Permit CITY OF TIGARD, I.71 PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2023-00452
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/1/2023
Parcel: 2S101 BA00101
Jurisdiction: Tigard
Site address: 7500 SW DARTMOUTH ST 150
Project: Kyuramen Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Adding(1) dishwasher,(9)2"floor drains/sinks,(3)3"floor drains/sinks,(1)ice machine,
(11)sinks,(4)water closets,and(1)urinal; Installing(5)primers and(1)water heater.
Contractor: FAR WEST PLUMBING Owner: DARTMOUTH DSK LLC
PO BOX 597 217 SE 136TH AVE#105
ESTACADA, OR 97023 VANCOUVER, WA 98684
PHONE: 503-318-5148 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 11/01/2023 $25.02
Specifics: 12 ea Floor Drain/Floor Sink/Hub 11/01/2023 $300.24
1 ea Ice Maker 11/01/2023 $12.51
Type of Use: COM 5 ea Sink 11/01/2023 $125.10
Class of Work: ALT 6 ea Lavatories 11/01/2023 $150.12
Type of Const: 1 ea Urinal 11/01/2023 $25.02
Occupancy Grp: 4 ea Water Closet 11/01/2023 $100.08
Stories:
5 ea Primer 11/01/2023 $62.55
1 ea Water Heater 11/01/2023 $37.52
1 12%State Surcharge- 11/01/2023 $100.58
Plumbing
Total $938.74
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:
#.2-,4_ 2.3.7-2
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.
- Numbing Permit AnD1ica N GD
Building FOR OR ohrluh: usi: 0I'sLI
City of Tigard BCT 2 4 L ZI Received y/ permitNo.: L�
la 11111 13125 SW Hall Blvd.,Tigard,OR 97223 p Date/By: IS)I�Hf 3 . _ � r�U.�-3" Wit�
I Phone: 503,718.2439 Fax: 503.598.;9 1 ( 1t - VtGAR Da g Review v
y�/ Other permit No.:4 _ rfi y3
T I GAR� inspection Line: 503.639.4175 C; Date Ready/By: / ��TT (jWr
[ntcmct: www.ti and or. ov y kk D NG DIVISION j t Bl See PsEc 2 for
8 6 �L� Notified/Method: �'bi n aia'�" "S. SupPtementallnformadon
TYPE OF WORK ,t ,ri i i FEE* SCHEDULE
1 I a - For special information use checklist.
-
L New construction El De j �I P J
�� Description I Qty. I Ea. I Total
(�Addition/alteration/replacement Othei, �-s m ew 1-2-family dwellings(includes 100 ft.for each utility connection)
- CATEGORY OF: CONSTRUCTION ` FR(1)bath 312.70
.
❑ 1-and 2-family dwelling Q Commerciallindustrial _SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 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:
, atch basin or area drain 18.76
Job site address:
756 c SvI Vww r tr;LI T,...i S-'t, SiS E i 5't-)
Drywe6
City/State/ZIP: Ti G� R� 1{� oy7-z-2; Footing
1,leach line,linearor trench drain Page 2
Footing drain(no. ft.:_) 2
Suite/bldg./apt.no.: r 5.c,t I Project name: . y J gkitsi,..1 Manufactured borne utilities 50.03
.
Cross street/directions to job site: Manholes 18.76-.A.
1 -t (CI A23' ,9-1 At I__ sj 1 7 Rain drain connector 1$.76
Cs
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,: 1 l Backflow preventer 31.27
t� ,(, PV U ac ter valve
- DESCRIPTION OF WORM -
Backwater 1 12.51
1 :... Clothes washer 25.02
G 'TO:L.Q Ii/-Uri.,'/ ' t) 2-/dJJii}„1,i l"ASitw.r3hr-,I"3 C;AY%p 5:st_K Dishwasher / 25.02 75 i.i
I- ':4,^ A kc 3.12.11 1A-t( FL b k� t't/- Gt,,.r'S; ic, i7-,-Iac;; .c.it k//-(.ri-1,-4 , Drinking fountain 25.02
)•i r,a t-e.�s a•nK . 'tLE�, SIly Ejectors/sump 25.02
D r PROPERTY OWNER. TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: C`k ,5 cam l 9 Floor drain/floor sink/hub 1'Z. 25.02 3v�.��
Address: .7L;..r S W j2 ,..rp.1r,61T+1 Sf S-G f 5 l% Garbage disposal 25.02
X City/State/ZIP: `-"C'iCyO,,f17 1 Oz. L77'2,Z Iiecrbib L__, 25.02
Phone:(S U3) *)( L .-. Z J - Fax:( ) Ice maker % 12.51 14,5�7 -
vi APPLICANT d CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:S ) Page 2
Business name: Kp,L:i CO 1v��~7Tt>JcT t"i i Vac(.y�l 7'iC, Primer S 12.51 4.4) 53
Contact name: Yll Roof drain(commercial) 12.51
x Address: 2..7 7y,..1 1-F. , -L,J_y J , j 1� Z.:�t D Sink/basin/lavatory i l 25.02 2-.7 j,,-.A
City/State/ZIP: lf,3 12.:T LF�.,2 A 1Z, 1 ? •2 j 6 Solar units(potable water) 62.54
Phone:( � ) . Fax::( ) Tub/shower/shower pan 12.51
�J"2 "��l-`{ - �) t, Urinal _/ 2..,;-.25.02d).
