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Permit CITY OF TIGARD PLUMBING PERMIT I • COMMUNITY DEVELOPMENT Permit#: PLM2022-00053 Date Issued: 3/21/2022 T I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S 135CA02600 Jurisdiction: Tigard Site address: 11130 SW GREENBURG RD Project: Good Neighbor Center Subdivision: None Lot: None Project Description: Interior plumbing for TI:ADDING(3)auto washer boxes,(1)laundry sink,and(1)floor drain. Contractor: CRAFTWORK PLUMBING INC Owner: EAST WASHINGTON COUNTY SHELTER 7939 SW CIRRUS DR BLDG 23 PARTNERSHIP COUNCIL BEAVERTON, OR 97008 DBA GOOD NEIGHBOR CENTER 11130 SW GREENBURG RD TIGARD, OR 97223 PHONE: 503-644-8698 PHONE: FAX: 503-644-5989 FEES Quantity Description Date Amount 3 ea Clothes Washer 02/18/2022 $75.06 Specifics: 1 ea Floor Drain/Floor Sink/Hub 02/18/2022 $25.02 1 ea Sink 02/18/2022 $25.02 Type of Use: COM 1 12%State Surcharge- 02/18/2022 $15.01 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total $140.11 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: Edgar-do-Ma oto-vu do- Permittee Signature: St.&0-pp-i.A..X..0-,6Ow 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 FI)12 (lhI l( i 5e. 0%1.1 city of Tigard Received IS � � t Permit No.: . 13125 SW Hall Blvd.,Tigard,OR 97223 DateiBy: /�> ^�'�- �L�f/��••- �� Phone: 503.718.2439 Fax: 503.598.1 1 i / • Plan Review u J j a'` Date/By: N Other Permit No.: Inspection Line: 503 639.4175 Date Read /B taro. ® See Page 2 for `fIGARD Y Y TA, I Internet' wssw.tigartl or.gos _ Notified/Method:ied/Method: r � Supplemental Information TYPE OF WORK it. t ...l:"rR a,, "; PEE* SlIEI)I)Iz _. ❑New construction Demolition or special information use checklist. 1)escri.don Qt-. Ea. Total [ Addilion'aIteration?replacentent ❑Other: New 1-2-family dwellings(includes I70 R.for each utility connection) .Al OkY OF.0 NSTRIIC'TTON' SFR(i)bath ❑ I-and 2-family dwelling _W- ❑C:ommercial'industrial - SFR(2)bath- � 312.70 ., � _ SFR(3)bath 500,32 ❑Accessory building ❑Multi-family Fitch additional bath/kitchen 25,02 _ ❑Master builder ❑°Other: Y _ Fire sprinkler l sq.R.) Page 2 JOI3 SITE INFORMATION ION AND LOCATION ION Site utilities: -___.__ r� Catch basin or area drain 18.76 Job site address: I l 1 � rr'�Q .rxLbsm - -_ -f-- Drywell,(each line,or trench drain 18.76 City/State/ZIP: + A Gil4 t' ---- b --- i �4-- Footing drain(no.linear ft.:�) _ Page 2 Suite/bldg.apt.no.: t Project name('t'o a Ile ( I kb o.(- Manufactured home utilities 50.03 - Cross street directions to job site: Manholes 18.76 a -- d l r 4 ,_ - __.__ Rain drain connector ________18.76 f - 30tt__ v Sanitary sewer(no.linear It.. ) Page 2 . ..Q 2i. :. :l1t �j ( 1 r r�� f Stoat sewer(no.linear II.:_1 Page 2 V_eL 2C Pi'' J 1st ISu e D fJ I-C. 0 C9 trd Water service(no.linear Ii.: ) Page 2 Subdivision: t Lot no.: Fixture or item: Tax map/parcel no _ Backflow presenter 31.27 D,Er# OJ WORI i3ackwarervalve 12.51 I ,��.�^`. ` '`'.�' "�' "`" 0/0 Clothes washer 25.02 77As-Va.-at i 3 et,e,c/...) t-C-+'-'4 'i- ^rs It -7" Dishwasher 25.02 Ell10,�'c E'SS 1 s, r'1 k-- l I Flee S 1- -G,f't-, Thinking fountain 25.02 __25.02 { P C)I'F R IS;OVI ly f R ❑ TENANT k xpansion tank 12.51 Fixture/sewer cap 25.02 Name: - -_ Floor drain/floor sink,/hub 25.02 t$- . Address: Garbage disposal 25.02 City/State/ZIP: Hose bib all 25.02 Phone:( ) Fax:( ) ice maker I 1251 ❑ AI'PLICANI' ❑ ('ONTAC'i' 1'EIISO,N' Interceptor/grease trap 25.02 Business name: Medical gas(value:S ) Page 2 Primer 12.51 Contact name: -- Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25,02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 ________.__ Water closet 25.02 C ONTRACCOIt. _ -_--i -- t - - ' Water heater 37.52 Business name: ft�a rJtf !,�6"`_ Water piping`DW V 56.29 - - Address: 7 i. ! ,_$,',,g, chezie us __ w Other: 25.02 City/State/ZIP:3a.re, „,i t q7o 6 Subtotal OS,tee Phone:6---D3 ipt..(`{ ') k t"i 8 Fax:( ) Minimum permit fee: $72.50 _J Plan review (25%of permit fee) CCR Lie.: 7 i �y�j(.