Permit CITY OF TIGARD PLUMBING PERMIT
2: COMMUNITY DEVELOPMENT.°111 Permit#: PLM2022-00477
Date Issued: 12/2/2022
T I G A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S136DC04600
Jurisdiction: Tigard
Site address: 7255 SW DARTMOUTH ST
Project: Planet Fitness Subdivision: 1995-013 PARTITION PLAT Lot: 3
Project Description: Installing 2 sanitizer dispensing units.
Contractor: WILLIAMS MECHANICAL INC Owner: COMMERCIAL NET LEASE REALTY, INC
3903 SMITH AVE 450 S ORANGE AVE, STE 900
EVERETT,WA 98201 ORLANDO, FL 32801
PHONE: 425-303-0828 PHONE:
FAX: 425-339-9244
FEES
Quantity Description Date Amount
50 Misc Other Fee 11/29/2022 $50.04
Specifics: 1 12%State Surcharge- 11/29/2022 S8.70
Plumbing
Type of Use: CMS 22 ea Minimum Fee Adjustment- 11/29/2022 $22.46
Class of Work: ALT Plumbing
Type of Const:
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: j/l^nw ( �yJ �1 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 OFFICE USE ONLY
City of Tigard Received
.\ g Permit No..-.I�11 ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: (� ,`J . '�(_/1' G �jl.��7
Phone: 503.718.2439 Fax: 503.598.1960 Date By Plan Review
Other Permit No.:
T I(;A R ri Inspection Line. 503.639 4175 Date Ready/By: ruris: IZ See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. [ Ea. I Total
®Addition/alteration/replacement 0 Other: New I-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
0 Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(-sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:7255 SW Dartmouth St Catch basin or area drain 18.76
Diywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard, OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Planet Fitness 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.:P2192126 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Install (2)sanitizers. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
21 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Planet Fitness Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:4 Liberty Ln W Garbage disposal 25.02
City/State/ZIP:Hampton, NH 03842 Hose bib 25.02
Phone:(844)880-7180 Fax:( ) Ice maker 12.51
❑ APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Williams Mechanical, Inc. Medical gas(value:$-) Page 2
Primer 12.51
Contact name:Marc Coalwell
Roof drain(commercial) 12.51
Address:3903 Smith Ave Sink/basin/lavatory 25.02
City/State/ZIP:Everett, WA 98201 Solar units(potable water) 62.54
Phone:(425 )754-6908 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:info@williams-mechanical.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Williams Mechanical, Inc. Waterpiping/DWV 56.29
Address:3903 Smith Ave Other: Sanitizer 2 25.02 50.04
City/State/ZIP:Everett, WA 98201 Subtotal 50.04
Phone:(425 )303-0828 Fax:(425 )339-9244 Minimum permit fee: $72.50 $72.50
CCB Lie.: 126975 Plumbing Lic.no.:37-424PB Plan review (25%of permit fee) �&1-3'
State surcharge(12%of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE $99.86'
Print name:Justin Williams Date:10/31/2022 Thus permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete. Q"I
"Fee methodology set by Tri-County Building Industry Service Board. vO
1'.1Budding\PermJs\PLMt1-PermitApp.doc 10/01/09 440.4616T(10/02/COMIWEB)
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
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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 S72.50
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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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 0 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related
-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 fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
_Water Closet-Toilet
Urinal
Other Fixtures:
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