Permit CITY OF TIGARD PLUMBING PERMIT
11 COMMUNITY DEVELOPMENT Permit#: PLM2022-00439
Date Issued: 10/26/2022
T EGARL 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 23101AA07600
Jurisdiction: Tigard
Site address: 12540 SW 68TH AVE
Project: Connect Physical Therapy Subdivision: WEST PORTLAND HEIGHTS Lot: 18
Project Description: Interior plumbing for TI:Capping(2)sinks and(1)water closet; Replacing(1)garbage disposal,(1)ice maker,
(6)sinks,and(2)water closets.
Contractor: LOCAL PLUMBING COMPANY Owner: H2S2 ENTERPRISES LLC
20833 SW OLDS PL 12540 SW 68TH AVE
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503-642-2067 PHONE:
FAX: 503-642-5954
FEES
Quantity Description Date Amount
3 ea Fixture/Sewer Cap 10/26/2022 $75.06
Specifics: 1Disposal
ea Garbage Dis 10/26/2022 $25.02
1 ea Ice Maker 10/26/2022 $12.51
Type of Use: COM 6 ea Sink 10/26/2022 $150.12
Class of Work: ALT 2 ea Water Closet 10/26/2022 $50.04
Type of Const: 1 ea Water Heater 10/26/2022 $37.52
Occupancy Grp: 1 12%State Surcharge- 10/26/2022 $42.03
Stories: Plumbing
Total $392.30
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 Application
Building Fixtures FoR oii►ci: USE ONLY
City of Tigard RECEIVE R eivy: to `� a� PermitNo.: �,M �1.1.�`�(4�r}
;1 ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan R LII `4 , ✓�''' ` L 1
11 a Review
Phone: 503.718.2439 Fax: 503.598.1960 OCT i) 2022 Date/By, /V Other Permit No.:J#/wp20 �klx-�
Inspection Line: 503.639.4175 fi Date Read/B 1 1�: ® See Page t2 for
TIGARD Internet: www.ti and-or. ov _il icii y Y ` /9 -' Supplemental P> g - ( r. - Notified/Method: Q /. Su lemental Information
TYPE OF WORK i3ulWlnin nmsinN J art. FEE* SCHEDULE
❑New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(inch ides 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑ Multi-family
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:12540 SW 68th 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 ft.: ) Page 2
Suite/bldg./apt.no.: Project name:Connect Physical Therapy 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.: O'S j e I���l(p Backflow preventer 31.27
DESCRIPTIONI OF WORK Backwater valve 12.51
Clothes washer 25.02
Plumbing for TI Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 3 25.02 75.06
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 1 25.02 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 1 12.51 12.51
la APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Local Plumbing Co. Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Brandy Solano Roof drain(commercial) 12.51
Address:20833 SW Olds Place Sink/basin/lavatory 6 25.02 150.12
City/State/ZIP:Sherwood, OR 97140 Solar units(potable water) 62.54
Phone:(503)462-2067 Fax::(503 )642-5954 Tub/shower/shower pan 12.51
E-mail: brandys@localplumbingco.com Urinal 25.02
Water closet 2 25.02 50.04
CONTRACTOR
Water heater 1 37.52 37.52
Business name:Local Plumbing Co. Waterpiping/DWV 56.29
Address:20833 SW Olds Place Other: 25.02
City/State/ZIP:Sherwood, OR 97140 Subtotal 350.27
Phone:(503)642-2067
Fax:(503)642-5954 Minimum permit fee: $72.50
CCB Lie.: 72253 Plumbing Lic.no.:34-197PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) 42.03
Authorized signature: TOTAL PERMIT FEE 392.30
Print name:Brandy Solano Date:10/26/22 This 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.
1:i Building\Permits'PLMU-PemdtApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
1
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
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty. Fee(ea) Total
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.
lnspe.lions 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 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
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stag ❑ New exterior plumbing site utilities for any complex structure
Drive Thnt as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ElMedical 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"
3 Isometric or Riser Diagram
0 Isometric or riser s
r dia am is required for new buildings
-Car Wash Dram �' q g
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: -IavBar non-food related 2 s
-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 t 2 plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2
111 Accumulative Sewer Tally
Tenant Name: CONNECT PIIYSICAL THERAPY SWR# N/A
r 1 ti t Site Address: 12540 SW 68TH AVENUE PLM# 2022-00439
Parcel#: 2S101AA07600
Fixture 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 I IP) 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 I
Sink:
-Lav/Aar-Non-Food Related 2 0 2 4 0 -2 -4
-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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 3 10 0 0 -3 -10
Current Fixture Value -10 divided by 16= -0.625 Current EDU 1 EDU= $6,625.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -10 divided by 16= -0.625 over (under) $ (4,173.75)
Enter EDU Change Here -0.630 *
*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: BRANDEN TAGGART 3C2449 Date: 10/26/2022
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\SewerTallyShect_6625_070122.xlsx