Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit#: PLM2022-00237
T I _�A 1?.t) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/1/2022
tr.;
Parcel: 2S112DD00701
Jurisdiction: Tigard
Site address: 15812 SW UPPER BOONES FERRY RD
Project: Sleep Metrics Systems Subdivision: None Lot: None
Project Description: Capping(1)sink adding(1)sink
Contractor: POWER PLUMBING CO Owner: PACIFIC REALTY TRUST
PO BOX 19418 ATTN: N PIVEN
PORTLAND,OR 97280 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 07/01/2022 $25.02
Specifics: 1 ea Sink 07/01/2022 $25.02
1 12%State Surcharge- 07/01/2022 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 07/01/2022 $22.46
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $81.20
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: f/1/10.7u2v)CA 04 Permittee Signature: Epp 'Celt\ G11
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 ApplicatiEI ` 0
Building Fixtures NAY 2 a 2022 FOR OFFICE USE ONLY
City of Tigard Received
° Date/By: �J!/�a/� ��) Permit No.: Lenadja -,jf ja,s1
13125 SW Hall Blvd.,Tigard,OR 9n11 Y OF TIUAHt1 r
t Plan Review
8 Phone: 503.718.2439 Fax: 503.59 �Q oQ Oilier Permit No.:
WILDING DIVISIQ�` Date
Inspection Line: 503.639.4175 y ) B! Sce Pngc 2 for
TIC7ARD Internet: vv'tigard•or.gov Notcie
Notified/Method: Supplemcnlnl Information
TYPE OF WORK FEE'' SCIIEDULE
❑New construction ❑Demolition Forffecial in orinalion use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement II Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-flmil dwellin SFR(2)bath 437.78
❑ y b ®Commercial/industrial
0 Accessory building ❑Multi-family SFR(3)bath 500.32
-
- ---------------- Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15812 SW UPPER BOONES FERRY RD Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:LAKE OSWEGO, OR 97035 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:22-597 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
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
SLEEP METRIC SYSTEMS INC. TENANT IMPROVEMENT Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER _r 0 TENANT _ Expansion tank 12.51
Name: Fixture/sewer cap 1 25.02 rr7,c.•
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
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: MIKE WARREN
--- Roof drain(commercial) 12.51
Address. P.O. BOX 19418 sink/basin/lavatory 1 25.02 35 aa.
City/State//il': PORTLAND, OR 97280-9418 Solar units(potable water) 62.54
Phone:( 503-244-1900 Fax::( 503-244-8825 Tub/shower/shower pan 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:POWER PLUMBING CO. Water piping/DWV 56.29
Address:6611 SW MULTNOMAH BLVD Other: 25.02
City/State/ZIP:PORTLAND, OR 97223 Subtotal ,i3.m.('`+
Phone:( 503-244-1900 Fax:( 5031-244-8825 Minimum permit fee: $72.50
CCI3 Lie.:52378 Plumbing Lie.no.: 34-1 QPB Plan review (25%ofpennit fee)
Authorized signature:C f State surcharge(12%of permit fee)
1 f I'�^ta+Z e R lZC �' TOTAL PERMIT PEE 3 t...ao
Print name:KRISTIE BRAMWELL Date:5-23-2022 This permit npplicntion expires if a permit is not obtained within 180 drys
after it has been accepted as complete.
"Fee methodology set by i'ri•County Building Industry Service Board.
1;Mudding\Permits\Pt 1IU-Peurui Apo.doe 10'01/09 440-4616T(10102/COMINeE'D)
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 $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/br 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 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 Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR9 18-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -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(Gas Station)
Rec.Vehicle Dump Station PLEASE CALL MIKE WARREN WITH QUESTIONS 503-936-5929
Shower: -Gang
-Stall
Sink: -Lae/Bar non-food related t t
-Bradley
-Coo/Sere/Util food related
-Service *Note: if the fixture work under this permit results in an
Swimming Pool Filter increase of sewer Mills,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:\1Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
ccumulative Sewer Tally
i Tenant Name: Sleep Metric SystemsA SWR#
Site Address: 15812 SW Upper Boones berry Rd PLM# PLM2022-00237
1I(iARD
Parcel#: 2S112DD00701
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 0 0 0
-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
I
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 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 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 1 2 1 2 0 0
Current Fixture Value 0 divided by 16= 0.000 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 0 divided by 16= 0.000 over (under) S -
Enter EDU Change Here 0.000 *
*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: y
Authorized Name/Signature: ,,f) CIP P Date: ///'/r c�
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