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Permit CITY OF TIGARD PLUMBING PERMIT 11 = COMMUNITY DEVELOPMENTPermit#: PLM2023-00158 158 T I t A R 1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19/2023 Parcel: 2S 110DCO2300 Jurisdiction: Tigard Site address: 11545 SW DURHAM RD B-6 Project: Bull Mountain Orthodontics Subdivision: 1998-128 PARTITION PLAT Lot: 1 Project Description: Interior plumbing:Adding(1)drinking fountain and(1)sink; Relocating(2)sinks;Installing medical gas. Contractor: QUALITY WEST PLUMBING LLC Owner: HIP WILLOWBROOK LLC 23050 SE FULQUARTZ LANDING BY HARSCH INVESTMENT CORP DUNDEE,OR 97115 PO BOX 2708 PORTLAND, OR 97208 PHONE: 503-289-7095 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Drinking Fountain 06/28/2023 $25.02 Specifics: 1 ea Medical Gas 06/28/2023 $72.50 3 ea Sink 06/28/2023 $75.06 Type of Use: COM 1 Plan Review 06/28/2023 $43.15 Class of Work: ALT Type of Const: 1 12%State Surcharge- 06/28/2023 $20.71 Plumbing Occupancy Grp: Stories: Total $236.44 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules Issued By: Permittee Signature: r rr e Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application i _ , • Building Fixtures FUR (>rrlcI u SE O\'l,l City of Tigard RECEIVED Received _ �� 1 Date/By: I' P�L%,� _ r/ 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2439 Fax: 503.5R$�y�60� 7 Plan Review Inspection Line: 503.639.4175 H f( L / 2023 Date/By: ;, 6-.1.' O. f i I. Tit;1hn _ ���,/. r 10 Internet: www.tigard or gov Date Ready/By: J~e, ® See Page 2 for Not leiified/Method:, 3 f j Supplemental Information Sup lem 1 0 ki ���,�s i x i ■ i, , sue.,.- u. :rJ, 4s, ,t 0 New construction �Yi Ir emo itton For special information use checklist. 9 Description I Qty. I Ea. I Total Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) ItoW:a."... . `RAritilr..eOlit :7..W 4 r a- :s it't:C,rags'$771 ', , :°;. SFR(1)bath 312.70 ❑ 1-and 2-family dwelling ►i ommercial/industrial SFR(2)bath 437.78 ['Accessory building ❑Multi-family SFR(3)bath 500.32 ❑Master builder Each additional bath/kitchen 25.02 ❑Other n Fire sprinkler( sq.ft.) Page 2 ,' R x. t :'.,ff;.r tr'.`afi r--4., ' '�`A t# :. ,, r"s{.. . ,a4 `,.',i '°'� '1 Site utilities:,. ..An , css:ra, t t+. 4tLw„ _ Job site ` 5 c, - ` ,u Catch basin or area drain 18.76 cu.) ��..� Drywell,leach line,or trench drain City/State/ZIP:address: d r• � rota 18.76 Page �� Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no. ►� I Project name:�u� _ v� / rl Manufactured home utilities 50.03 Cross street/directions to job site: 1C) 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: t -. 110 c-0 2-3 • I Lot no.: t/ QC% Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 �,s r ,� `y « k. 0s Backwater valve 12.51 I ��w Q Clothes washer 25.02 + p 1c 5 q� -, �t �1 \[�� Dishwasher 25.02 ` ` `V ) A`'C,-f)te, La.) 5 Drinking fountain f 25.02 25,©2. ‘e.-- t ctci )5 1 ii. c r5 Ejectors/sump 25.02 p s y ,�_ � 1' Expansion tank 12.51 Name: tA. \'Wo,^ Fixture/sewer cap 25.02 r 4 O Floor drain/floor sink/hub Address: I' C r _ 1 � 25.02 JVL! 1 Garbage disposal 25.02 City/State/ZIP: O7- Ck•'1 Z _ 1 ` Hose bib 25.02 Phone:( ) / e,,.,.%/' Fax ( ) Ice maker 12.51 rw � ` ,,A?PU r+', -it. a 7 , `GQ1VT',+L"T"`ll+ ' Interceptor/grease trap 25.02 Business name:QJ�NA J--CJi wp C}! Mum,Di n3 Medical gas(value:$4Q 1 Page 2 I7 , 56 Contact name: wv Primer 12.51 �y ^�� Roof drain(commercial) 12.51 Address: 23� S�C� `L(`l� T.� , n,�' - V �-�C.'IfiL�� Sink/basin/lavatory 3 25.02 i�5 d6 City/State/ZIP: Q� ��/ 1-1 I 15 Solar units(potable water) 62.54 Phone:( �l - S Fax::( ) Tub/shower/shower pan 12.51 E-mail: Sc - p [um @ 'zy �,t ,�,, /' ,,,_\� Urinal 25.02 CONTRACTOR' l W (�V Water closet 25.02 Business name: Water heater 37.52 AD Water piping/DWV 56.29 Address: so) Other: 25.02 City/State/ZIP: Subtotal /V,SSE Minimum permit fee: $72.50 Phone:( ) Fax:( ) CCB Lic.: Plumbing Lic.no.: l 52g Plan review (25%of permit fee) 93,/5 State surcharge(12%of permit fee) J C�,11 Authorized signature: Q'3 yy �/ `` TOTAL PERMIT FEE Print name: �/ Date: This permit application expires if a permit is not obtained within 180 days r • after it has been accepted as complete. *Fee methodology set by�di Tri-County Buildingy Industry Service Board. 1:ABuiiilldiin U nngVPermits\PLM -PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) P t '4, la 0 2.2. r.itire a --* 11r�4r....- /t Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Su I I ression S stems: '>` " .� !,I :' c ,w,.rs n six. a „ ;: . ".i:. .. Footing drain-1"100' 50.03 0 to 2,000 $121.90 2,001 to 3,600 $169.69 Footing drain-each additional 100' 37.52 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and• eater $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 k $' =r 62.54 °: rl. fir. , Storm&Rain Drain-1st 100' $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 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 ea 00 for the firse$50,000.00 orfraction aand ereo1.20 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*. � : . :; °" ''''''''''''''''' ''':''''1**-- ''' "'''''* ';''.Wikrar:Tf":ZL::17MAC Plan review is required for any of the following. t Please check all that apply. ,d ,, t,, ❑ 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 0 Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system. Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain i Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" p " -4" ❑ 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 Comments regarding fixture work: Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lay/Bar non-food related • % 9' -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 plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: 1:\Building\Permits\PLMF_PetmitApp.doc 08/04/2011 2 Accumulative Sewer Tally Tenant Name: BULL MOUNTAIN ORTHO SWR# 2023-00180 T 1 G A R D Site Address: 11545 SW DURHAM RD B-6 PLM# 2023-00158 Parcel#: 2S110DCO2300 Fixture Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values Baptiseiy/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 1 1 1 1 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 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 0 0 0 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 3 2 3 Current Fixture Value 3 divided by 16= 0.188 Current EDU 1 EDU= $6,625.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 3 divided by 16= 0.188 over (under) $ 1,258.75 Enter EDU Change Here 0.190 * *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: BRANDEN TAGGART X2449 Date: 6/27/2023 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