Permit (19) 14CITY OF TIGARD PLUMBING PERMIT
I. ' COMMUNITY DEVELOPMENT Permit#: PLM2023-00468
T[GAR L 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/31/2023
Parcel: 1 S 126DC00902
Jurisdiction: Tigard
Site address: 9500 SW GREENBURG RD
Project: Crown Oak Apartments Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: Add(1)toilet and(1)sink in leasing office.
Contractor: MODERN PLUMBING Owner: WS-JP LLC
11120 SW INDUSTRIAL WAY BY CAMBRIDGE REAL ESTATE SERVIES
TUALATIN, OR 97062 PO BOX 2968
PORTLAND, OR 97208
PHONE: 503-691-6166 PHONE:
FAX: 503-691-6771
FEES
Quantity Description Date Amount
1 ea Sink 10/30/2023 $25.02
Specifics: 1 ea Water Closet 10/30/2023 $25.02
1 12%State Surcharge- 10/30/2023 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 10/30/2023 $22.46
Type of Const: Plumbing
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 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: a ..? Permittee Signature: 5 l `` p (, c,�'� . ti
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.
)DEPlumbing Permit Applicatio -- ' %...
Building Fixtures 3 0 2023 FOR OFFICE ISE O.vLl
Cityof Tigard Received Z ,,_. fib, j/
g Date/By: t Q 0 �7 ,.� „ Permit No;: Ft M y�`0,,)3_X`(62*
i • 13125 SW Hall Blvd.,Tigard,OR 9722CITY OF TIGARD Plan Review ' B r' t -" t '`�(-
Phone: 503.718.2439 Fax: 503.598(3f11LDING DIVISION Date/By: a Other ' t� 1C7
Inspection Line 503 639 4175 y y H See Page 2 for t i c o! 1\ Date Read B 7xgi
Internet: www.tigard-or.gov Noufed/Method:' k • ,1 ) Su.plementalInformation
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�r �' Ti' d t l, i�' r r b< k'lieu ¢
J,.... _�....r,.� � .,,,..,�., ,..t em ... ...a.. „tM.._^� �`.��. ,. " �.'. '�... ` r ,...
El New construction ❑Demolition °i t C'! 4 I For special information use checklist
� Description I Qty. I Ea. I Total
fig Addition/alteration/replacement 0 Other: .) I►ff New 1-2-family dwellings(includes 100 ft.for each utility connection)
'. ,r " . + ) 1 r f ,, s ", SFR(I)bath I 312.70
❑ 1-and 2-family dwelling •Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler L___sq.ft.) Pagc 2
Job site address: ti5-o arznt_tAr f�„( Catch basin or area drain 18.76
la I�.Gri Drywell,leach line,or trench drain 18.76
City/State/ZIP: '"�'6 ram f1 0 ctri. �-5
� T""'r' Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:i t t)r t1E I Manufactured home utilities 50.03
Cross street/directions to job site: �+ � "1 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.: ) Pagc 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
s x `. tw� r x � '' Backwater valve 12.51
,t.,41"r"&tts �otA,-,,<4-z, ,,.„1,Y`„ y.e1,L r i._?S ii,.4:;.::.,,,,.,:,z # .i.. ,,,.-..4,-,,, r_i - i'?ri:
Clothes washer 25.02
I tJSTA-u I.]F.t,.) ' b I LR T- Es Dishwasher 25.02
VA tv Si i3 k .PAL&.L.& - Drinking fountain 25.02
ge-P La.t a Ejectors/sump 25.02
Yr 4oKt `_ , jam t1 � Ott , Expansion tank 1251
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
Interceptor/grease trap 25.02
Business name: Medical gas(value;$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory i 25.02 2.SD"L,
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
' � Water heater 37.52
^
Business name: r ► tt i 6 � R.,,, ,fit Nc D 40Water piping/DWV 56.29
Address: In I a 0 St)) l NtllAs RI LA)Ail l N C_3 Other: 25.02
City/State/ZIP:Tu Q I t1"i.l Y'�,�(tL c)O(iZ �"W Subtotal
Phone:(5'3)to9 ( _6l to G Fax:( b3 (aq I _6-1--7 r Minimum permit fee: $72.50
CCB Lic.: '$`7 Clip 6 Plumbing Lic.no.: '3l„�_2 9$ Plan review (25%of permit fee)
! � r State surcharge(12%of permit fee)
Authorized signature: to tom_- €__ J TOTAL PERMIT FEE
Print name:gE,Li/vb/9 L A Qm�•✓Jr_^6 Date:1013i a Iz -L This permit application expires if a permit is not obtained within 180 days
�4�.0 l after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
L\Budding\Permits\PLMU-PcrmitApp.doc 10/01/09 440-4616T(10/O2/CO10LWEB)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Sup ression S stems:
sue,aet ti'l `._ i _- ,'R 4,01 Y ,
Footing drain-1"100' 50.03 0 to 2,000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain-each additional 100' 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:
t''
Water Service-each additional 100' 37.52 1 51,6 tb �m2-- A�
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
a n K each additional$100.00 or fraction thereof,to
Jt, - i Y '•ki VI,. 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.
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 each additional S 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* w _ ,.... '
byl re`neve'' Plan review is required for any of the following.
Fizture'Type fur 'R,epMce/ ' Please check all that apply.
w�prkretturmedr.
