Permit .1111 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00070
Date Issued: 3/3/2022
T t G A I+i) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S136DD03400
Jurisdiction: Tigard
Site address: 11740 SW 68TH PKWY 200
Project: Mindful Therapy Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Interior plumbing for TI: ADDING(1)ice maker;CAPPING(1)sink;and REPLACING(1)ice maker,(1)sink,&(1)
dish washer.
Contractor: POWER PLUMBING CO Owner: 11740 SW 68TH PARKWAY LLC
PO BOX 19418 111 SW COLUMBIA ST STE 1380
PORTLAND, OR 97280 PORTLAND,OR 97201
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Dishwasher 03/02/2022 $25.02
Specifics: 1 ea Fixture/Sewer Cap 03/02/2022 $25.02
2 ea Ice Maker 03/02/2022 $25.02
Type of Use: COM 1 ea Sink 03/02/2022 $25.02
Class of Work: ALT 1 12%State Surcharge- 03/02/2022 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.09
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: Edgardo-Ma.ld ovIado' Permittee Signature: ye e,
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 AnnlicattlFCEIVEDCO
Building Fixtures FEB 14 2022
I TIGARD
' A 1'� Receit.d 7 •y�
13125r SW Hallll Blvd.,d Tigard.OR 9 5I' OF I IGl'1RU Date�By ,j /�- �- ( I ' �/
Phone. 503.718.2439 Fax: SU3 Plan Review
' VI� NG DIVISION DatdBy /yam [i✓ave
Inspection Line: 503.639 4175 Date Ready,By: fJ� yrir_ p See Page 2 for
Internet wuw'.tigard-oLgor e 'Method: Supplemental Information
-TYPE OF WORK_.. FEE' SCHEDULE--
0 New construction ❑Demolition For special information use clrecklisl.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 fl.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312 70
❑ i-and 2-famil dwellin SFR(2)bath 437.78
y' g 2 Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other. Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11740 SW 68TH PKY Catch basin or area drain 18.76
W
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.:200 I Project name:22 510/tiZ/11/�_/ Manufactured home utilhics 50.03
'T
Cross street/directions to job site: ]_ .�a�^ f/"a� Manholes 18.76
/ �� � Q 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: Lol no.: Fixture or item:
• Tax map parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes hasher 25.02
MINDFUL THERAPY T.I. Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name Fixture/sewer cup 1 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 2 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name. MIKE WARREN Roof drain(commercial) 12.51
Address: P.O. BOX 19418 Sink/basin/lavatory 1 25.02
City/State/ZIP: PORTLAND, OR 97280-9418 Solar units(potable water) 62.54
Phone:( 503-244-1900 Fax: :( 503-244-8825 Tub/shower/shower pan 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
Water closet 25.02
- - - CONTRACTOR
Water heater 37.52
Business name:POWER PLUMBING CO. Water piping/DWV 56.29
Address.6611 SW MULTNOMAH BLVD Other: 25.02
City/State/ZIP.PORTLAND, OR 97223 Subtotal
Phone:( 503-244-1900 Fax:( Minimum permit fee: $72 50
� 503L244-8825 ---
Plan review (25%of permit fee)
CCB Lie.:52378 Plumbingum Lic.no.: 34-15OPB State surcharge(12%of permit fee)
Authorized signature: r fir' !����5/I` '" � TOTAL PERMIT FEE
Print name:KRISTIE RAMWELL "" Date 2-11-2022 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-Connry Building Industry Service Board.
I buildingPermits PLs1U-PernatApp doe I00I.09 440-4616T110;02.'COMM'Eut
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: • Residential Fire Suppression Systems:
Site Utilitie§ Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1"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 Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain- Ist 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
Other Inspections or Fees Qty. Fee(ea) Total and each
addiit ng$10,00tional 0(Nor fraction thereof,to
Inspection orexisting 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 S25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,00000 and$1.45 for
hours(minimum charge-2 hours) - each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00fir $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-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*. Plan Review for Plumbing Installations
Quanti 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
D Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
Domestic El Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
-ye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink -2"
3,. Isometric or Riser Diagram
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Maeh.lRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station PLEASE CALL MIKE WARREN WITH QUESTIONS 503-936-5929
Shower: -Gang
-Stall
Sink' -Lav/Bar non-food related t t
-Bradley
-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:
I:\Building\Pemtits\PEMF_PermitApp.doc 08/04/201 1 2
` Accumulative Sewer Tally
Tenant Name: MINDFUL THERAPY SWR#
RD Site Address: 11740 SW 68TH PKWY PLM# PLM2022-00070
TIciA
Parcel#: 1 S136DD03400
Fixture Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptistry/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
-3 inch 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:
-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 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 1 2 0 0 -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: ***CREDIT***
Authorized Name/Signature: JULIE DRINKWATER X2804 Date: 3/2/2022
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