E-mail: •gAl^Y. Sl G h15 yA a tip . caw • Water closet ..._.--.1"- 25.02 !Eg ,L"�
CONTRACTORWater heater f 37.52 37,S 1
Business name: Fgk. u1 t:.5 r P(v✓-m to i. .e Water piping/DWV 56.29
Address: pc, 13D x 5' 7 Other: 25.02 _
c.
City/State/ZIP: S'/'QG„c$Zcc. L"]i2 c 7 0 2.3 Subtotal ,
Phone:(5o'S) 318 .. t 5 A./ Tax:( ) 3 . j`Il6 ? Minimum permit fee: $72.50
CCB Lie.: h$ 9 5-q Plumbing Lie.no.: 3 4,3 J Plan review (25%of permit fee) 1
State surcharge(12%of permit fee) �,()L ,,y
Authorized signature: J n/ TOTAL PERMIT FEh V ��/
Q KJP� . I
Print name: Date: This permit applicslioa expires if a permit is not obtained wi Lin 180 aye
TjpU� I L.K({ 9�Z C/ 3 after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
1:`3uilding\Permitsl?l.ML*-PmmitApp.doc 10/01/09 440-4616T(10/02/CAM/WEB) 5' ,�^ `i
r
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qry• Pee(ea) Total t Square Footage: Permit Fee:
Footing drain-1"100' 4 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-let 100' 62.54 7,201 and greater S327.54
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
i., each additional$100.00 or fraction thereof,to
Other Inspections or Fees. Qry Fee Total 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 S100.00 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 S379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional S 100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr S50,001.00 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 Replacel Please check all that apply.
Work performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -T,blShower engineer.
-Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash: • -Each Stall as defined in OAR918-780-0040.
-Drive Thin ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wasb
Floor Drain/sink: -2" Dl
3" 3 Isometric.or Riser Diagram.
4" 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 MachJRefrig.Drains 1 Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related F,
-Bradley
-00m/Serv/Util food related LE
-Service I *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 l
Other Fixtures: _
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Plumbing Permit Application
Building Fixtures
FoR OFFICE 1'SL OM 1'
City of Tigard Received
s 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: r :.,./lf/A I� Permit No.:pf.✓1 142 3_ , ��
E Phone: 503.718.2439 Fax: 503.598.1960 Plan ReviewIII
4t
71 G A it L) Inspection Line: 503.639.4175 Date/By: Other Permit No.:
Internet: Bard-or.gov Date Ready/By: kris: 1 ®See Page 2 for
Notified/Method:
TYPE OF WORK Supplemental Information
FEE* SCHEDULE
New construction ❑Demolition For special information use checklist.
