Permit (22) CITY OF TIGARD PLUMBING PERMIT
2. COMMUNITY DEVELOPMENT Permit#: PLM2023-00482
Date Issued: 11/9/2023
T f G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S113AB00101
Jurisdiction: Tigard
Site address: 16101 SW 72ND AVE
Project: PacTrust Subdivision: None Lot: None
Project Description: Interior fixtures in common area:Add(1)shower,(1)sink,(1)toilet.Relocate(1)dishwasher,(4)sinks.Cap(1)
shower,(2)sinks.
Contractor: POWER PLUMBING CO Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 19418 ATTN: N PIVEN
PORTLAND, OR 97280 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Dishwasher 11/07/2023 $25.02
Specifics: 3 ea Fixture/Sewer Cap 11/07/2023 $75.06
5 ea Sink 11/07/2023 $125.10
Type of Use: COM 1 ea Tub/Shower/Shower Pan 11/07/2023 $12.51
Class of Work: ALT 1 ea Water Closet 11/07/2023 $25.02
Type of Const: 1 12%State Surcharge- 11/07/2023 $31.53
Occupancy Grp: Plumbing
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 forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Permittee Signature: sj � elfr ) C4"
Call 503. 9.4175 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 ApplicatioRECEIVE
Building Fixtures NOV FOR OFFICE USE ONLY
O b 2023 Received Permit
City of Tigard Date/13y: 1 1. a� 6 a-3 � "f -
a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
il
I Phone: 503.718.2439 Fax: 503.598.1try OF TIGARD Date/By: °ti°` ➢' �� '�' '
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION DateReadyBy: ,f / a� Juris: ® See Page 2for
Internet: www.tigard-or.gov Notified/Method: .1/ (� Supplemental Information
TYPE aF WORK led ed ri't4614 SCHEDULE
❑New construction ❑Demolition For special luformate,'use checklist"
Description I Qty. I Ea. I Total
1 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-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: 16101 SW 72ND AVE Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD, OR 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:23-778 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.: Back flow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
PACIFIC BUSINESS PARK 191 COMMON AREA REMODEL Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER l 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 3 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
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: MIKE WARREN Roof drain(commercial) 12.51
Address: P.O. BOX 19418 Sink/basin/lavatory 5 25.02
City/State/ZIP: PORTLAND, OR 97280-9418 Solar units(potable water) 62.54
Phone:( 503-244-1900 Fax::( 503-244-$825
Tub/shower/shower pan 1 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
Water closet 1 25.02
CONTRACTOR
Water heater 37.52
Business name:POWER PLUMBING CO. Waterpiping/DWV 56.29
Address:6611 SW MULTNOMAH BLVD Other: 25.02
City/State/ZIP:PORTLAND, OR 97223 Subtotal
Phone:( 503-244-1900 Fax:( 5031244-8825 Minimum permit fee: $72.50
CCB Liz":5237$ Plumbing Lie.no.: 34-150PB Plan review (25%of permit fee)
,. State surcharge(12%of permit fee)
(b�4/Authorized signature: TOTAL PERMIT FEE
Print name:KRISTIE BRAMWELL Date:11-6-23 This permit application expires if a permit is not obtained within 180 days
alter it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:113uilding'PermitsU'I.MU-PermitApp.doc 10/01/09 440.4616T(10/02ICOJUVEt3)
PIumbing 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- Ist 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-Ist 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
Fee(en) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty.
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 El Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
- hrCuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 0 Any multipurpose fire sprinkler system.
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"
3" Isometr.ic 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 Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station PLEASE CALL MIKE WARREN WITH QUESTIONS 503-936-5929
Shower: -Gang
-Stall t t
Sink: -Lav/Bar non-food related 2 1 4
-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 l
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\13uilding\Permits\PLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
I Tenant Name: PacTrust SWR# 2023-00385
Site Address: 16101 SW 72nd Ave PLM# 2023-00482
TIGARD
Parcel#: 2S113AB00101
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 lIP) 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 1 2 1 2 0 0
Sink:
-Lay/Bar-Non-Food Related 2 0 2 4 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 3 6 3 10 0 4
Current Fixture Value 4 divided by 16= 0.250 Current EDU 1 EDU= $6,824.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 4 divided by 16= 0.250 over (under) $ 1,706.00
Enter EDU Change Here 0.250
*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: 11/7/2023
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\SewerTallySheet_6625_070122.xlsx