�, Plumbing Lic.no. 0 /L('P.:. State surcharge(l2°u o1'permit fee) /S; /}..I Authorized signature: {' A°ri-/ - y ,. TOTAL PERMIT FEE Ala// Print name: f/� ` Date: / I,-yoy 3 J IJ 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-C outay Building Industry Service Board. I-Boilding`..Permits,.PLMU-Pcrmitrlpp.doc 10.01;09 440-4616T1 10,02ICOMAVEUI , . Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Qty. lag) "'Total Square Footage: .Perunt Footing drain- 100' 50.03 0 to 2,000 5121.90 Footing drain-each additional 100 37.52 2,001 to 3,600 S169.69 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-1st 100' 62.54 $1.00 io S5.000.00 Minimum fee 572.50 Storm&Rain Drain-each additional 100' 37.52 $5.001.00 to$10,000.00 $72.50 for the first$5.000.00 and S1.52 for Qty. Fee(as) Total Other Inspections or Fees each additional$100.00 or fraction thereof,to 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 andSI.54 for "- which no fee is specifically indicated 90.001ir each additional$100.00 or fraction thereof,to (minimum charge-1.12 hour) and includ1ng_$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 £379.50 for the first S25,000,00 and$1.45 for hours(minimum charge 2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50000.00. Additional plan review for revisions 90.00/hr £50,001.00 and up £742.00 for the first 550,000.00 and$1.20 for Jtninimum charle-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 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 ('Sr Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru Medical gas and vacuum systems for health care facilities. CuspidcirlWater Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye wash Floor Drain sink: - 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 Comments regarding fixture work: lee Mach,/Rcfng.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang • -Stall Sink: -Lav/Bar non-food related -Bradley -Corn/ServiUtil 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 ')Vasher-Clothes -2. fees assessed for the sewer increase must be paid before the Water Extractor plumbing permit can be issued. Water Closet-Toilet • Urinal Other Fixtures: I:\Building\Pennits\PLMF_PcnrtitApp.doc 08/04/2011 2 IAIIAccumulative Sewer Tally j Tenant Name: GOOD NEIGHBOR CENTER SWR# SWR2022-00020(Revised) t l> Site Address: 11130 SW GREENBURG PLM# PLM2022-00053 Parcel#: 1 S 135CA02600 Fixture Previous Previous Credits Capped 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 1 2 1 2 -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: -Lay/Bar-Non-Food Related 2 0 0 0 0 0 -Bradley 5 0 0 0 0 0 -Com Sery Util-Food Related 3 0 0 1 3 1 3 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 2 12 2 12 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 4 17 4 17 Current Fixture Value 17 divided by 16= 1.063 Current EDU 1 EDU= $6,085.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 17 divided by 16= 1.063 over (under) $ 6,450.10 Enter EDU Change Here 1.060 * *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 TAGGARI'X2449 Date: 2/24/2022 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 Plumbing Permit Applica / S6 ?0a?-_I_* r t�- '7 a -F Building Fixtures CEI \1 E FOR OrFI('I use; ONLY City of Tigard FEB 7 2022 Received L "A' t'y* '' -l/(��_.. ■ 13125 SW Ilall Blvd.,Tigard,OR 97223 Plan Review /dila / ��y�y 1 8 Phone: 503.718,2439 Fax: 503.5 t • ' ! INS /� �i�°0�TiGAFI[� Date/By: fi t taA1C 1) inspection Line 503 639 4175 �y tf n Date Ready/By: ntrIs: Sec Page 2 for Internet wwwtigard orE,ov 'tJILWlNG f+ IS `t Notified/Method ? Sulplement:1lnformation _.1,. ,,, TYPEiFW 4 ' t. .. 43 D n A ' ' ' ❑New constt Uction ❑Demolition •or special information use checklist - --- --- Description Qt . F.a. Total [ ddition.talteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath - 312.70 ❑ 1 and 2-faintly dwelling ❑Commercial, SFR(2)bath 437.78 industrial ____ _ SFR(3)bath 500.32 ❑Accessory building ❑Multi-family - _ __..._ Each additional hathrkitchen 25.02 ❑Master builder D Other: Fire sprinkler( sq.ft.) -- Page 2 JOH SITE: INFOR MA i ION AND LOCATION l. . Site utilities: -� -� Job site address Catch basin or arcs drain 18.76 I .1 ,�0 - 1 i T k.0lh Drywell,leach line,or trench drain 18.76 City/State/ZIP: Cj-� a l3 _ -- Page..