Permit „ CITY OF TIGARD PLUMBING PERMIT
= COMMUNITY DEVELOPMENT Permit#: PLM2021-00483
Tigard OR 97223 503.718.2439 13125 SW Hall Blvd.,Ti Date Issued: 12/1/2021
TiC AKI? 9
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 180
Project: Gold's Gym Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Interior plumbing for TI: REPLACING(1)clothes washer,(1)drinking fountain,and(1)floor drain.
Contractor: WESTERN PLUMBING Owner: PACIFIC REALTY ASSOCIATES
9460 SW TIGARD AVE SUITE 101 ATTN: N PIVEN
TIGARD, OR 97223 15350 SW SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
1 ea Clothes Washer 11/30/2021 $25.02
Specifics: 1 ea Drinking Fountain 11/30/2021 $25.02
1 ea Floor Drain/Floor Sink/Hub 11/30/2021 $25.02
Type of Use: COM 1 12%State Surcharge- 11/30/2021 $9.01
Class of Work: ALT Plumbing
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: Ho-U.Ad Va.w De,W ege Permittee Signature: Ow App1,uutioyt,
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 Application
Building Fixtures NOV 8 2021 I t)I< 01 P1( f Is' O,1 ,,
City of Tigard PITY OF TIGARD Received `! /1 Ar 1 ,t/40e 1 /,W
• 13125 SW Hall Bled.,Tigard,OR 972 . Dale-a•
' 0 Phone: 503.718.2439 Fax: 503.54 1 1DING DIVISIO Plan Review
Dme'B)
Inspection Line: 50. 639 4175 Date Ready By: ��/ / - iyy S See Page for
I1t�A1:t7 y )I-1C.24 g
Internet: WwwJigard or tloe otifi Method: Supplemenral Inf arena tion
• TYPE OF WORK' FEE*SCHEDULI..
❑New construction 0 Demolition For special information use checklist.
Description j Qty. I Ea. I Total
4 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
:CATEGORS'OF CONSTBIJCTiON SFR(I)bath 312.70
❑ I-and 2-family dwelling .4 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.tt.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: nc .b su. a.` k /�' Catch basin or area drain 18.7n
y �+�`J (41.0 -�1"159„. Diywel drain line,o trench drain 18.76.
City'State,ZlP:
Footing drain(no.linear ft.:_) Page
Suite'hldg.'apt.no.: Project name:
(li S C/�
JvrU Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear II.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
p ,R•.�.,,t� `'- Clothes washer ` 25.02 t0Z
okaivt,G, brr r'ltt ,t1,lfl i) WitAL J Dishwasher 25.02
4'. '`n'i �✓y%- �'r\Y'1i+Y r"a`�j 1�'``'v`ie,, Drinking fountain 1 25.02 b-L
""' Ejectors/sump 25.02
0 PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Fluor drain/floor sink/hub I 25.02 25 02_
Address: Garbage disposal 25.02
City-State ZIP: Hose bib '5.0'
Phone:( ) Fax:( I Ice maker 12.51
XAPPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
13usiness name:\h_illt y�,\ e\f `1 lit\a, 1�C Medical gas(value:9_) Page 2
�iX i4,� \r t Roofd 12.51
Contact name:
drain(commercial) 12.51
Address:CAt.„‘ I\ "--) Sitial 1 SAA.4.001 Sinkihasin-lavatory 25.02
City Slater ZIP:.' T 2Z.- Solar units(potable water) 62.54
Phone:I _S Fax::( I Tub/shower/shower pan 12.51
E-maildajoSduasityyleluimiroir lnC. . urinal 25.02
CNTRAC'I'OR Water closet 25.02
Wale'heater 37.52
Business name: -�-¢-�q Water piping/DW V 56.29
Address: <� (5C-S lJ�� Usher: '_SA_
C'ity!State;ZIP: J Subtotal
Phone:I ) Fax:( ) Minimum permit fee: $72.50 t ;(31.p
�'��,,((,; j Plan review(25°r of permit fee)
CCB Lie.:c. "t Plumbing Lie.no.: _2 61 p
State surcharge(12%of permit fee)
Authorized signature: ' 8 jt01�
6 l J TOTAL PERMIT FE v_'
Print name: Date:j,1 tit This permit application expires if permit is not obtained wi ' IaBAgr�
l V after it has been accepted as complete.
*Fee methodology set byTri-t'ounty Building industry Son ice Board.
I.nuading PCrrnas PLMU-P.,nvilApp.doe 10111 6S 445-0leTu0112(.OMwrnI
Plumbing Permit Application- City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty• Fee(ea) ` TOW Square Footage: Permit Fee:
Footing drain-1"100' 50.03 Il 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 $32".54
Sewer-each additional 100' 37.52
WaterSenice-1st 100' 62.54 Medical Gas Systems:
Water Set ice-each additional I 0(1' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $I.i 1)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
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty. Fee 02) Total nod including$10,000.00.
Inspection of existing plumbing or for $1(1,001.0(1 to S25,000.0(1 $148.50 for the first$10.000.00 and$1.54 for
which no fee is specifically indicated 9(1.00'hr each additional$100.00 or traction thereof,to
(minimum charge—12 hour) and including$25,000.00.
Inspections outside of normal business 90.00•hr $25.001.00 to S50,000.00 $37950 for the first$25,000.00 and$1.45(or
hours(mininntun charge—2 hours) each additional$100.00 or traction thereof to
Rcinspection Fees 90.00 hr and including$50,0110.00.
Additional plan review for revisions 90.0(Yhr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
each additional$100.00 or fraction 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 Revile*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
Baptistn!Font greater.except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
Jacuzzi/Whirlpool ,_ 0 New exterior plumbing site utilities for any complex structure
Car Wash: Each Stall • as defined in OAR918-780-0040.
-Drive That -- ' 0 Medical gas and vacuum systems for health care tacilities.
CuspidorVt ater Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
-Domestic i 0 Any complex structure as defined in O.AR918-780-0040.
Drinking Fountain Submit 2 sets of plans with any of the above.
Eve Wash
Floor Drain;sink: -2"' 1
isometric or Riser Diagram
_. _ 0 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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Las Bar non-food related
-Bradley
-C'onrScrvilftil 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 _ ' 1 fees assessed fur the sewer increase must be paid before the
Water Extractor I! plumbing permit can be issued.
Water Closet-Toilet _
Urinal
Other Fixtures:
l:Building.Permits\PLMF_PetmitApp.doc 08 04 2011 1
Julie Drinkwater
From: #Building Permit Technicians
Sent: Tuesday, November 30, 2021 8:30 AM
To: Dana Jensen
Subject: PLM2021-00483, 15575 SW Sequoia, Gold's Gym
Attachments: Invoice.pdf
Hello Dana
The permit for Gold's Gym is ready to be issued. The balance due is$84.07. Attached please find the invoice for your
review.
The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record
number under the Building tab. There is a service fee of 3%for payments by card, and there no service fee for payments
made by e-check. On the payment screen, select the payment method from the dropdown list next to the 'payment'
field.
Please email the permit technicians at TigardBuildingPermits@tigard-or.gov once the fees are paid so that they can
issue the permit and make it available for pick up.
Thank you
Julie Drinkwater
Permit Technician
City of Tigard I Building Department
13125 SW Hall Blvd
Tigard,OR 97223
503-718-2804
Due to an increased demand for services, please expect longer wait times for responses to emails,voice messages and building
inspections. Requests for permit status may not be responded to until the permit is ready to issue. Other requests deemed non-
essential,such as fee estimates, may take longer to respond. In the meantime, please view this quick guide on how to submit
common service requests.
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