Permit CITY OF TIGARD PLUMBING PERMIT
` ff , COMMUNITY DEVELOPMENT Permit#: PLM2022-00093
Date Issued: 3/21/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AD03100
Jurisdiction: Tigard
Site address: 6950 SW HAMPTON ST 100
Project: Hampton Square Subdivision: WEST PORTLAND HEIGHTS Lot: B
Project Description: Interior plumbing for TI:Adding(1)sink and(1)hub drain; Installing(1)primer and(1)water heater.
Contractor: BEAVERTON PLUMBING INC Owner: WESTON INVESTMENT COMPANY
13980 SW TV HWY ATTN: JOSEPH E WESTON
BEAVERTON, OR 97005 2154 NE BROADWAY ST
PORTLAND, OR 97232
PHONE: 503-643-7619 PHONE:
FAX: 503-643-7620
FEES
Quantity Description Date Amount
ea Floor Drain/Floor Sink/Hub 03/17/2022 $25.02
Specifics: 1 ea Primer 03/17/2022 $12.51
1 ea Sink 03/17/2022 $25.02
Type of Use: COM 1 ea Water Heater 03/17/2022 $37.52
Class of Work: ALT 1 12%State Surcharge- 03/17/2022 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.08
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: Edgavdo-Ma(.do-v ado- Permittee Signature: ye -a��
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.
W .
Plumbing Permit Applieat ECEIVED -
. tall
Building Fixtures FEB 2 4 2022 IOR Ol FICE USE ONE.l
CityReceived
13125 Of HallallBCfl 7� D./By: j'i . Permit No.: p �� .,-i'� y) t3
1111 iv ]3125 SW Blvd.,Tigard,OR 93t 1 OF TfUARU Plan Re trees l t/v\
Phone: 503.718.2439 Fax: 503. Other Permit No.: t 2 /,
IIe�9JNG DIVISION' Date/By: /t/ dip
� 10`sri"�a :all
1 I G 1 R 1> Inspection Line: 503.639.4175 Date Ready/By: -� • �],� 0 See Page 2 for
Internet: www.tigard-oi gov Notifiedfklethod: /f iI/';� �,?-"r"1 1C-A Supplemental Information
TYPE OF WORK ,t , t, / Fix SCHLOULE
❑New construction ❑ Demolition For special information use checklist
- Description Qty. Ea. J Total
S'Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El1-and 2-family dwelling la Commercial/industrial SIR(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.ft.) Pagc 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ‘45b 6t,i 1064't¢I . Catch basin or area drain 18.76
City/State/ZIP: 'f � /'j� Q�r�� � • Ur}nvell,leach Tine,or trench drain 18.76
g4v ►--> o Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt,no.: f Project name: `{171�'' /�_ „� � .'ci, ,. 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 ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel rt . Backflow preventer 31.27
._ - Backwater valve 12.51
DESCRIPTION R PTION OF WORK
--- C -` Clothes washer 25.02
it r r r fib/ C/at ►t - J{✓1 IL` Dishwasher 25.02
War �-Va /A S f i/ut0 r�(j �V We -,.Q� Drinking fountain 25.02
t,t,poi, / ! Ejectors/sump 25.02
Expansion tank 12.51
0 PROPERTY OWNER i 0TENANT Ex p
Fixture/sewer cap 25.02
Name: Floor drain/floor sink/hub ( 25.02 / 02.
Address: ''r
Garbage disposal 25.02
City/State/ZIP: _ Hose bib 25.02
Phone:( ) Fax.( ) Ice maker 12.51
jgrA-PPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: eawdi Medical gas(value:$ ) Page 2
�,^�, i Primer f 12.51 11,AI
Contact name: Q �`�v 61/\. ____ Roof drain(commercial) 12.51
Address: L-3' 1
.6(x) 1J ( Sink/basin/lavatory I 25.02 ' 1 C -
City/State/ZIP: elQ- (4 Solar units(potable water) 62.54
Phone:( 1t ) 44 1,f 3`? Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
�i'�1IGt,V€-4t„'Yt ."[d-t t44.101 5_ ,
Water closet 25.02
CONTRACTOR •
//// �(�(� � Water heater I 37.52 31 l �
Business name: i . '1 w1.-14l4,61 Water piping/DWV 56.29
Address: �L Other: 25.02
City/State/ZIP: Subtotal __tI7Ch_Sy
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 1 Ii,U f Plumbing Lic.no: t pg Plan review (25%of permit fee)
State surcharge(12%of pennit fee) f'L„0e0I'
Authorized signature: TOTAL PERMIT FEE (1 L.t t5
,7 / 4 This permit application expires if a permit is not obtained within 180 days
Print name: ig- Q�(n��1/` Date: // L Z after it has been accepted as complete.
�� LL *Fee methodology set by TmCounty Building Industry Service Board.
ABuildmg\Permits\PM M/
LU•PermiiApp.doe 10/01/09 440-4616T(I0/02/COWEB) 3 K`�✓�-z'e._..ff4 '
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
� :��t' r<���,n�r.t1.- A0Ofte�V.A .irS ware 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 S stems:
Water Service-each additional 100' 37.52 c s"i: v .114
Stonn&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
C ther'' ii5peCtions or Fees Qty "e' k' t: each additional$100.00 or fraction thereof,to
x and including$10,000.00.
Inspection of existing 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$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 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 90.00/hr $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
Quantity by Fixture Type Plan reviccA. is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems.for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
-3"
4" 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 Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
rs -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: {� h
1:1Building\Permits\PLMF_PetmitApp.doc 08/04/2011 2
4,4
Accumulative Sewer Tally
■ au Tenant Name: I IAMPTON SQUARE SWR# 2022-00037
T l R Site Address: 6950 SW HA�A1PTON ST PLM# 2022-00093
Parcel#: 2 S 101 AD03100
Fixture A'aluc Previous Previous Credits Gapped 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
-3 inch 5 0 0 0 0 0
-4inch 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 HI') 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
t 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
:'i Urinal 6 0 0 0 0 0
rt
Previous EDU Count 0 0
r
9, Capped EDU Credit 0
TOTALS 0 0 0 0 1 2 1 2
f
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: BRANDEN TAGGART'X2449 Date: 3/11/2022
a
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