Permit 1114 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00215
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/17/2022
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Parcel: 25101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Project: Total Quality Logistics Tenant Improvement Subdivision: VARNS ACRES Lot: 9
Project Description: Adding:(1)floor drain,(1)garbage disposal,(1)ice maker,(1)primer and(1)sink.
Contractor: PMSI LLC Owner: TRIANGLE POINTE TWO LLC
8295 NW EVERGREEN PKWY#204 901 NE GLISAN ST, STE 100
HILLSBORO, OR 97124 PORTLAND, OR 97232
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 06/15/2022 $25.02
Specifics: 1 ea Garbage Disposal 06/15/2022 $25.02
1 ea Ice Maker 06/15/2022 $12.51
Type of Use: COM 1 ea Primer 06/15/2022 $12.51
Class of Work: ALT 1 ea Sink 06/15/2022 $25.02
Type of Const: 1 12%State Surcharge- 06/15/2022 $12.01
Occupancy Grp: Plumbing
Stories:
Total $112.09
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
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Issued By: /'j,,/�i= ^ Permittee Signature: p)i Cq
b GT)
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 Applicati V CEP
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Building Fixtures FOR OUTItE_ I'SF ()NIA'
MAY 1 1 2022 Received G
City Of Tigard Plan Review
• /��a Permit No.: M
+ 13125 SW Hall Blvd.,Tigard,OR 972 yy Plan Review 1 '
>: Phone: 503.718 2439 Fax: 503.59e.. 6U UI- I IGAHi✓ Other Permit No.:S aka_GCYi73
• Date/By:
T I G A R D Inspection Line: 503.639.4175 BUILDING DiVISIQR! Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental information
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TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition _ For special information use checklist.
Description Qty. I Ea. I Total
,,..irf6.dditionialterationfreplacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath!kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: j 1 Drywell,leach line,or trench drain 18.76
CCity/State/ZIP: _13 C�.1 r.a v t� C-1 Z 2.3
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: r i��41` 'aU;n O� 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.: Backtlow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Y) iZ/.\LC� il U 11 LD ���r n>V>;rick Y ttl1-T'S Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
.PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture sewer cap 25.02
Name:--it i c -te, 1 t 'Po',,i kL ) c..A.t L.1..C= Floor drain/floor sink/hub ( 25.02 2 0,,,
Address: )-2 F .. F�)C.-v.�
s� St.� lo +t..
y Garbage disposal ( 25.02 is_L-2_,
City/State,/Z1P:-T,c .t r,A t G(L, (,r(Z 2,3 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker I 12.51 '15.s/ ,
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: p1kA5=) ___L.C..,
Primer I 12.51 )Z J 1
Contact name: A ma n Re'r i fry Roof drain(commercial) 12.51
Address:E7 GI S' 1uE Eve ciye eZ 1)\4A"',,0 t>ti 7 C,sL( Sink/basin/lavatory ( 25.02 25 OZ
City/State/ZIP: 44-l11.,‘,. Ci ) o __ cm 1 Z,q Solar units(potable water) 62.54
Phone:(cj 1 ) i Fax: :( ) Tub/shower/shower pan 12.51
t, a(r:(� 227 2Urinal 25.02
E-mail: accles 6' fvts, `.. )i f • s.con-,3
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: ISM Ste ) L-Lx__ Water piping/DWV 56.29
Address:c32�AS �E; C vC c ,�C.) x Other: 25.02
OO L"u' I 1 S-k., ZC�`-t
City/State/ZIP: Subtotal )&j,0$
�111Sb�C r✓ >6Z-- az(1 Z� Minimum permit fee: $72.50
Phone:(riG'', ) 6„cv -77.2 Z-
CCB Lic.: Plumbing Lic.no.:?)
Plan review (25%of permit fee)
�g2R� �C{�u �) State surcharge(I2%of permit fee) Ja,ei I
Authorized signature: 4lL�yf/ �F Zvi.= TOTAL PERMIT FEE `)a,b'( !
C 0 'this permit application expires il'a permit is not obtained M'iihin 180 days
Print name: Date: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
IP13uitding:Petmita'FLMU-fcrmitApp,doc lO,0t109 440-4616T(IO'O2,C'OM'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-1" 100' 50.03 0 to 2,000 SI21.90
Footingdrain-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:
t Storm&Rain Drain- 1st 100' 62.54
51.00 to S5.000.00 _ Minimum fee$72.50 -
1 Storm&Rain Drain-each additional 100' 37.52 55.001.00 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 Fees and including$10,000.00.
Inspection of existing plumbing or for S10,001.00 to S25,000.00 S148.50 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
f (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
nhours(minimum charge-2 hours) each additional S 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:
1
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
v 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 Replacer
Capped Added Relocate Please check all that apply.
Work Performed:
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower ii
ii engineer.
Jacuzzi/Whirlpool
0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall Drive Thru as defined in OAR918-780-0040.
❑ Medical gas and vacuum systems for health care facilities.
Cuspidor Water Aspirator
li ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
i? Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain'sink: -2" l
-3•• Isometric or Riser Diagram
ill ElIsometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related l
-Commercial food related
u food related
I Ice Maeh.'Refrig.-Ind Drainsstrial _ Comments regard�i g fixt re work:
Oil Separator(Gas Station) ,t• Ckd- '\cn� L��
Rec.Vehicle Dump Station f3QI , IS
rz Shower: -Gang
-Stall
r,
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/L:til food related -
1.
Service i *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.
1Urinal
$. Other Fixtures:
I'.
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Tenant Name: Triangle Pointe
III A TQLccumulative Sewer Tally SWR# SWR2022-00073
Site Address: 1333 SW 68th Parkway PLM# PI.M2022-00215
TIGARD
Parcel#: 2S 101 DA00104
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 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
f 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 1 1 1 1
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 2 3 2 3
Current Fixture Value 3 divided by 16= 0.188 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 3 divided by 16= 0.188 over (under) $ 1,156.15
Enter EDU Change Here 0.190 *
*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: 7 ( 1 Date: (a7i +f,
Building Division
Note: 'Hie 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