__l.CL 31 Footing drain(no,linear ft.:�) Page 2 Suite/bldg./apt.no.:_-- Project name('c)crd /),€,t c j -r- Manufactured home utilities -._.._.._-.._� 50.03 Cross streci/direclions to job site: +'°ror/z'tlr' - Manholes 18.76 r • Rain drain connector 18.76 �led ,���_E r tl Sanitary sewer(no.linear ft.:�) Page 2 -50 12 C 0>'i lot t--C.j 1 ill t ci i 'C'i, mot.t`l iAi i'lth..kdPrytyv.s Storm sewer(no.linear II.:_ ) Page 2 � 7 ts. C Y 'k ( 1`. ..._.l fit; ?i`� 0 Water service(no.linear 11.:^) Page 2 Subdivision: l Lot no.: Fixture or item: ,_- - p . Tax map/parcel no.: Backflow re venter ---- 31.27 - 'k 11ti '1 I rt r T D)SCRIPTION`OF,WORK Backwater valve 12.51 .o a. >axa .. - Clothes washer 25.02 -7s-oia 1 - ` .s r r) '�{.•.aL.t-�"�' �G`r-S JLe„, Dishwasher 25.02 7-- �N�� f / -/ si Drinking fountain 25.02 Ejectors/sump 25.02 '`' 0 PRiiiiE'R'i`i OV'V NLR © TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 rNi1 Name: _- Floor draintfloor sink/hub �i 25.02 dp Address: Garbage disposal 25.02 City/State/7iP: - - Hose bib -_ 25.02 -- Phone:( ) Fax:( ) Ice maker 12.51 �� ACT..- s Interceptor/grease trap 25.02 -- �` Business name: Medical gas(value:S ) Page 2- - _-- Printer 12.51 12.51 Contact name' -- -- Roof drain(commercial) 12.51 Address: ________ Sink/basin/lavatory / 25.02 .2c)-__ City/State/ZlP: Solar units(potable water) 62.S4 ________Fax: :( ) Tub/shower/shower pan 12.51 a E-ntatl. s{/4/1 '„Mrs. er✓43 - rra Urinal 5.02 e Water closet _- 2.. cONT A Oii Water heater 37.52 Business name:C.g ,4ff1't 0 itic. Ptvii i le&' Water piping/DWV 56.29 _ Address: . f a citie t !u,.S Did--. Other: 25.02 City/State/'LIP:3610.4 "kr y-i c fa.- �'j 7Oc) t� Subtotal t fa S�_ Minimum permit fee: $72.50 Phone:( � 4(4 Li (p ci Fax:( ) Plan review (25%of permit fee) CCI3 Lic.: C 6 tj(p Plumbing Lic.no.0 U /C(`8/�lg _-- _-_..__-_--- State surcharge(12%of permit fee) /S, 0/3-1 Authorized signature 172 j M t., TOTAL PERMIT FEE f se / yyY Date' I This permit application expires if a permit is not obtained within ISO days Print naltte: t`�r �W {, s / J/ after it has been accepted as complete. It �•u. *Fee methodology set by Tri County Building Industry Service Board. 1:113uildin5U'ermiis\PLMU-PennitApp.doc 10,01/09 440-4616T(I0/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: t2(v 1 ' Site Utilities Feeea_._..._..._. � ) Total Scare I'ootitoe Permit Fee: Footing drain- I" i00' 50.03 (1 to 2,000 5121.90 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 andgreater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Storm&Rain Drain- 1st 100' 62.54fdluation: Permit Fee: __- $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 SS,000.00 and$1.52 for Other Inspections or Fees Qty. Fete(ea) Total each additional$100.00 or fraction thereof,to 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 90.001hr $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'lu S50,001.00 and up $742.00 for the first$50,000.00 and$1.20 Mr (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 Plumbin 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 Retomtte ❑ 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 El New exterior plumbing site utilities for any complex structure Car Wash: -Each i as defined in OAR918-780-0040. Cuspidor/Water As-Dr Stall ator _- ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: -Commercial El Arty multipurpose fire sprinkler system. Domestic Li Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Dr-ain'sink: -2" 3„ Isometric,or Riser Dia_ram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the .ualifications above. -- Disposal: -Domestic food related -Commercial food related -Industrial food related Ice lvtach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -LavBar non-food related -Bradley -Com/ServiUtil tood related -Service 1,,,, s.t,tier 1 *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: 1:ABuilding\Permits\PLMF_PennitApp.doc 08/04/2011 2