Permit CITY OF TIGARD PLUMBING PERMIT
e COMMUNITY DEVELOPMENT Permit#: PLM2022-00420
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/15/2022
Parcel: 1 S 126CC00200
Jurisdiction: Tigard
Site address: 10069 SW CASCADE AVE
Project: Tesla shell only for future showroom Subdivision: None Lot: None
Project Description: Site utilities for a new 4,757 Shell building.
Contractor: MESA CONTRACTING Owner: 10065 SWC LLC
20152 SW ROY ROGERS ROAD BY ALSTON & BIRD LLP
UNIT 215 BANK OF AMERICA PLAZA
SHERWOOD, OR 97140 101 SOUTH TRYON ST STE 4000
CHARLOTTE, NC 28280
PHONE: 971-224-4848 PHONE:
FAX:
FEES
Quantity Description Date Amount
12 ea Catch Basin or Area Drain 11/14/2022 $225.12
Specifics: 2 ea Manholes 11/14/2022 $37.52
201 If Sanitary Sewer 11/14/2022 $137.58
Type of Use: COM 1077 If Storm Sewer 11/14/2022 $437.74
Class of Work: ALT 247 If Water Service 11/14/2022 $137.58
Type of Const: 1 ea Backflow Preventer 11/14/2022 $31.27
Occupancy Grp: 1 ea Roof Drain(Commercial) 11/14/2022 $12.51
Stories: 1 Plan Review 11/14/2022 $254.83
1 12%State Surcharge- 11/14/2022 $122.32
Plumbing
Total $1,396.47
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 s a ed by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You a obtain a opy oft rules
Issued By: _ Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available insI%4ction 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.
w
Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLY
City of Tigard Received 1 Permit No.:
48 13125 SW Hall Blvd.,Tigard,OR 97 Datellly. ��l 1 '�// �` ""� �"'P"�
`' Plan Review r1 /� /
Phone: 503.718.2439 Fax: 503.598 GENE DateBy: i,/y/� NI") aherPermit No.: y�10��,��/16
i l G A R D Inspection Line: 503.639.4175 „ Date Ready/By r[K/^ Qom_ Jam. ® See Page 2 for
Internet: www.tigard-or.gov 61{T 1 - Try±2 r' Notified/Method �'I 1l.1.',/ '.t'.!/I / !� Supplemental Information
TYPE OF WORK �. �, Avil. ,�,,,�,ts r{.1`'14;./,..:.. FEE* SCHEDULE
Y J For special information use checklist.
®New construction ❑De 1no �,VISIQrI
�(Ii1VG Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑ er: 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 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
��51 JOB SITE INFORMATION AND LOCATION Site utilities:
Jobsiteaddress:1.10065 SW Cascade Ave Catchbasnorazeadran 12 1s.76 225. 12
Drywell,leach line,or trench drain 18.76
v City/State/ZIP: Tigard OR 97223
La Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: T e S 1 a Manufactured home utilities 50.03
-:'J Cross street/directionstojobsite: South on SW Cascade Manholes 2 18.76 37 . 52
coming from SW Scholls Ferry Road Rain drain connector 18.76
71 Sanitary sewer(no.linear ft:_1 2 01 Page 2 137 .5E
Storm sewer(no.linear ft.: ) 1 077 Page 2 437 .74
Water service(no.linear ft.: ) 247 Page 2 137 .58
���,������ Subdivision: I Lot no.: Fixture or Item:
,., Tax map/parcel no.: 1 S 12 6CC-2 0 0 Backflow preventer 1 31.27 31 .27
N Backwater valve 12.51
DESCRIPTION OF WORK
Clothes le.. 1 New storm system, sanitary sewer and washer 25.02
Dishwasher 25.02
13 water system for a new outparcel building Drinking fountain 25.02
. .. _ Ejectors/sump 25.02
( •••- l ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
.'". ., Fixture/sewer cap 25.02
4 Name: Benderson Development Company, LLC
Floor drain/floor sink/hub 25.02
ddress: 570 Delaware Ave
Garbage disposal 25.02
City/State/ZIP: Buffalo, NY 14202 Hose bib 25.02
V Phone:(716) 8 7 8-9 3 9 7 Fax:( ) Ice maker 12.51
0 APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name: Benderson Development Company, Medical gas(value:$ ) Paget
Primer 12.51
Contact name: Matthew Oates, P.E.
Roof drain(commercial) 1 12.51 12 .51
Address: 570 Delaware Ave ytl an : n . ..�r --.02
- City/State/ZIP: Buffalo, NY 14202 Solar units(potable water) 62.54
� Phone:(716) 878-9397 Fax::( ) Tub/shower/shower pan 12.51
.*E-mail: mattoates@benderson.com Urinal 25.02
CONTRACTOR 1 25.02 2 5. 2 pu if I,
waater heater 7 37 Cl 37 . 52
�Businessname: �e�`,r `/.. A.i.z 1/-1 Water pipingfDWV 56.29 14130
Address: r C)r S..1 � Other: 25.02 8 T
City/State/ZIP: ,Si ,v- .c 71u' /c4e e j p Subtotal /0/ci.3
Minimum permit fee: $72.50
Phone:(etn) 21 ttfKir Fax:( ) Plan review (25%of permit fee) D, 5W, 7
CCB Lie.: el ei lq �( Plumbing Li
fa'"�{,t U�� State surcharge(12%of permit fee) J - 3.,,2
Authorized signature:l -xf / / TOTAL PERMIT FEE ; '!t-.4 7
Print name: u/e j, �� `�R?T �J p Date: 10 /y/,� This permit application expires if a permit is not obtained within 180 days
�_l ` f after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:tBuildingWermitslPt.MU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
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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 fce 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 rust$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*.
Quanti by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath Tub/Shower El Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thm ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter g
Washer-Clothes Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU_PetmitApp.doc 2
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• Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional,drawn
to scale) labeled with:
A. ❑ map&tax lot# El project name ❑ site address ❑ suite number
❑ zoning 0 applicant name El phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS - Two (2) complete sets,civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size. I
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) ' Sanitary sewer line location,pipe size, type of material, slope of piping,manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:1Building\Permits\PLMF-PermitApp.doc 12/30/05
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Permit Advisors TRANSMITTAL
LIVE .
SEP 12 202Z
October 4, 2022
uITY OF TIGARD
WILDING DIVISION
FROM: TO:
Alex Raymond City of Tigard Permit Center
Permit Advisors 13125 SW Hall Blvd.
3001 Bishop Drive #300 Tigard, OR 97223
San Ramon, CA 94583 503-718-2439
RE: Tesla - Plumbing Site Utility Permit Application
Project Address: 10069 SW Cascade Ave
Please find the following in the attached package:
• (3) Set of complete Civil plans
• (3) Sets of geotechnical reports
• (1) Permit application form
Should you have any questions or concerns, please feel free to contact me at (925)
858-1785 or email me at alex@permitadvisors.com.
Regards,
Alex Raymond
Permit Advisors 18370 Wilshire Blvd Suite 330 I Beverly Hills, CA 90212 1310.275.7774