Permit (2) IN CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00214
TIGAR_D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/16/2022
Parcel: 2S103DD00850
Jurisdiction: Tigard
Site address: 13815 SW PACIFIC HWY 50
Project: Avalon Massage Tenant Improvement Subdivision: None Lot: None
Project Description: Adding:(1)clothes washer,(1)sink and(1)water heater.
Contractor: LOTUS PLUMBING COMPANY Owner: D W SIVERS CO
8100 SW ELMWOOD ST 4730 S MACADAM AVE#101
PORTLAND, OR 97223 PORTLAND, OR 97239
PHONE: 503-522-2728 PHONE:
FAX: 503-892-2639
FEES
Quantity Description Date Amount
1 ea Clothes Washer 06/15/2022 $25.02
Specifics: 1 ea Sink 06/15/2022 $25.02
1 ea Water Heater 06/15/2022 $37.52
Type of Use: COM 1 12%State Surcharge- 06/15/2022 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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: i� 4 )vi/ Permittee Signature: S ,
I
I
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 E E I V F 6
Building Fixtures ®Apq� ry roiz tlrrIcE 1 S1. O'\l.\
of Tigard
MAY 1 0 2022 Received c.1 permit No.: j
City g Date/By: ��R dp.A.-<a t'1
;� + 13125 SW Hall Blvd.,Tigard,OR 97223 if Y OF 1IGARt Plan Review ,
I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: "j,,,R`; r ,..r>r ,•"7a.
Inspection Line: 503.639.4175 ,I L.,D I N G MIS.I n e. Date Ready/By: 1 ® See Page 2 for
f I�;A IL[� Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE' SCHEDD
❑New construction ❑Demolition For special information use checklist
Description Qty. I Ea. Total
[ Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION" SFR(1)bath 312.70
El1-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:
Catch basin or area drain 18.76
Job site address: [�
�� ( •��` `- C\l�v C 'k-' ,, A Drywell,leach line,or trench drain 18.76
City/State/ZIP: "'�\ C--(-CA. �C� . 1:: ---". 1:: --- Footing drain(no.linear ft.: ) Page 2
(ur t 1dg./apt.no. l Project name: ..-Ps\j a t ')('\ ti��C e, 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: ( Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK ��
Clothes washer 1 25.02 �
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 1 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02 •
Phone:( ) Fax:( ) Ice maker 12.51
[ya APPLICANT VS CONTACT PERSON Interceptor/grease trap 25.02'
Medical gas(value:$ ) Page 2
Business name: -V.N^v\ or cx c
Lotus Plumbing Company Primer 12'51
Contact name: Roof drain(commercial) 12.51
Address: 8100 SW Elmwood St. ,ma's
Portland, OR 97223 Sink/basin/lavatory zs.oz �
City/State/ZIP: Solar units(potable water) 62.54
503-522-27?8
Phone:( ) C C 8# 1894 tx: :( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: 1 c' :�a i-�10t�-Ili, , C.:'Clr..C..� C",------
Water closet 25.02
CO OR • Water heater 1 37.52
31
Business name: Water piping/DWV 56.29
Address: Lotus Plumbing Company Other: 25.02
City/State/ZIP: 8100 SW Elmwood St. Subtotal ' "} �
Portland, OR q.7aX2?�3 Minimum permit fee: $72.50
Phone:( ) 503 522 27Z8 ) Plan review (25%of permit fee)
CCB Lie.: O p ing Lic.no.: �t -1
CCB# 1$,.4r'�� b" State surcharge(12%of permit fee) 10'
Authorized signature: c ',. , TOTAL PERMIT FEE i G,��Print name: Z.-t Lc: \� Date:�4`�1 - This permit application expires if a permit is not obtained within 180 days
!l � `� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
`p 3
1:\Building\Permils\PLMU-Permi[App.doc I0/01/09 440-4616T(10/02ICOM/WEB)
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 r 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-Ist 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
Qty: Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Feesand 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
Cuspidor/Water Aspirator0 Medical gas and vacuum systems for health care facilities.
C W Dishwasher: -Commercial El Any multipurpose fire sprinkler system.
0 Any complex structure as defined in OAR918-780-0040.
-Domestic
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 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
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related i
-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 1 fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:L..Jc ., �k (
1:\Building\'ermits\PLMF_PermtApp.doc 08/04/2011 /..50 & y
." IR
Tenant Name:Avalon Massa
gAe ccumulative Sewer Tally SWR# SWR2022-00072
TIGARD Site Address: 13815 SW Pacific Hwy PLM# PLM2022-00214
Parcel#: 2S103DD00851
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 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3inch 5 0 0 0 0 0
-4inch 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 HP) 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
Sink:
-Lav/Bar-Non-Food Related 2 0 0 1 2 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 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 2 8 2 8
Current Fixture Value 8 divided by 16= 0.500 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 8 divided by 16= 0.500 over (under) $ 3,042.50
Enter EDU Change Here 0.500
*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:
Authorized Name/Signature: / i z. A Date: (�,7)1 ,,�;),
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\SewerTallySheet_6085_070121.xlsx