Permit (5) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2023-00371
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 8/21/2023
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 215
Project: Sedgwick Subdivision:
Lot: 2
Project Description: Interior plumbing for TI: Capping(1)sink; Replacing(2)sinks and(1)hub drain; Installing(1)primer.
Contractor: ASSOCIATED PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES
PO BOX 1827 ATTN: N PIVEN
GRESHAM, OR 97230 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-492-1922 PHONE:
FAX: 503-492-1923
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 08/21/2023 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 08/21/2023 $25.02
1 ea Primer 08/21/2023 $12.51
Type of Use: COM 2 ea Sink 08/21/2023 $50.04
Class of Work: ALT
1 12%State Surcharge- 08/21/2023 $13.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $126.10
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
S.
Issued By: Permittee Signature:
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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.
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
Site Utilities Qty. Fee(ea) Total Square Footage: -`A ti a
p iFooting drain-I"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
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 I 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. FCC(ea) 'Total each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including the first$10,0 0.00.
which no fee is specifically indicated 90.00/hr
$10,001.00 to$25,000.00 each a 0 for first$10,000.00orfraction
and$1.54 for
(minimum charge—1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr and including the first 0.00.
hours(minimum charge—2 hours) $25,001.00 to$50,000.00 each$37 a 0 for first$25,000.00 and thereof,for
Reinspection Fees 90.00/hr each additional$100.00 or fraction to
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 0 Any new commercial buildingwith water service 2"and
Baptistry/Font
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial 0 Any multipurpose fire sprinkler system.
Domestic 0 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 -w,
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
IceMach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related / L
-Bradley
-Com/ServfUtil food related
Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter
washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures: Ale..., tire,;..,
I:BBuilding\Permits\PLMF_PermitApp.doe 08/04/2011 2
. Accumulative Sewer Tally
j Tenant Name: SEDGWICK CLAIMS MANAGEMENT SERVICES SWR# N/A
T I c;A It a Site Address: 6650 SW REDWOOD LANE 215 PLM# 2023-00371
Parcel#: 2S 112DA01400
Fixture Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Pont 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 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
-Stall 0
2 0 0
Sink: 0 0 0
-Lav/Bar-Non-Food Related 2 0 1 2 0 -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 0 0
0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0
Urinal 6 0 0
0 0 0 0
Previous EDU Count 0
0
Capped F,DU Credit
0
TOTALS 0 0 1 2 0 0 -1 -2
Current Fixture Value -2 divided by 16= -0.125 Current EDU I EDU= 86,824.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -2 divided by 16= -0.125 • over (under) $ (887.12)
Enter EDU Change Here -0.130 *
*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 X2449 Date: 8/21/2023
Building Division
ote: 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\ScwerTallySheet_6625_070122.xlsx