floor sink/hub 2 25.02 50.04
Address:13240 SW Pacific Highway
Garbage disposal 1 25.02 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:( )503-639-6571 Fax:( ) Ice maker 12.51
:) 031 APPLICANT ' CONTACT PERSON Interceptor/grease trap 25.02
.;, Business name:American Heating Inc. Medical gas(value:$)OJ �4 Page 2 j 5{ ,�0
+_ Primer 12.51
Contact name:Amanda Bostic
Roof drain(commercial) 12.51
Address:5035 SE 24th Ave. Sink/basin/lavatory 10 25.02 250.20
City/State/ZIP:Portland,OR.,97202 Solar units(potable water) 62.54
Phone:(503)239-4600 Fax::(503)239-7038 Tub/shower/shower pan 1 12.51 12.51
E-mail:a.bostic@americanheating.net Urinal 25.02
Water closet 2 25.02 50.04
Water heater 1 37.52 37.52
Business name:American Heating Inc. Water Pm rP P�WV 56.29
Address:5035 SE 24th Ave. Q her as 2 25.02 54144
City/State/ZIP:Portland,OR.,97202 Subtotal 487.88
Phone:(503)239-4600 Fax:(503)239-7038 Minimum permit fee: $72.50 �'_
CCB Lic.:33135 Plumbing Lic.no.:PB982 Plan review (25%of permit fee) ell,,/�
State surcharge(12%of permit fee) iti 7y
Authorized signature.• (..
160', 'J TOTAL PERMIT FEElf oi,,l2I
Print name:Amanda Bostic Date:8/5/2021 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) tr 1 I iotA lhy
Plumbing Permit Application - City of Tigard N
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Si ° Utilities Qry• Fee(ea) Tota Square Footage: Permit Fee:
Footing 6 .in-1'100' 50.03 0 to 2,000 $121.90
Footing drain -ach additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.5, 7,201 and greater $327.54
Sewer-each additional 4 0' .52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 11 J' 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
# e Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fee° and including$10,000.00.
Inspection of existing plumbing or fi $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indic. d ;1.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of norm. iusiness 90.00/h $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-, hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan red•w for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum char: 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ 1 '
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower CI Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ® Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash 1
Floor Drain/sink -2" I Submit 2 sets of plans with any of the above.
3» /r
I Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riserdiagramis required for new buildings
Garbage -Domestic-non-food q g
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related Att
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station - . () 9 ' (-ic r-f L d( ,W7L 4,S�tJ��f rt,,.
Shower -Gang SIJ(� ` g t _ `""l
-Stall 1 43 !f ,s, !i/o6%', L/4J4 Ao 7'
Sink/Lav -Non-food related 4 8 111^'ee " rr yritel ow-1 `r, 4( TAt 4 Ai?fir'
-Bradley 157 jr1w,rr _da./kt , AVioieVA/ /5.J'
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-Commercial-food related 1 -_ ri', eri a.6( .1.I14 tv ..4J.W.4,4.4 dOte AO, N/ ',1
-Service 1 �I fp/�
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes 1
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet 2 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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Branden Taggart
From: Branden Taggart
Sent: Tuesday, October 12, 2021 9:53 AM
To: Amanda Bostic
Subject: Westside Surgery Plumbing Permit: PLM2021-00344 - 13240 SW Pacific Hwy
Importance: High
Hi Amanda,
The Westside Surgery plumbing plans include medical gas, but the Plumbing Permit Application does not. We will need
a valuation for the medical gas in order to complete our plan review. What is the valuation?
Thanks,
Branden Taggart
7: elCity°of Tigard
m Senior Permit Technician
Community Development
13125 SW Hall Bivd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or.gov
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