Permit (12) CITY OF TIGARD PLUMBING PERMIT
11111
z COMMUNITY DEVELOPMENT Permit#: PLM2023-00266
Date Issued: 6/28/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S101AB01608
Jurisdiction: Tigard
Site address: 7455 SW BEVELAND RD
Project: LifeStance Health Subdivision: HERMOSO PARK Lot: 19
Project Description: Replace washer box in lower level restroom.
Contractor: LOCAL PLUMBING COMPANY Owner: AWAKEN MEDICAL LLC
20833 SW OLDS PL 7455 SW BEVELAND RD
SHERWOOD,OR 97140 TIGARD,OR 97223
PHONE: 503-642-2067 PHONE:
FAX: 503-642-5954
FEES
Quantity Description Date Amount
1 ea Clothes Washer 06/28/2023 $25.02
Specifics: 1 12%State Surcharge- 06/28/2023 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 06/28/2023 $47.48
Class of Work: OTR 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 CC le �(
Center. Those rules are set fo in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: .�%��r f e �J Permittee Signature: --!1A 51 e)
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.
* A
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
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
Water Service-each additional 100' 37.52 Medical Gas Systems:
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 additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and includingrt $10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 each a 0 for the first$10,000.00 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 additional
0 for first$25,000.00 and thereof,for
Reinspection Fees 90.00/hr and including$so,000.00.
0 fraction to
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 1
Work Performed: Capped Added Relocate may'
Baptistry/Font ElAny new commercial building with water service 2"and
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 Thnt as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 0 Any multipurpose fire sprinkler system.
Domestic El 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 diagram is required for new buildings
-Car Wash Drain ?'>r Cq
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: -Cav/Bar non-food related
-Bradley
-Com/Serv/Util food related
service *Note: If the fixture work under this permit results in an
Swimming Pool Filter
Washer-clothes 1
increase of sewer EDUs,a sewer permit will be issued and
Water Extractorfees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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