Permit t CITY OF TIGARD PLUMBING PERMIT
"�1 COMMUNITY DEVELOPMENT Permit: PLM2022-00213
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 t Y� Date Issued: 7/1/2022
Parcel: 1 S136DD03800
1 ) ' .•� Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Project: Mountainwood Homes office Tenant Improvement Subdivision: WEST PORTLAND HEIGHTS Lot: 4-8&27
Project Description: Bathroom remodel:capping(5)fixtures,adding:(1)dishwasher,(1)drinking fountain,(2)floor drains,(1)primer,
(3)sinks and(3)water closets. 10/31/22:REPRINTED permit to add(1)drinking fountain, (3)2"floor
drains/sinks,(2)sinks,and(2)water closets.
Contractor: CRAFTWORK PLUMBING INC Owner: TANGLEWOOD DEVELOPMENT LLC
7939 SW CIRRUS DR BLDG 23 ATTN WOOD, ROBERT
BEAVERTON, OR 97008 8324 SW NIMBUS AVE
BEAVERTON, OR 97008
PHONE: 503-644-8698 PHONE:
FAX: 503-644-5989
FEES
Quantity Description Date Amount
1 ea Dishwasher 07/01/2022 $25.02
Specifics: 1 ea Drinking Fountain 07/01/2022 $25.02
5 ea Fixture/Sewer Cap 07/01/2022 $125.10
Type of Use: COM 2 ea Floor Drain/Floor Sink/Hub 07/01/2022 $50.04
Class of Work: ALT 1 ea Primer 07/01/2022 $12.51
Type of Const: 3 ea Sink 07/01/2022 $75.06
Occupancy Grp: 3 ea Water Closet 07/01/2022 $75.06
Stories: 1 12%State Surcharge- 07/01/2022 $46.54
Plumbing
1 ea Drinking Fountain 10/31/2022 $25.02
3 ea Floor Drain/Floor Sink/Hub 10/31/2022 $75.06
2 ea Lavatories 10/31/2022 $50.04
2 ea Water Closet 10/31/2022 $50.04
0 12%State Surcharge- 10/31/2022 $24.02
Plumbing
Total $658.53
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: - Permittee Signature:
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���CE VV E l"e�
Building Fixtures FOR OFFICE USE ONLY
Received Persmt No..
City of Tigard OCT 31 2022 Deceive ��/3 r Jd+ - Pam►7tl a}-uv D_t3
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 Dale/ , Other Permit No.:
Inspection Line: 503.639.4175 CITY OF TIGARU naleRradyhaw ®/By: h See Page 2for
TIGn RD Internet www.tlgard-or.gov ,7f itI nlhi(, Divislat, Notified/Method: Supplemental Information
TYPE OF WORK
DemolitionFor special information use checklist
❑New constructionconstruction Description I Qty. I Ea. I Total
O Addition/alteration/replacement 0 Oth ?. j 1 I New 1-2-family dwellings(includes 100 ft.for each utility connection)
T'EGORY OF CONS '•;Ut(�u SFR(1)bath 312.70
,� ❑Co st oJoeu reAta.MI SFR(2)bath 437.78
❑1-and 2-family dwelling ""' ' -
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE.INFQRMA;I'ION AND Lo' 04�; Site utilities:
'''`^ " »` Catch basin or area drain 18.76
Job site address: if
f 16 7 S .5;,�J 104 y 2 Drywell,leach line,or trench drain 18.76
City/State/ZIP: / /�,, Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: tW -I�/J,{ f '"" F) 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: I Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.: 12.51
- ;it:v 'Xp[} .l ",`SU:•^< Clothes washer 25.02
/44,6,j Ta e?.s %11f p/eN1: Dishwasher 25.02
._�/ .d / i / -�j,u! (') 0�i z iv,...� / Drinking fountain \ 25.02
/lX r N l I� ✓�1^�i t►J ." s.�u Ejectors/sump 25.02
L. a
't;l1 i ' Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( )
Ice maker 12.51
se
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: 12.51
Primer
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 'j, 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: ( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: Water closet Z 25.02
CONTRACTOR Water heater 37.52
Business name: Cp.;011),t/0.{ti YIr.n.LL:pj Tel C, Water pipingfDWV 56.29
Address: 793.1 sw e: .-tip A--
Other: 25.02
City/State/ZIP: Qey 0/„it al orZ $7 o o u3 Subtotal
Minimum permit fee: $72.50
Phone:(5 n) 6471-$6 9 is, Fax:( ) Plan review (25%of permit fee)
CCB Lic.: 7.4664 Plumbing Lic.no.: State surcharge(12%of permit fee)
Authorized signature. 1:0 •I je 1114 TOTAL PERMIT FEE
Print name: Date: tO`31This permit application expires if a permit Is not obtained within 180 days
?� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building1Perntti\PLMU-PernulAPP.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
Qty. Fee(ea) Total �u �
Site Utilities Satalxtge _ •
";
Footing drain-1°'100' 5(103 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 S stems:
Water Service-each additional 100' 37.52 [,qy{, n�{';
Storm&Rain Drain-let 100' 62.54 $1.00'to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 3752 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
x - ' each additional$100.00 or fraction thereof,to
�titeryfns>lenls
��}� •3;....rs.n,. and including$]0,000.00.
