Permit (7) CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit#: PLM2023-00150
Date Issued: 6/1/2023
T[G ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9467 SW WASHINGTON SQUARE RD All
Project: Hearth PDX Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Adding(2)2"Floor drains/sinks and(5)sinks;Capping(4)2"floor sink/drains,(5)sinks,
and(1)water closet; Installing(1)grease trap.
Contractor: 7 PINES PLUMBING LLC Owner: PPR WASHINGTON SQUARE LLC
3146 SW EVERGREEN AVE BY MACERICH RET
REDMOND, OR 97756 PO BOX 4085
SANTA MONICA, CA 90411
PHONE: 971-381-0157 PHONE:
FAX:
FEES
Quantity Description Date Amount
10 ea Fixture/Sewer Cap 05/31/2023 $250.20
Specifics: 4 ea Floor Drain/Floor Sink/Hub 05/31/2023 $100.08
1 ea Interceptor/Grease Trap 05/31/2023 $25.02
Type of Use: COM 2 ea Sink 05/31/2023 $50.04
Class of Work: ALT 3 ea Lavatories 05/31/2023 $75.06
Type of Const: 1 Plan Review 05/31/2023 $125.10
Occupancy Grp: 1 12%State Surcharge- 05/31/2023 $60.05
Stories: Plumbing
Total $685.55
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: 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
` ' BUll(llntrr,, Fixtures RECEIVED FOR OFFICE USE ONLYCity of 1 igard ,,,,.,,,,,i
i1 tc L, �i"►� -Wl�
w 1i1 >�11 }ItllRlsd 1i3ard.c)N 97�22 1 , tco�ty_
t 2 Phone- 50 Dt 4t 9 "3 'APR„)K 2 6 2023 1',
il lnslexm>tt I ln. 511i(„r)_)1':> i
TIGARD ii t hcnh P, _ ".m Si® -c l age 2 for
I tllttet A ris ss Iit`;trdrtt i•uc c tmc.l`tcth�tt 57/ 7 �f"3 / Suppli manta!Information
1 GIPt-01 TIGARD 1 1TE OF 11"O �+ �+ > FEE" SCIIF.DI LF.
���n��L"1���..7�®� ri� Tom+•"�t�r,
"vess ecnstnlcuolr ❑Demolition
F'orspr(•ial injr n rerklict ation me l } '
Description I Ots I I,a 1 11 aa1
i ❑Addition alteration replacement ❑()then. `en 1-2-iamily ds cllin s(includes i1Nl it.for each utihls 4-44117:A.Ia in
CATEGORY OF CONSTRICTION SFR(1)bath 312 71I
I ❑ 1-and 2-11imils duelling. /)t/I Commercial industrial SIR(2)bath 137 7ts I
`' L SIR(3)bath 5>>0 t2 ,
❑:Aceessors building 0 Multi-family
ladl additional bath kitchen 25 02 1
❑NI:aster builder 0 Others
Piro sprinkler( sq.}i.) Pa^c 2
MI 4I J7ORRMATiON AND LOCATION Site utilities:
Job site address: r�' ' 1,/( < / Catch basin or area drain 18'(>
�ifi
{�tCld[� Gf'i 9
�J:� }k}��ell.leach line.or Crutch drain 18,76
Cih State Z1P. + Vi;C: 1
�(j( t�o u!K (� n] 3 Footing drain(no linear ft: ) Page 2 1
Suite Bldg.apt.no.: �t 1 Project name: �/il�A Manufactured home utilities r 50.I)3
iCross street directions to job site: 1 Manholes 18,76
Rain drain connector 18 7E
1 Sanitary sewer(no.ling ft.: ) Page 2
t -
1 Storm seucx(no.linear ft.: ) Page 2
f Water service(no.ling R.: ) Page 2
Subdisisicn: Lot no.:
Fixture or item
Tax map Farrel no.: I3ad lose prev ter 31.27
i Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
f�•�0. S�1 � 'fro� �/i''Ylf. 5!h ) Dishwasher25.02
�eC . j'C. (Oaf i(',- ) }� i } thinking fountain 25.02
Crj Ejector sump 25 0t2
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fix1ura'szs>i r cap ( 25 02
Address:
Floor drainfloor sink hub 25 02
Garbage disposal 25 02
i City State ZIP-
lime bib 25.02
i Phone( ) Fax:( ) Ice maker 12.51
I ❑ APPLICANT 0 CONTACT PERSON Interceptor golembip, I 25.024
Business name /L
'?v(�4� )} ill p i h 9Prim Medical gas(value:S ) Page 2
Contact name: . ;�1�,
Primer 12.51
�l
Address:
�o q 3 atA. .�� Roof drain(conmtercial) 12.51
Sink basin lavatory —5- - 25.02
( Cits State/ll': V (--u/7 0)_ C e /J / Solar units(potable water) l t,__54
i Phone:( j ) ,) (i/, C/�I-G Fax.:( ) Tub shoviershosse pan 12.51
t C ,ylb'/l Qi,"G�a . CO '" ' Prone! 25.02
j E-mail: .JGr k t 17 S
Water closet 25 01
(IONTIL1(TOR
Business name: •
/ Water hater 3?;2
{�tY,,Qa� �[�)lot b^ �h� / Water piping OW 5o 2`t
Address: \ C,9 S c.1 I Other: 25 2
Chits State LIP. L1 o O Or.,,, q7 I / Subtotal
!'hone-( j ) `?('1 0 rS.— Fax:( ) — _ Minimum genii fee: 172 50
CCH Lie. ..,3 "7 C� 11 1ytuimtg 1_ic_no__
Plan revues (25 of permit Ice)
L.
