Permit 1PermCITY OF TIGARD PLUMBING PERMIT
! 2. ' COMMUNITY DEVELOPMENT
it#: PLM2022-00428
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19/2022
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Project: Walen Construction Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 37
Project Description: Interior Plumbing for TI:CAPPING;(1)drinking Fountain, (1)2"floor drain,(1)lay,(3)water closets,and(1)urinal.
REPLACING;(1)commercial dishwasher,(1)2"floor drain,(6)lays, (3)water closets,and(1)urinal.
Contractor: ASSOCIATED PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 1827 ATTN: N PIVEN
GRESHAM, OR 97230 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-492-1922 PHONE:
FAX: 503-492-1923
FEES
Quantity Description Date Amount
1 ea Dishwasher 10/19/2022 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 10/19/2022 $25.02
6 ea Lavatories 10/19/2022 $150.12
Type of Use: COM 1 ea Urinal 10/19/2022 $25.02
Class of Work: ALT 3 ea Water Closet 10/19/2022 $75.06
Type of Const: 1 12%State Surcharge- 10/19/2022 $57.04
Occupancy Grp: Plumbing
Stories: 5 ea Fixture/Sewer Cap 10/19/2022 $125.10
1 ea Primer 10/19/2022 $12.51
1 ea Water Heater 10/19/2022 $37.52
Total $532.41
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:
1'1//A412.---,e,- ).-7
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.
Plu ml,in Permit A licati
BuilJing Fixtures CEIVE .` FOR OFFICE USE ON1.1
City of Tigard OCT 1 9 2022 Received t�fl jZ7 21 f F
w 13125 SW Hall Blvd.,Tigard,OR 97223Plan Riew
Date By. �(� �/h��
N . Phone: 503.718.2439 Fax: 503.59 i OFTIGAHU Date/BY i' a 2-2--190 Ic
C.---
Inspection Line: 503.639.4175 BUILDING
I I DING �IVI S I() early y `O!/5� /L�( 63 See Page 2 for"PIGARD DateR /B -,14 Jan,:
Internet: www.tigard-or.gov otified/hiethod: Supplemental Information
TYPE OF WORK / „ �ar� FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
NIAddition/alteration/replacementOther: Description I QtY. I Ea. I Total
ieP 0New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling KCommerciaUmdustrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bathfldtchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION7 AND LOCATION + Site utilities:
Job site address: .((„(O�W 7 l pi, /n } f d a.ft Catch basin or area drain 18.76
City/State/ZIP: tyJ{ + �\� ��2�� Drywall,leach line,or trench drain 18.76
D Y 1ra , t Footing drain(no.linear R: ) Page 2
Suite/bldg./apt no.: Project name: W 0..5Qft. 5 Csh CC( 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.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
te.Y►W o-t- 6 E Ppxic 2- ILtt,t(ittjL ►"fir( Dishwasher ( 25.02
till 3 S ief ; 1.1,�r IIJ( i r wYl W.I 5'k1dfY, f,tfrk, Drinking fountain 25.02
c A (n* iiYt4 $(7114 f j- (f X tps -eoA �l/ry 14 Ejectors/sump 25.02
d PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixtltre/sower cap 25.02
Floor drain/floor sink/hub I 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
O/
A yy t_ a) C �� l Medical gas(value:S_) Paget
Business name: /
Contact name: Y Primer I. 12.51
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory CA 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal I 25.02
E-mail: (r(SSG� ,ox.\£(KetutVI6ihere y /alai) -CAr Water closet S 25.02
CONTRACYOR i .
1 f 1 Water heater 1 37.52
Business name: 04.6 CSC,Lt c..4 ,(��y;01t,lt� ( e Water tin WV 56.29
L�1U piping/DWV
(5 0 ,A i r-, G1,v-f, Other: 25.02
City/State/ZIP: (�1 .S 1^ti p( . ct--1 030 Subtotal
Phone:(S?rj)461,Z ' too,Z. Fax:(SU3) C{".-/- (c 2 3 Minimum permit fee: $72.50
CCB Lic.: Qc-7 /(/V2_
i PlumbingLic.no.:Z'-((.1�116
Plan review (25%ofpermit fa)
/' State surcharge(12%of permit fee)
Authorized signature: e/11J �_ TOTAL PERMIT FEE
Print name: L 1111'C`,,J r Date: ,` / This permit application expires if a permit is not obtained within 180 days
-To. _Ili Of Z after it has been accepted as complete.
V *Fee methodology set by Tri-County Building Industry Service Board.
1:1Building\Permits\PLMU-PermitApp.doc 10/01/09 440.4616T(10/011COM/WEB)
Plumbic 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 a 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/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
Quaoti 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 Pp y'
Baptistry/Pont ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure
-Drive tall as defined in OAR918-780-0040.
Cuspidor Water Aspirator 0 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" t
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: -Lay/Bar non-food related 1p
-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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet 43• S plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
IN a Tenant Name: WALEN CONSTRUCTION SWR# N/A
T 1 t_ l) Site Address: 16655 SW 72ND AVENUE PLM# 2022-00428
Parcel#: 2S113AC00101
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 1 1 0 -1 -1
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 1 2 0 -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 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 IIP) 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 I
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 1 2 0 -1 -2
-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 3 18 0 -3 -18
Urinal 6 0 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 7 29 0 0 -7 -29
Current Fixture Value -29 divided by 16= -1.813 Current EDU 1 EDU= S6,625.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -29 divided by 16= -1.813 over (under) $ (11,991.25)
Enter EDU Change Here -1.810 *
*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: JULIE DRINKWATER Date: 10/19/2022
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.
1:\Building\Sewer Tally\SewerTallySheet_6625_070122.xlsx