Addition/alteration/replacement Other: �^ Description f Qty. Ea. Total
ew 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION FR(1)bath
312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath
437.78
:-
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
0 Other:
JOB SITE INFORMATION AND LOCATION Fire sprinkler( sq.ft.) Page 2
Site utilities:
Job site address: 7566 SUJ .TM uUT S-L. S ft)
, Catch basin or area drain
18.76
City/State/ZIP: '� Ij � L"1.� Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: Project name:(�� Z Footing drain(no.linear ft.: ) Page 2
yu Manufactured home utilities Cross street/directions to job site: 50.03
Manholes
�CC `+zN{L._ C�_A 2 18.76
Rain drain connector
18.76
1 ki
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: Water service(no.linear ft.: ) Page 2
Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer
31.27
DESCRIPTION OR 'PORK Backwater valve 12.51
ir;s 1 ,% /t 10�,> Clothes washer/ T� CI th h 25.02
Fa/w r'y t :f/ f YJ.+T7/3tH*+.Sfi�l"t/ J C u11'� 'J Eby
P (S Dishwasher at 25.02
/ 16"<.,Aki3 chavt.w(Fl.Drtiy,,vj /-ata„.}`s'.Y,Ni ;}d.1e=c,1, <. k//-to-i-i Drinking fountain
s•ls_? lwc.,sp.s',:i)V. 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER IV TENANT Expansion tank
,�^� � 12.51
Name: i--m c' -i`� Fixture/sewer cap
25.02
Address: 7 s�z� Su! ;'1r �� -'(1
Floor drain/floor sink/hub 25.02
X City/State/Zip: - L� � '�11 Garbage disposal
t-f 4-s�s'CZTJ t) 9-7 7`2_`> 25.02
(563) (6- Zad7 Fax:( ) `�Yr.� 5•�k i 25:02
Phone:
Ice maker 12.51
ELNAPPLICANT "
t CONTACT PERSON Interceptor/grease trap 25.02
Business name: -4� - Medical gas(value:$
(�'v � ) Page 2
Contact name: - /� Primer 12.51
x Address: �7 Roof drain(commercial) 12.51
City/State/ZIP: �2�� � a�tr=� Sink/basin/lavatory 7 25.02
cde t-' � O� - .2'2-6 4 Solar units(potable water) 62.54
Phone:(4-0)3 �t_� I Fax:
� ( ) Tub/shower/shower pan 12.51
E-mail: 1�- /,� s� i „ p -0 t C Urinal / 25.02
��fi�7`6�t 1-t, ia-+�..�' Water closet CONTRACTOR 25.02
Business name: y Water heater / 37 52
Address: pc, Box 6-7 Water piping/DWV 56.24
Other: 25,02
City/State/ZIP: 3'FQC e cke. C R. 9 7 0 2.
Phone:( ( ) Subtotal
1 al/ -' ) c 7((� 0Minimum permit fee: $72.50
CCB Lic.: 7 g ? -- Plumbing Lic.no.: c -- Plan review (25%of permit fee)
! ?t3 a P
Authorized signature: IIti State surcharge(12%of permit fee)
6,446._^7 TOTAL PERMIT FEE
l Print name: ,6 i rr r IA K/.1 I Date: !/Z 472.3
This permit application expires it 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.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09
440-4616T(10/02/C0M/WES)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr. Fee(ea); Total Square Footage: Permit Fee:
Footing drain-1"100' 50.03 0 to 2,000 $121.902AM. o 3,6%1 ,,169.69
Footing drain-each additional 100' 37.52 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
each additional$100.00 or fraction thereof,to
*�` (Irv,-- Fee(ea) Tot I and including$10,000.00.
ether Inspections or r des ,
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 $37 50 orad thenal$first 2 o000.00 fraction and$1.45 for
hours(minimum charge—2 hours) and including$50,000.00.
,to
Reinspection Fees 90.00/hr
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof.
(minimum charge—1/2 hour)
Subtotal: l I
mow/ ...m.=
v
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 ❑ 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 0AR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above
Eye Wash
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 Comments regarding fixture work:
Ice Mach./Re&ig,Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/SerWT..1dt 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:
I:\Building\Permits\PLMF PetmitApp.doc 08/04/2011 2
10111 Accumulative Sewer Tally
m Tenant Name: KYURAMEN SWR# 2023-00366
T 1 Gn RD Site Address: 7500 SW DARTMOUTH STREET SUITE 150 PLM# 2023-00452
Parcel#: 2S 101 BA00101
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 1 4 1 4
-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 9 18 9 18
IIMMIMmr
-3 inch 5 0 0 3 15 3 15
-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 1 1 1 1
hiving 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 6 12 6 12
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 5 15 5 15
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 4 24 4 24
Urinal 6 0
0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit
0
TOTALS 0 0 0 0 30 95 30 95
Current Fixture Value 95 divided by 16= 5.938 Current EDU 1 EDU= $6,824.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 95 divided by 16= 5.938 over (under) $ 40,534.56
Enter EDU Change Here 5.940 *
*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: 10/30/2023
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.
1:\Building\Sewer Tally\SewerTallySheet_6625_070122.xlsx