Permit Support Document CITY OF TIGARD PLUMBING PERMIT
1111
a COMMUNITY DEVELOPMENT / 1-� Permit#: PLM2022-00248
I Date Issued: 7/7/2022
T"I i;A R.t7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: IS1260000300
Jurisdiction: Tigard
Site address: 9677 SW WASHINGTON SQUARE RD C05
Project: Levi's Subdivision: None Lot: None
Project Description: Interior plumbing for TI:CAPPING(1)3"floor drain,(1)non-food related sink,(1)mop sink,and(1)water closet.
Adding(1)drinking fountain.Installing(1)water heater.7/18/22:REPRINT to correct address and project name.
Contractor: SAKRISSON PLUMBING Owner: PPR WASHINGTON SQUARE LLC
PO BOX 821 BY MACERICH RET
RIDGEFIELD,WA 98642 PO BOX 4085
SANTA MONICA,CA 90411
PHONE: 360-909-8141 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 07/07/2022 $25.02
Specifics: 1 ea Fixture/Sewer Cap 07/07/2022 $25.02
1 ea Floor Drain/Floor Sink/Hub 07/07/2022 $25.02
Type of Use: COM 1 ea Sink 07/07/2022 $25,02
Class of Work: ALT 1 ea Laundry Tray 07/07/2022 $25.02
Type of Const: 1 ea Water Closet 07/07/2022 $25.02
Occupancy Grp: 1 ea Water Heater 07/07/2022 $37.52
Stories: 1 12%State Surcharge 07/07/2022 $22.52
Plumbing
Total $210.16
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 9 2-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: -' Permittee Signature: t G ct /
"ific4
iicr -
Call 503.639.4178 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job she until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit ApplieatioRECEIVED Gti _ OF
Site.Utilities JUL' 7 qq
20LL L
City of Tigard Received
Date/By:
13125 SW Hall Blvd.,Tigard,OR 97223 By:
r O fIGaHU Plan Review /� Z Pe� �-•'° lu
= Phone: 503.718.2439 Fax: 503.598.1y6� Other Permit No.:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date/Ready/By: Juris See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist.
Description Qty. Ea. Total
[Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
- Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
_?G77 10B SITE INFORMATION AND LOCATION Site utilities:
Job site address: R-2r{4'g •• /, c K A
Catch basin or area drain 18.76
�� �� tt �L/,�Gj Drywell,leach line,or trench drain 18.76
City/State/ZIP: T 1 (� r U Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: C 0 Project name: f' Manufactured home utilities 50.03
Cross street/directions to job site: Co 4.rV1 L. 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 no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
' Clothes washer 25.02
P ,'7A
'x rt L 0 e eL 4-k. 0-._ Dishwasher 25.02
Drinking fountain r -( • 25.02 2 S.02
Ejectors/sump 25.02
j PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: PIU� t ) t 31,1 ,�sf1,� �A rt / t Fixture/sewer cap + 25.02
Address: P b 0. V C ' ` G 1 `" vf/ Flooradgrain/poor sink/hub • 25.02 2 p 2
"t Garbage disposal 25.02
City/State/ZIP: .c l.1 /-7 1(/L(r}/%,( (A f �A- GG( 1 Hose bib 25.02
Phone:( ) 7 Fax:( ) Ice maker 12.51
121 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: , I<v.i.
SS, Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
S et Vl.VL4 /7-1 Y1�i SA en SS✓1'ti Roof drain(corercial) 12.51
Address: To I
i Sink/basin/lavatory 25.02 5o ey
City/State/ZIP: I�vj `, L I 1/1/I V/ r Solar units(potable water) 62.54
Phone:( fU olVq / 1��`��A11 Fax:
:`(( ) u Tub/shower/shower pan 12.51
//�`CC SVIG•kWL, , g"`"'"1IIIC cr;ss1/4 ,v.,, ,„,)J( Urinal 25.02
E-mail: �1'Yl Water closet /, " 25.02 lc. O2
CONTRACTOR
C'^ Water heater . ( • 37.52 7, sZ
S
Business name: ( kt }'SSn, ut'.rrr 61 1.i.5 LA.„C_ Water pi tpin DWV 56.29
Address: pp ! o'c �( Other: 25.02
City/State/ZIP: �1'd 'Q x( 6( ' WA- %(Q/`1`'� Subtotal 1622, OrL
Phone:( Coo) el Oc l �f Fax:( ) J 7/� Minimum permit fee: $72.50
CCB Lie.: ',2 2 5;l / /� al
-1 a Plumbing Lic.no.: P� .�j l Plan review (25%of permit fee)
ll , • I � ' State surcharge(12%of permit fee) to,5 I
Authorized signature: �1/` Le TOTAL PERMIT FEE
)^ This permit application expires if a permit is not obtained within ( day 3
Print name: "h.,
Date: `7 11 -2:-2, after it has been accepted as complete. G , (��
.A,.„...0,..4
/ *Fee methodology set by Tri-County Building Industry Servic rI-----
2 V 7 . 5
I:1BuildingPermits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) �
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-1s`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-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
Other Inspections or Fees Qty. Fee(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 90.00/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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower El Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic `fie(�� ❑ An multipurpose fire sprinkler system.
DrinkingFountain , T 7 0 Anycomplex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink 2" Submit 2 sets of plans with any of the above.
`--' _3„ 'y?5 )
Car Wash Drain Isometric or Riser Diagram
Garbage Domestic-non-food El Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station . 1/1/4(I /411- 1-a vet)
Shower -Gang e/V v'[So, a) eArreli
-Stall• ` • �j
.� Sink/La; Non-food related ► �({S lJ / 3'7 G,
�,. • go CO we, e!s
L� -Commercial-food related
vG -Service 01110 S%b/L•
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet 1.- V -Nit 5 Cr) fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
- Other Fixtures:
I:\Building\Permits\PLMU_PermitApp.doc 2
II ■ Site Utilities — Plumbing Permit Application
I
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. 0 map&tax lot# ❑ project name 0 site address ❑ suite number
❑ zoning 0 applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS-Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping,manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
1:\Building\Permits\PLMF-PennitApp.doc 12/30/05
111111 Accumulative Sewer Tally
Tenant Name: ARTIZIA SWR#
TI GAItD Site Address: 9665 SW WAS!IINGTON SQUARE CC05 PLM# PLM2022-00248
Parcel#: 1 S 1260000300
Fixture Value 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 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 1 5 0 -1 -5
-4 inch 6 0 0 0 0 0
-Car\l ash 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 1 2 0 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 1 3 0 -1 -3
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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOT\LS 0 0 4 16 1 1 -3 -15
Current Fixture Value -15 divided by 16= -0.938 Current EDU l EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -15 divided by 16= -0.938 over (under) $ (5,719.90)
Enter EDU Change Here -0.940
*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: 7/7/2022
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