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$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to _
accurately report fixtures could result in increased sewer fees* , " t 444. s 1O ` la l I� l i$I ,
• Quantity,byFizture,Type, Plan review is required for any of the following.
Fixture Type for • Replace/ Please check all that apply.
Work performed: .. . Capped Added : Retocarer
❑ Any new commercial building with water service 2"and
Baptistiy/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial 0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink. -2"
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/Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
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
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:
I:lBuildinglPermits\PLMF_PermitApp.doc 08/04/2011 2
Plumbing Permit Application - City of i !�2
Page 2 - Supplemental Information U _`
Fee Schedule: Resi ential Fire Suppression Systems:
Site Utilities tt>y. Fee(ea) Tots! Square Footage: Permit Fee:
Footing drain- 1' 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
Storm&Rain Drain 1st 100' 62.54 valuation: 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$5,000.00 and$152 for
Qfy- Fee(ea) Total each additional$100.00 or fraction thereof.to
Other Inspectionsor Fees 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''`. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Relaxed 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
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher. Commercial El Any multipurpose fire sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain b•41ew
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" /q]j 2
3' (',/ Isometric or Riser Diagram
4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
Stall
Sink: -IavlBar non-food related t t 2 CiA
-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 aWaterCloset-Toilet 2 t 2 plumbing permit can be issued.
Urinal 2
Other Fixtures.
L\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
III Accumulative Sewer Tally
Tenant Name: MOUNTAINWOOD HOMES SWR# N/A
Site Address: 11675 SW 66TH AVENUE PLM# PLM2022-00213 Vt
T IGARD )
Parcel#: 1 s136DD03800
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 1 2 1 2
Drinking Fountain 1 0 0 2 2 2 2
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 3 6 3 6
-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 tl 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:
-Lav/Bar-Non-Food Related 2 0 I 2 1 2 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 2 12 1 6 -1 -6
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 2 12 0 -2 -12
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 5 26 8 18 3 -8
Current Fixture Value -8 divided by 16= -0.500 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -8 divided by 16= -0.500 over (under) $ (3,042.50)
Enter EDU Change Here -0.500 *
*Round EllUs 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: BRANDEN TAGGART X2449 Date: 10/31/2022
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\Sewer PallySh eet_6085_070121.xlsx
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00213
Ti G A 11 Ti.) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/1/2022
Parcel: 1 S136DD03800
Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Project: Mountainwood Homes office Tenant Improvement Subdivision: WEST PORTLAND HEIGHTS Lot: 4-8&27
Project Description: Bathroom remodel:capping(5)fixtures,adding:(1)dishwasher,(1)drinking fountain,(2)floor drains,(1)primer,
(3)sinks and(3)water closets.
