Permit CITY OF TIGARD PLUMBING PERMIT
' ' COMMUNITY DEVELOPMENT Permit#: PLM2022-00072
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/17/2022
Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 105
Project: Cognex Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: Interior plumbing for TI:Adding(1)drinking fountain and(1)bottle filler; Replacing(1)dishwasher and(1)sink.
Contractor: WESTERN PLUMBING Owner: JDS LLC
9460 SW TIGARD AVE SUITE 101 CRITERION CREEKVIEW LLC
TIGARD, OR 97223 BY SPECTRUM REAL ESTATE ADVISORS
1125 SE DIVISION ST#209
PORTLAND, OR 97202
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
ea Dishwasher 03/07/2022 $25.02
Specifics: 1 ea Drinking Fountain 03/07/2022 $25.02
1 ea Ice Maker 03/07/2022 $12.51
Type of Use: COM 1 ea Sink 03/07/2022 $25.02
Class of Work: ALT 1 12%State Surcharge 03/07/2022 $10.51
Type of Const: Plumbing
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: Edgaa,do-M ( Permittee Signature: yt 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 Application I 4..4
Building Fixtures RECEIVE I FOR OFFICE LSE ONLI
City of Tigard Dat."v`d J 7 Lf O' �� �_a 'atc'Ry: Permit No.:
1114 a 13125 SW'Hall Blvd..Tigard.OR 97223 Finn Review
_ Phone: 5(13.718.2439. .Fax: 503.598.196 �n / Other Permit No.: t
Inspection Line: 503.639.4175 Date Rcady'Hr: foil, ® See Page 2 for
TI�'`R° CITY OF TIGARD
www.ttgard-ot'.gov Dale.Beady' rod t3 /�.,t, s Supplemental 2 Information
TYPE OF Wo8 jILDING DIVISION ry1w-,G.4 FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. 1 Ea. 1 Total
114.Addition/aIteration'replacemcnt 0 Other: New I-2-family dwellings(includes 100 fl.for each utility connection)
CATEGORY OF CONSTRUCTION- SFR(I)bath 312.70
ElI-and 2-family dwelling *Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION :AND LOCATION Site utilities:
.lob site address:\S%�5 `3W') (a��„Q; _ Catch basin h area drain 18.76
Drywcll,leach line.or wench drain 18.76
l C•it'/Statc i
> --V 2,LA Footing drain(no.linear ft.: ) Page 2 _
Suite/bldg./apt.no.. I Project name. /'�t Manufactured home utilities 50.03
Cross streeddircctions to job site: s j(O 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 II: ) Page 2
Subdivision: Lot no.: Fixture or item:
31.27
Tax map p arcel no.: 4-1 QGc I tic Backtlow preventer 12.51
Backwater valve
DESCRIPTION OF
WORK
� Clothes washer 25.02
NV. m a�\ INA,)\y `toy7tdA ' Y Dishwasher \ 25.02 .0"1,,
Drinking fountain k 25.02 25 uZ
Ejectors/sump 25.02
VI PROPERTY OWNER r 0 TENANT Expansion tank 12.51
s Fixture'sewer cap 25.02
Nam e: 'i�� t Y- Nv_ Floor drain/floor sink/hub 25.02
Address: ` , i‘ty.c., Garbage disposal 25.02
City/State/ZIP: N 16.`MA `1- 0 Hose bib 25.02
Phone:( 1 Fax:( 1 Ice maker \ 12.51 1 2,,cj
APPLICANT 0 CONTACT PERSON Intcrccptorgrcasc trap 25.02
Medical gas(value:$ ) Page 2
Business name: Ukli (\(\ 1VW g'
Primer 12.51
Contact name: (-NaN Al t Roof drain(commercial) 12.51
Address: alk 0
0 (lt 3 1..\(gut\ &wo\` \jam, Sinkrbasin/lavatory , 25.02 �,Cj2
City/State/ZlP`. 1 1 y � 21, lv Solar units(potable water) 62.54
Phone:(J `p}��.C'1� Fax::( ) Tub/shower/shower pan 12.51
��CC ,,�`' Urinal 25.02
�E-mail: !' ��IilU �11 IM�}��(LQx�'�'�1
1�.�� Water closet 25.02
CONTRACTOR 37.52
Water heater
Business nante:Sd it1�1]ptM?t\k1rvN�\ ,`t(�C, Water piping/DWV 56.29
•
Address: -1 Vpppl0,lOt00JS-,`(i 5 I c ra a I Other: 25.02
1 P Act � + T�C1✓ Subtotal r ,57
City/StatciZlP:
Phone:
��j _Cj�q Fax ( ) Minimum permit fee: $72.5
JIiC,� -- �/�, Plan review (25%of permit fee)
CCB Lie.: P ti robing Li .no.: � 1-'
_ State surcharge(I 2' of permit fee) -•L�'� 4 (�►,5'
Authorized signature: • TOTAL PERMIT FEE AI tdr
This permit application expires if a permit is not obtained within 180 days
Print name: `f1 D`ttC• �f after it has been accepted as complete.
_
�� J! *Fee methodology set by Tri-County Building Industry Service Hoard.
C.Building,Permils'PI.,Mt4PcrmitApp.dot, I 0,01,00 4411-4011 rf II/02. l)M WEB)
fe ,O6, EOc4 (IN u-e.-a-t
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. - Fee(ea)- Total Square Footage: Permit Fee:
Footing drain-I"100' 50.03 0 to 2,00(1 _ $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-I st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-I st 100' 62.54 $L(1(1 to$5.000.00 Minimum fcc$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
+ Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Feesand including$10.000.00.
Inspection of existing plumbing or for 510,001.00 to$25,000.00 S 14R.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$100.0(1 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
each additional$100.00 or traction 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 Review 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
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 OAR9 I 8-780-0040.
-Drive Thai
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
❑ Any multipurpose tire sprinkler system.
Dishwasher: -Commercial
-Domestic 1 ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain I Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3, Isometric or Riser Diagram
❑ 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
Ice Mach./Retrig.Drains. Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/Bar non-food related 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 n
Other Fixturesrr}�g64 I
I:\Building\Pennits\PLMF_PennitApp.doc OR/04/2011 2
Accumulative Sewer Tally
I . 'I"enant Name: COGNEX SWlt# 2022-00032
TIGARD Site Address: 15865 SW 74TI1 AVENUE PLM# 2022-00072
Parcel#: 2S112DC01400
Fixture Value Previous Previous Credits Capped Igixture 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 1 1 1 1
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 I-IP) 32 0 0 0 0 0
-Industrial(over 5 I IP) 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 0 0 0 0
-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 1 1 1
Current Fixture Value 1 divided by 16= 0.063 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 1 divided by 16= 0.063 over (under) $ 365.10
Enter EDU Change Here 0.060 *
*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: 3/4/2022
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:ABuilding\Sewer Tally\ScwerTallyShect_6085_070121.xlsx