Permit (20) CITY OF TIGARD PLUMBING PERMIT
a . COMMUNITY DEVELOPMENT Permit#: PLM2023-00472
T i ;;.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/8/2023
Parcel: 2S101 DA01900
Jurisdiction: Tigard
Site address: 7000 SW VARNS ST
Project: Madrona Recovery Subdivision: VARNS ACRES Lot: 3
Project Description: Interior fixtures for TI:Add(2)drinking fountains,(1)shower stall,(2)sinks,(1)water closet.Relocate(2)shower
stalls,(2)sinks,and(2)water closets.
Contractor: POINT PLUMBING Owner: MRC RE LLC
4510 SW 182ND AVE 7000 SW VARNES ST
ALOHA,OR 97007 PORTLAND,OR 97223
PHONE: 503-265-1708 PHONE:
FAX: 503-268-1567
FEES
Quantity Description Date Amount
2 ea Drinking Fountain 11/06/2023 $50.04
Specifics: 4 ea Sink 11/06/2023 $100.08
3 ea Tub/Shower/Shower Pan 11/06/2023 $37.53
Type of Use: COM 3 ea Water Closet 11/06/2023 $75.06
Class of Work: ALT 1 12%State Surcharge- 11/06/2023 $31.53
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $294.24
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 fort in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the[rules
•
Issued By: Permittee Signature: 6 ev •
cr ',
c w` �7
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 Appli'RECEIVED
Building Fixtures
City of Tigard NU V 1 2023 DReceived , ` 7 Pen fla,/U -
III r 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
II Phone: 503.718.2439 Fax: 503.59Sp(OF TIGARD Date/By: °the,lii a)3 .. U0 7 713
I 1 t_;n I.a Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: i Juris: B! See Page 2 for
Internet: www.tigard-or.gov Notifted/Method:1 I � Supplemental Information
TYPE OF WORT{ EeFta1C t-d )sl. EE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description I Qty. 1 Ea. I Total
Addition/alteration/replacement 0 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 0 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:1 (1 Ct. ,y,t VAWN 'Di•
Catch basin or area drain 18.76
City/State/ZIP: 11(p taw ei 7- Li ) Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite Id /apt.no.:J$1, I Project name: NI A 9-4.0 N A Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
T Clothes washer 25.02
l 0 M M �i t(.a L t2 e- t}l Dishwasher 25.02
Drinking fountain :.,, 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
Y'APPLICANT ija CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: V 0.I N`T Lk: lv1‘;``)I N Li, 4 IL" •
Contact name: Primer 12.51
TO SN � �� Roof drain(commercial) 12.51
Address:
CFI 0 J04 i(r32 �� • Sink/basin/lavatory 117 25.02
City/State/ZIP: t LA.) l~1 A LA i'i-4-) ? Solar units(potable water) 62.54
c e a Phone:(v71)3) 3 14 t?() 2. Fax::.0 r t( 9/1' 2.4! - i 1-0 o Tub/shower/shower pan 3 12.51
Urinal 25.02
E-mail: .3-
0 r G, VC)i fv`T L--•k N11,i N . Ivy.t Water closet 25.02
CONTRACTOR
-
Water heater 37.52
Business name: pp I i,,,j•T' ‘2 L.() ' vol.'(y (t L. . Water piping/DWV 56.29
Address: 4 1 L < ( p.Jt'7 k'i Other: 25.02
City/State/ZIP: f .-1 A • L)'%` G i 4.6 Subtotal
Phone:(�--*5) Attt3-_4 v,'b Fax:( 2) ) 2. - 1.1tr�-1-• Minimum permit fee:Plan review (25%of permitit fee)
CCB Lic.: 1(Y 0 l 1 I' j V1� yt.? Plumbing Lic.no.:11 6i1 0 1
State surcharge(12%of permit fee)
Authorized ' ature: TOTAL PERMIT FEE
Print name: Date: / 2,-5
This permit application expires if a permit is not obtained within 180 days
_ -- "" y 1 l30after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1::3uildinglPermits\PLMU•PcrmitApp.doc 10J0l/09 4444616T(IO/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-I"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 Qty. 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 cheek all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Stall ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each as defined in OAR918-780-0040.
-Drive Thr
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ 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" 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 MachJReeig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station At./r
Shower: -Gang iZ C r��j cv<,�v,y /�.�
-Stall
Sink: -Lav/Bar non-food related "Vie#4.
-Bradley 2- pxr %.N3 , -Y`i
-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 j :2 plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PennitApp.doc 08/04/2011 2
IIIAccumulative Sewer Tally
_ Tenant Name: Madrona Recovery SWR# 2023-00378
TIGARD Site Address: 7000 SW Varns PLM# 2023-00472
Parcel#: 2S 101 DA01900
Fixture Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/1knt 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 2 2 2 2
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 IIP) 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 1 2 1 2
Sink:
-Lay/Bar-Non-Food Related 2 0 0 2 4 2 4
-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 6 14 6 14
Current Fixture Value 14 divided by 16= 0.875 Current I:DU 1 EDU= $6,824.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 14 divided by 16= 0.875 over (under) $ 6,005.12
Enter EDU Change Here 0.880 *
*Round I;DUs 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:J Joe Bailey EXT 2763 Date: 11/2/2023
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.
T:A Building\Sewer Tally\Sewer`T'allySheet_6625_070122.xlsx