Permit (9) CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit#: PLM2022-00307
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/22/2022
Parcel: 1 S 134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 600
Project: Donburi Factory Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: Interior plumbing for TI:
Contractor: Owner: ROBINSON,JERRY CHRISTOPHER TRUST
DIETRICH, NANCY BISHOP
9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Floor Drain/Floor Sink/Hub 08/22/2022 $50.04
Specifics: 1 ea Ice Maker 08/22/2022 $12.51
1 ea Interceptor/Grease Trap 08/22/2022 $25.02
Type of Use: 1 ea Primer 08/22/2022 $12.51
Class of Work: 3 ea Sink 08/22/2022 $75.06
Type of Const: 1 ea Water Heater 08/22/2022 $37.52
Occupancy Grp:
Stories:
Total $212.66
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 the rules
Issued By: Permittee Signature: s
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 RECEIVE,) Received Kill
City of Tigard D). permit No.:
13125 SW Hall Blvd.,Tigard,OR Plan Review 1�/I
."A" 8 2022 '�pa 4e 4 0,herPcrnailN..: _d)j
Phone: 503.718.2439 Fax 503 59 Date/By:
Inspection Line: 503.639.4175 Date Ready/By: Juris See Page 2 for
Internet: www.tigard-or. C'TY OF Twau Notified/Method: 0% Supplemental Information
gov kill,
t
77
R
EIN!y construction olition Won use checklist
Description I Qty. I Ea. Total
f; Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
At SFR(1)bath 312.70
❑ 1-and 2-family dwelling p_el�mmcrcial/industrial SFR(2)bath 437.78
❑Accessory building [I Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
El Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
Site utilities:
NET
WWWR "F!
Job site address: plis vig- 0 Catch basin or area drain 18.76
City/State/ZIP: T'I-A 61Drywell,leach line,or trench drain 18.76 113 Footing drain(no.linear III.: Page 2
Suite/bldg./apt.no.: Project name: 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 no.: Backflow preventer 31.27
Y
Backwater valve 12.51
Clothes washer 25.02
C b^12 Dishwasher 25.02
6-9 -7 1e--0_4rs Drinking fountain 25.02
t-- 4 ecz Ejectors/sump 25.02
Expansion tank 12.51
MW
mc W
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02 _110
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: Fax: lee maker 12.51
Interceptor/grease trap 25.02
0 Wl!4
-%F� R
Business nameMedical gas(value:$ Page 2
: fioln
Primer 12.51 12-j;-)
Contact name: Mal H 1A Roofdrain(commercial) 12.51
Address: 10AS MIMS AVE Sre 600
213 Sink/basin/lavatory 25.02 7 37,66
City/State/ZIP: I[AM V_ Solar units(potable water) 62.54
Phone:(3 F ax: Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
7.7
Water heater 37.52
Business name: Waterpiping/DWV 56.29
Address: 9 Other 25.02
City/State/ZIP: Subtotal
GEC
>Phone:(,S�il 1 It 2 q6 Minimum permit fee: $72.50
Plan review (25%of permit fee)
S,*� CCB Lic.: 7 2 Plumbing Lic.no.: j State surcharge(12%ofpermit fee
Authorized signature: TOTAL PERMIT FEE
Date: This permit application expires if a permit is not obtained within 180 days
Print name: L) L- �A L. 64 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I\Build ing\Per=1s\PLMU-Pernu1App.doe 10/01/09 440-4616T(10/02/COM/WEB)
Plumbiny, Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
�Lfi7 st{b�
Footing drain-I'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-1 st 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
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
each additional$100.00 or fraction thereof,to
a
-,� 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*.
Qanti b:FiXt'ure T e Plan review is required for any of the following.
Fhture'#'Ypefor Reptacei Please check all that apply.
WOrltftrfotatied: Capped Added Relocate
El 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
Stall El New exterior plumbing site utilities for any complex structure
Car Wash: -Each S
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water idor/Water As ire T ElMedical gas and vacuum systems for health care facilities.
Dishwasher: Commercial [I Any multipurpose fire sprinkler system.
❑ Any complex structure as defined in OAR918-780-0040.
Domestic
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" �i F,0• h �:
-3„
-4" ❑ 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./Refri .Drains b Comments regarding fixture
/work: la
Rec.Vehicle Dump Station
Shower: Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
S 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 �I-O C()gOther Fixtures: ,
1:\Building\Permits\PLMF-PermitApp.doc 08/04/2011 2 A L� Sn 7
Accumulative Sewer Tally
Tenant Name: Donburi Factory SWR# SWR2022-00115
Site Address: 10115 SW Nimbus Ave,#600 PLM# PLM2022-00307
C 7
Parcel#: 1 S 134AAO1900
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Ba tiscr y/Pont 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-jacuzzi/Whirlpool 4 1 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 3/41IP) 16 0 0 0 0 0
Commercial to 5 1411 32 0 0 0 0 0
Industrial(over 5 HP) 42 0 0 0 0 0
Ice Machine/Refri orator Drain 1 0 0 1 1 1 1
Living Unit 16 0 0 0 0 0
Oil Sc Gas Station 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gan (per head 1 0 0 0 0 0
Stall 2 0 0 0 0 0
Sink:
Lav/Bar-Non-Food Related 2 0 0 1 2 1 2
Bradley 5 0 0 0 0 0
Com/Sery/Util-Food Related 3 0 0 2 6 2 6
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 5 11 5 11
Current Fixture Value 11 divided by 16= 0.688 Current EDU 1 EDU= $6,625.00
Previous Fixture Value 0 divided by 16= 0.000 Previous UDU
Change 11 divided by 16= 0.688 over (under) $ 4,571.25
Enter EDU Change Here 0.690
*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: Date:
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_6625_070122.xlsx