Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00338
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/1/2022
Parcel: 1 S136DC04600
Jurisdiction: Tigard
Site address: 7255 SW DARTMOUTH ST
Project: Planet Fitness Subdivision: 1995-013 PARTITION PLAT Lot: 3
Project Description: Interior plumbing for TI:Capping(1)drinking fountain, (2)floor drains/sinks,(6)sinks, (3)water closets,and(2)
urinals;Adding(1)drinking fountain, (6)sinks,(6)showers,(8)sinks,(7)water closets,and(2)urinals.
Contractor: RECON INC DBA MANZCO PLUMBING Owner: COMMERCIAL NET LEASE REALTY, INC
PO BOX 822964 450 S ORANGE AVE,STE 900
VANCOUVER,WA 98682 ORLANDO, FL 32801
PHONE: 360-772-8149 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 09/01/2022 $25.02
Specifics: 2 ea Fixture/Sewer Cap 09/01/2022 $50.04
6 ea Floor Drain/Floor Sink/Hub 09/01/2022 $150.12
Type of Use: COM 8 ea Sink 09/01/2022 $200.16
Class of Work: ALT 6 ea Tub/Shower/Shower Pan 09/01/2022 $75.06
Type of Const: 2 ea Urinal 09/01/2022 $50.04
Occupancy Grp: 7 ea Water Closet 09/01/2022 $175.14
Stories: 6 ea Water Heater 09/01/2022 $225.12
1 12%State Surcharge- 09/01/2022 $114.08
Plumbing
Total $1,064.78
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 y to fol w the rules adojted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yo ay ob in a cop of the rules
Issued By: Permittee Signature:
r7
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 1oR onFici LSE ONL1
Cis,of Tigard Received
`, g a t.Rev ,. Permit No.: l
11111 III 13125 SW Hall Blvd.,Tigard,OR 97223RECEIVE �. V 3d/% "� �0��y
96 � �Review
Phone: 503.718.2439 Fax: 503.598.1 0 Date/By, N OtherPermit No.: ® ."�j 7
brspectiou Line: 503.639.4175 AUG 3 0 2022 /� r
i"1GARD Internet: www.ti xrd-or, ov DatiRe/Metho See Page or
g g Notified/Method: / ,/I Supplemental Information
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❑New construction ❑D€UI4i9ING DIVISION For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
-"• r a u7e 3 k ' e
,r .; s.. a"§# ., ha,-- ., at :__ _ :fin SFR(1)bath 312.70
is
ID1-and 2-family dwelling p Commercial/industrial SFR(2)bath 437.78
❑Accessory building El Multi-family
SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
�'t " - a 3 " �c Isnt i 1;.
Fire sprinkler(_sq.ft.) Page 2
a , .....� a 1 i` Ala
abite utilities:
Job site address: -7 2 55- S L.,,.../ lDa,-.�trwt��.�k 5 T Catch basin or area drain 18.76
City/State/ZIP: /2'L 3 Drywell,leach line,or trench drain 18.76
�(9nr O{Z- Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I/Project name: 7p �in.{ '�
� /
1'T yye S S 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:
Tax map/parcel no.: 0 is ' A , ',- ., Backflow preventer 31.27
€ ` CQ - Backwater valve 12.51
,t4•.,, tt lN ]J .. S She.,.. -
lc
f n v t_ Clothes washer 25.02
(A)C. ( - IA R` C S Dishwasher
25.02
2 i i c J i 6 'c0 aCr+elf eI Ly 6/ I 0 fr Drinking fountain 25.02 ,25--,,
Ejectors/sump 25.02
maw ' "�`" SrL. e t. w ..a a -i...... , a... ate', � /:r r, Expansion rank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 6 25.02 ,r a
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
" .:;'S
u 4y` ._. fig Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Contact name: Primer 12.51
Roof drain(commercial) y2 12.51
Address: Sink/basin/lavatory ,�L 25.02 4d0.6(o
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan (Q 12.51 -,s-. ,
E-mail: M'l r 4 gy�ZL� ` � Urinal 25.02 J,tt1-t
PRIV _ _ , .m +t wu z , � xt.i Water6'w' I 25.02
"' Water heater (,p 37.52c ji
Business name: Mgh-2_ZO PA4H1 1)/N Water g/r m DWV 56.29
P P
Address: -U 6,e,I( ; 2 9G.yA Other: 25.02
City/State/ZIP: (Jplei �,i4✓..- I,'H 9 dG L Subtotal y 7,
Ste►.
Phone:(36,a)77 2 t_J/C.f Fax:(540) e, - y S 5 / Minimum permit fee: $72.50
Plan review (25%of permit fee)
t�/ 'CCB Lic.: / ' 3/y Plumbing Lic.no.:*/5 5 2 3
� am�� 7/ /' State surcharge(12%of permit fee) iiii,(f'
Authorized signature: TOTAL PERMIT FEE idol'7;
Print name: Gt/t (Jc-/ Z/4 vs s-- Date: 8730/2 2 This permit application expires if a permit is not obtained wit in 180 days
after h has been accepted as complete,
*Fee methodology set by Tri-County Building industry Service Board.
tlBalding\Permits\PLMU.-PermitApp.doe 10'01/09 440-4616T(10H12/COMIWE13)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su r r ression S stems:
'`3 'sf _ ' �Eti3 iTK"•, k�1 2� E1Y13s'J;trk lv ': LrAriltf� f2a
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-1st 100' 62.54 7,201 and?eater $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 ' ,. e 1 � ._,lam
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
fri4r'�i%�i e`jI):0-1 rs0?3`' "`� :ryr't ' '� Fr ) each additional$10000orfractionthereof,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 char_e-1/2 hour and including$25,000.00.
Inspections outside of normal business - 90.00Ru - $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours minimum char e-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 there-1/2 hour each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
r c 5"o r>• sac Y h= .°
accurately report fixtures could result in increased sewer fees* i.+ T ; };sw ,x,,4. cia i;j oar rr_�otat-t,_r I } 4
"d" QdsutitytbyiF' bra J e..r.+%' Plan review is required for any of the following.
Ftxt re"I'y re40r ,+�$ £ ;rkpt3 ii?, Please check all that apply.
�'iVd'ItPerfoF iedi cap5ed „ns t Sq:.,Rkloeete-
Baptistry/Font El Any new commercial building with water service 2"and
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
Drive as defined in OAR9I8-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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" v (1._
q�
4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the •ualifications 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: - av/Bar non-food related (Fr
-Bradley
-Com/Serv/lltil food related '2-
-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 lumbin permit can be issued.
Water Closet-Toilet 3 �( P g
Urinal i.- L-
Other Fixtures:
I:1Building\Permits\PLMF_PermitApp.doc 08/04/201 I 2