State surcharge(12 oh penult leo i
Authorised signature: �C7:25 vZ� - -.-- — .5`
TOT_11.f'F.it. I_r
Print name p}dh. " J r....
- phis permit application expires if a permit is not obi mid alih' Inn days
._( [/_.,,,� _I_.j.,,__..____ .__._._�__.__L.._" _. � after it has been accepted as complete.
,,,_,__....�
" 'lumbin2 Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Su! !ression S stems:
w .�` `` M19 yf..''
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
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 S stems:
Water Service-each additional 100' 37.52
-tz .4r
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
144i- € ail each additional$100.00 or fraction thereof,to
ttQ`r- A! ! off`; .. 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
(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* A), A
` ®w nti ibI�+Ii t� e: ,d Plan review is required for any of the following.
04, lt 3' 5 Please check all that apply.
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
Wrator 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator Cp al ❑ Any multipurpose fire sprinkler system.
Dishwasher:
Domestic ❑ 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" MI ii (ii it
3„ lm.,4,11111,w1111 11 A t,,q43 0 Pe Iv!9
4" • Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the •ualifications 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) 64,0 n/r-36-- Pea.; C.:LLt-C i Sf3 f
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related 1
-Bradley
-Com/Serv/Util food related t r1 N
-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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Plumbing Permit Application
Building Fixtures r()iz ()IAA( F. i s1: ()NI.i
City of Tigard Received
Date/By: Permit No.:f`
41 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review /i �
Phone: 503.718.2439 Fax: 503.598.1960 DaDate/By: 7- O`0y-a3 j other Permit No
T I( A R i) Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF"WORK FEE*SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I 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
❑ 1-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 ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE.INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.: ) Page 2
Suite/bld ./a t.no.: I Project name: 1 2 ' '' '.,
g P J /'.. r_. „ • '; e }- ..-,X., 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.: Backflow preventer 31.27
DESCRU! UO1N OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPER IT OWNER ( TENANT,, Expansion tank 12.51
Name: t Fixture/sewer cap / ,% 25.02 3<.< , 2,f:
Floor drain/floor sink/hub 25.02 /()a,, Oa
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
�'❑ A,�CANT 0 NtACT FU,nQ Interceptor/grease trap J 25.02 ,' t,;�-,
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 1. 25.02 /, . 1(,,
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal ?;G ?-yt%
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) ),'?�:-, i
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee) CO C.
Authorized signature: TOTAL PERMIT FEE tC 1 ,, , S f
Print name: Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/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-1st 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-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$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 Qe3' Fee(ea) Total each additional$100.00 or fraction thereof,to
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
(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
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.
ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El 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
4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
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: -Lay/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 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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
1111 Accumulative Sewer Tally
S Tenant Name: HEARTH PDX SWR# N/A
TIGARD Site Address: 9467 SW WASHINGTON SQUARE RD PLM# 2023-00150
Parcel#: 1 S 1260000300
Fixture 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 4 8 2 4 -2 -4
-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 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 1 2 3 6 2 4
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 4 12 2 6 -2 -6
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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 10 28 7 16 -3 -12
Current Fixture Value -12 divided by 16= -0.750 Current EDU 1 EDU= $6,625.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -12 divided by 16= -0.750 over (under) $ (4,968.75)
Enter EDU Change Here -0.750 *
*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: 5/1/2023
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_6625_070122.xlsx