Permit CITY OF TIGARD PLUMBING PERMIT
1 a COMMUNITY DEVELOPMENT Permit#: PLM2022-00494
Date Issued: 1/10/2023
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: SAFEWAY#1478 Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Adding(1)floor sink and(1)hand sink for floral department.
Contractor: EVOLUTION PLUMBING LLC Owner: ROIC OREGON LLC
7210 NE 47TH AVE BY PROPERTY TAX RESOURCES LLC
PORTLAND, OR 97218 PO BOX 130339
CARLSBAD, CA 92013
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 12/12/2022 $25.02
Specifics: 1 ea Sink 12/12/2022 $25.02
1 12%State Surcharge- 12/12/2022 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 12/12/2022 $22.46
Type of Const: Plumbing
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:G�%� 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 - City of Tigard
Page 2 -Supplemental Information
Fec Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-I"100' 50.03 0 to 2,000 S121.90
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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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 naddittionclugal$1100.00�or fraction thereof,to
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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Ba tist Font Please check all that apply.
P ry
Bath -Tub/Shower CIAny new commercial building with water service 2"and
Jacuzzi Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thu ❑ 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 El Any multipurpose fire sprinkler system.
Drinking Fountain - _ El 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.
1•Feral _
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagramis required for new buildings
Garbage -Domestic-non-food B
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 n 5 f UU - 3 `Z1Z. 50
Shower -Gang V
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service 1-utility sink Oval
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
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:
1:1Building\Permits\PLMU_PermitApp.doc 2
Gary Gray
From: #Building Permit Technicians
Sent: Wednesday, December 7, 2022 11:00 AM
To: Chelsea Elford
Subject: RE: New - 15570 SW Pacific Plumbing App
Chelsea,
Your Permits are ready issue and your permit numbers are: PLM2022-00494 and SWR2022-00242. Below is the link to
pay the fees:
https://aca-prod.accela.com/TIGARD/Welcome.aspx
Please let us know when you have paid the fees so that we may prepare documentation ahead of permit pickup. If you
have any questions do not hesitate to reach out.
Best,
Gary Gray
City of Tigard
Permit Tech Asst.
III ..
a
lc;
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
From: Chelsea Elford <Chelsea.Elford@evoplumbing.net>
Sent:Wednesday,October 5, 2022 9:55 AM
To:#Building Permit Technicians<TigardBuildingPermits@tgard-or.gov>
Subject: New- 15570 SW Pacific Plumbing App
You don't often get email from chelsea.elford@evoplumbing.net Learn why this is important
Hello,
Please see the attached plumbing permit application.
Thank you,
Chelsea Elford
503-655-3388
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