Added" �'- 'tr ❑ 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 ❑ 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 Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" I a`
-3•. 53; ;, �"irg 'II1ei�C l fe V-
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./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: . -Lav/Bar non-food related 1
-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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Plumbing Permit AnnlicatifiECEIVED
Building Fixtures
0 2023
City of Tigard DateRecei/Byved: 1:v o- Permi it O •- CV Lti$
'is 13125 SW Hall Blvd.,Tigard,OR 972 y'
Phone: 503.718.2439 Fax: 503.598. �@1 t � RD
� A Plan Review
Date/B Other Permit No.:
1'It ,,,,., Inspection Line: 503.639.4175 t3(.,ILDIN(: DIVISION y:
Date Ready/By: Juris: ® See Page 2 for
Internet www.tigard-or.gov Notified/Method: Supplemental Information
❑New construction ❑Demolition For special r'njorntadttu use checkless
Description I Qty. } Ea. I Total
+[Addition/alteration/replacement 0 Other: New
1-
1-2-famil dwellings
(i cludes,l00 ft foreach utility connection)
, t : aj cu i� SFR(1)bath 312.70
❑ 1-and 2-family dwelling lj Commercial/industrial SFR(2)bath 437.78
AccessorybuildingSFR(3)bath 500.32
❑ 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other Firc sprinklersq.ft.) g
,N i ikR _ A: a r k „ Site utilities:
Page
Job site address: C �- f iv
����� Catch basin or area drain 18.76
�-� Drywell,leach line,or trench drain 18.76
City/State/ZIP: L i 0 b.. ' t -
�- 3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:� { /� F( Manufactured home utilities 50.03
Cross street/directions to job site: "'1 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
<. -' -i Backwater valve 12.51
4. 94 ..-1' F' RIr ON t?k� 1111i 1 t�
' Clothes washer 25.02
I Ni -1 A bt Dishwasher VA i- ! .Stj�,� ( AL '� Drinking fountain 25.02
( ( P(y CJI.- Ejectors/sump 25.02
'" pEii, 1$ j i CANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax ( ) Ice maker 12.51
s I" 1i. - T Interceptor/grease 25.02
�(�� �� IC�1 ,"� -�;�� "� � �,`,ADTat ��QN:r��„ trap
Medical gas(value:$ ) Page 2
Business name: -
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory j 25,02 ._.S.D-
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
ti � Jyfl� Water closet i 25.02 a�.D'Z
�::. � .� ... !�w Water heater 37.52
Business name: ryinc ) P1,..0 jevIAL Pcl 6 4, Water piping/DWV 56.29
Address: I I I 0 6(1) t L1 f N r -it,r,,� t . j 1�9-3 Other: 25.02
City/State/z_iP: ,,, 1&'f t -0 t4-1062_ ✓' Subtotal
Phone:(5b'3)IA I. _tot to l, Fax:(S63 (Dq t..,(�"r"? f Minimum permit fee: $72.50
CCB Lie.: 'f"�c0(n Plumbing Lic.no.:"3`1_z J f� Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: 2g. 1„.....1.......„)'
e , L,:e01-4.-- --- TOTAL PERMIT FEE
Date: ((}�.I+�n r� This permit application expires if a permit Is not obtained within 180 days
Print name:
E i I IVbI� 1�S t �m�f La, after it has been accepted as complete.
*Fee methodology set by Tri-County Building industry Service Board,
I:\Building\Permits\PLMU-PcrmitApp doe 10/01/09 440-4616T(I 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: ResidentialP es Systems:
Fireu
Footing drain-l"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 - �"
,
62.54 -..4 .� �.k _ .._
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 S 10,000.00 $72.50 for the first$5,000.00 and$1.52 for
k each additional S100.00 or fraction thereof,to
_
�+, t a t � s
'� '���" � 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 S25,001.00 to S50,000.00 S379.50 for the first$25,000.00 and S 1.45 for
hours(minimum charge-2 hours) each additional S I00.00 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$1.20 for
each additional S 100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees* a tla0 ,, f#! ssttdl oz s
Qu ti 'b 51xtdra�e o ., Plan review is required for anyof the following.
��i�d�� � � q g-
)EF rc Type foii��� 1,,� 911 q�;, _ i 1aP.m Please check all that apply.
.Wor kI!�ormed ..,.,,i iai_ . C*pcd Added Ret a*t�
�"� r" � -� �0 Cl Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool Cl New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
-Commercial � Cl Any multipurpose fire sprinkler system.
Dishwasher: - m om Cl Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" 1
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig,Drains Comments regarding fixture work:
Oil Separator Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: .„,,VT-Bar nvn-foodretat R.PLACAA' (�
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor j� plumbing permit can be issued.
Water Closet-Toilet ft s$U4[
Urinal �:J
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
m Tenant Name: Crown Oak Apartments
Sewer Tally SWR# 2023-00365
TIGARD Site Address: 9500 SW Greenburg Rd PLM# 2023-00468
Parcel#: 1S126DC00902
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 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 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 2 8 2 8
Current Fixture Value 8 divided by 16= 0.500 Current EDU 1 EDU= $6,824.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 8 divided by 16= 0.500 over (under) $ 3,412.00
Enter EDU Change Here 0.500 *
*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: Joe Bailey EXT 2763 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.
I:A Building\Sewer Tally ASewerTallyShect 6625_070122.xlsx