Contractor: CRAFTWORK PLUMBING INC Owner: TANGLEWOOD DEVELOPMENT LLC
7939 SW CIRRUS DR BLDG 23 ATTN WOOD, ROBERT
BEAVERTON, OR 97008 8324 SW NIMBUS AVE
BEAVERTON, OR 97008
PHONE: 503-644-8698 PHONE:
FAX: 503-644-5989
FEES
Quantity Description Date Amount
1 ea Dishwasher 07/01/2022 $25.02
Specifics: 1 ea Drinking Fountain 07/01/2022 $25.02
5 ea Fixture/Sewer Cap 07/01/2022 $125.10
Type of Use: COM 2 ea Floor Drain/Floor Sink/Hub 07/01/2022 $50.04
Class of Work: ALT 1 ea Primer 07/01/2022 $12.51
Type of Const: 3 ea Sink 07/01/2022 $75.06
Occupancy Grp: 3 ea Water Closet 07/01/2022 $75.06
Stories:
1 12%State Surcharge- 07/01/2022 $46.54
Plumbing
Total $434.35
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: Permittee Signature:
aki,Q) QC\VVOCt
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 ai
Building Fixtures RECEIVED 1-0u oii I( 1. 1 SI O\I.I
Cityof Tigard i V 2 q qq Received
g F' I L�LL Date/11 g O� Permit\';, pi_01 a,4a a3
N -a 13125 SW Hall Blvd.,Tigard-OR 97223 Plan Re.ics,
1 II Phone: 503.718.2439 Fax: 503 598.1 other Permit No
t1Y OF TIGARD Date It,
Inspection Line: 503.639.d175 - -------
T I G A R D n `'n bate Ready Its 7„rn HI See Page 2 for
Internet ww�s.tigard-orgov t DING DIVISION '`Denied\IctIad Trier
��IL ll� �1 Supplemental Information
TYPE OF WORK FEE* SCIIEDULE
El New construction 0 Demolition Fore'cial in Urination use checklist
Description I Qt -1 tel
®Addition/alteration/replacement ❑Other. New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling • ®Cornmercialuindustrial SFR(2)bath 437.78
SFR(3)bath
❑Accessory building 0 Multi-family 500.32
---� _ Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:11675 SW 66th Ave. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard, OR 97223 Footing drain(no.linear It.:,) Page 2
Suite/bldg./apt.no.: Project name:Mountainwood Homes new office 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:
Fax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Office space and bathrooms remodel
Dishwasher 1 25.02 aSeoa
Drinking fountain 1 25.02 a5,61.,
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 5 25.02 lay)O
Floor drain/floor sink/hub 2 25.02 ,O$
Address:
Garbage disposal 25.02
City/State✓ZII' Hose bib 25.02
Phone:( ) I as:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: ,, 5 ,.,, -� Medical gas(value:$ ) Paget
1'(l0 _ C �1 W, 1`� Primer 1 12.51 ,a,si
Contact name: Roof drain(commercial) 12.51
Address. _ - -Sink/basin/lavatory 3 25.02 75,a("
City/State/ZIP: Solar units(potable water) 62.54
Phone:( 1 Fa. ::( ) Tub/shower/shower pan 12.51
E-mail: J Urinal 25.02
Water closet 3 25.02 75.E
CONTRACTOR
Water heater 37.52
Business name:Craftwork Plumbing, Inc. Water piping/DWV 56.29
Address:7939 Sw Cirrus Drive Other: 25.02
City/State/z.IP:Beaverton, OR 97008 Subtotal
Phone:( 503.1644-8698 Fax:( 503 644-5989 Minimum permit fee: S72 50 _
Plan review (25°'e or permit fee)
CCB tie.:79666 Plumbing Lic.no.:20-148PB
State surcharge(12%of permit fee)
•
Authorized signature: TI ll AI PERMFF FE:E 437*.35
Print name:Arron elso Date:5/2/22 This permit application expires if a permit is not obtained within 130 days
after it has been accepted as complete.
*fee rtrethodologs set b}Trid•ounts Building industry Service Board
tlBuiidmg,Permits5Pl.MU-PermitApp.doe 10/01/09 440-4616T(10/02/COMtWEn1
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: _
looting drain- I' 100' 50.03 0 to 2,000 $121.90
60Footing drain-each additional 100' 37.522,00 to 3, 0O $169.69
3,601 to 7,200 $233.20
Sewer- 1st I00 62,54 7,201 and greater $327.54 _
Sewer-each additional IOU' 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 10O'. 62.54 $1 00 to$5,000 00 Minimum lee$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
Qt . Fee(ea) l otaf each additional$100.00 or fraction thereof.to
Other Inspections or Fees and including$10,000.00.
Inspection 01 cvi,ting plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no tee 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 $25,00 1.00 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-- 12 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
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive fhru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
ntiash Cp ial ❑ Any multipurpose fire sprinkler system.
DConine-Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain ,t
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" 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/Refrig Drains Comments regarding fixture work:
Oil Separator IGas Station)
Rec.Vehicle Dump Station
Shower. -Gang
-Stall
Sidk: -Lav/Bar non-food related 1 1 2
-Bradley
-Com/Serv/Util food related
-Service *Note: lithe 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 lixtntetor
Water Closet-Toilet 2 1 2 plumbing permit can he issued.
Urinal 2
Other Fixtures.
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
_ Tenant Name: Mouintanwood
AHomccuesm ulative Sewer Tally SWR#
TlGARD
Site Address: 11675 SW 66th Ave PLM# PLM2022-00213
Parcel#: 1 s 136DD03800
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# valuc 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 1 2 1 2
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
-3inch 5 0 0 0 0 0
-4inch 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 g 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 1 2 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 2 12 1 6 -1 -6
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 2 12 0 -2 -12
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 5 26 4 11 -1 -15
Current Fixture Value -15 divided by 16= -0.938 Current EDU 1 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: 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:\Building\Sewer Tally\SewerTallySheet_6085_070121.xlsx
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