Permit CITY OF TIGARD PLUMBING PERMIT
I. COMMUNITY DEVELOPMENT Permit#: PLM2022-00010
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/26/2022
T I t;A R.D 9 Parcel: 2S 101 BB01300
Jurisdiction: Tigard
Site address: 11956 SW GARDEN PL
Project: Zoom+Care Subdivision: CROW PARK 217 Lot: 1
Project Description: Interior plumbing for TI:Adding(3)2"floor drain/sinks and(8)sinks; Installing(1)ice maker, (2)primers,and(1)
water heater.
Contractor: DP PLUMBING INC Owner: BKM PARK BC 252 LLC
15825 NE SPRINGBROOK BY SLK GLOBAL SOLUTIONS AMERICA
NEWBERG, OR 97132 2727 LBJ FREEWAY STE 806
DALLAS,TX 75234
PHONE: 503-537-9492 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Floor Drain/Floor Sink/Hub 01/18/2022 $75.06
Specifics: 1 ea Ice Maker 01/18/2022 $12.51
2 ea Primer 01/18/2022 $25.02
Type of Use: COM 8 ea Sink 01/18/2022 $200.16
Class of Work: ALT 1 ea Water Heater 01/18/2022 $37.52
Type of Const: 1 12%State Surcharge- 01/18/2022 $42.03
Occupancy Grp: Plumbing
Stories:
Total $392.30
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:
Ho!!ci Va-vt, De Weqe, Qw A
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 Applicati C M _ E
Building Fixtures CIVE FOR 0141( 1 1 SE 0\1.1 ,
City of Tigard pEC 2 7 2QZ Received ! / Permit No
13125 SW Hall Blvd.,Tigard,OR 9722 Date/By 1 (p 7� p � �
Ili
Phone: 503.718.2439 Fax: 503.598. r-*ry jy t`W ^,/�,�( Other Permit No., J �-w17�,
Inspection Line: 503.639.4175 v� u�TI(aNRD '/ Jive).
1� �tO"
f I G A R I) Date Ready/By. 11 Sc age 2 for
Internet: www.tigard-or.gov IliILDJNG DIVISION Notified/Method: /J/ 'fj' 11 Supplemental Information
I TYPE OF WORK I' ' al'\otntt /7i�yvY��/ FEE* SCHEDULE
❑New construction 0 Demolition
,6a For special information use checklist
Description I Qty. I FA. I Total
N Additionialteration/replaccmeIII ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION 1 SFR(1)bath 312.70
❑ I-and 2-family dwelling Ri Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
El 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:
e S./ $u) �J ,k PEO Catch basin or area drain 18.76
Job site address: _1 C (YC.
44.
Drywell,leach line,or trench drain 18.76
City/State/ZIP• "y p�
e . Footing drain(no.linear ft.. ) Page 2
Suite/bldg./apt.no.. ( Project name: 00►►% Lai Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear tl.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service no.linear ft.. Page 2
Subdivision: Lot no: Fixture or item:
Tax map/parcel no.: JU/ y.) Backflow preventer 31.27
`� Backwater valve 12.51
DESCRI ION OF WORT{
n /� p J �+ I I_ Clothes washer 25.02
r -FAr' t O"S1M Ks/ 3 Floor shift 1- WA�KIP Dishwasher 25.02
1 ! htdv ( " fGL 1,0)( Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink:hub 1 25.02 -� -�i Lib Address: 5
Garbage dispo al 25.02
City/State/ZIP' Hose bib 25.02
Phone:( ) Fax:( ) Ice maker I 12.51 51 ,
0 APPLICANT d] CONTACT POISON Interceptor/grouse trap 25.02
Business name: I Medical gas(vahie:$_) Page 2
I Primer A% 12.51 ) - e
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory % , 25.02 hiaif,
City/State/ZIP Solar units(potable water) 62.54
Phone:( ) Fax: (I. ) Tub/shower/shower pan 12.51
F-mail. Urinal 25.02
CONTRACTOR
Water closet 25.02
Water heater ' 37.52 37 S)-
Business name: tif Pt1nikthi 9 T. Water piping/DWV 56.29
l
Address: (�zS CIE �t,WIDY�k Other: 25.02
City/State/ZIP: t/14tui1�� O,J' h/(?ZSubtotal 5-21,17
Phone:( 73) sic(.7 6 "t Fax:( I Minimum permit fee: $72.50
CCB Lie.. )ZZq 6 V Plumbing Lie.no_ ea Z(-1' Plan review (25"%of permit fee)
5
n n State surcharge(12%of permit4 fee) ),u
Authorizedsignuture. 4,`�.1 70...p,/{,�,,J TO'TALPERMIT FEE 31)�
Print name: Ill et it. Date. �Z� / This permit application expires if a permit is not obtained wit inlet,days
o-t r Z'�l EA 1 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I.iauildotlll'umibirLMU-1'mnitAppaoc: 10/01109 44o-wte1rt t0/02/CoM/wrn)
j e /' i t1 ?.,/vc,s(y4tre
1 ____________________.
,
Plumbing Permit Application - City of Tigard
Page 2- Supplemental Information
Fee Schedule: Residential Fir Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footag : Permit Fee:
Footing drain-le 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 S327.54
{ Sewer-each additional 100' 37.52 I
I 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 1 Minimum fee$72.50
' Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.001 $72.50 for the first$5,000.00 and S1.52 for
Id
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty. Fee(ea) Total 'II and including$10,000.00.
Inspection of existing plumbing or for $10,001.00to S25.000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr j each additional$100.00 or fraction thereof,to
'j (minimum charge-1/2 hour) I 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
1 Reinspection Fees 90.00;1tr I and including$50,000.00.
11 Additional plan review for revisions 9000:1nr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
'1 .(minimum charge 1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
it
it
Commercial Fixture Work:
'/ Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
1
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 than,apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font
i greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool/Whirlpool
❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall
Drive Thru as defined in Of'R9l8-780-0040.
Cuspidor/Water tUater Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurp4tse fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit isets of plans with any of the above.
Floor Drain/sink: -2" 3
3., Isometric or Riser Diagram
4., 0 Isometric or riser diagram is required for new buildings
-Car Wash Dram
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related 1
Ice Mach Drains Comments regarding fixture work:
Oil Separator(Gas Station) q047e_.e. )d)( J J :1 i^ )C-iG .rC7 xA/ .vsi1 t,(."C-1
Rec.Vehicle Dump Station AO- h. e I?'"I"-i/4 .47"r)4 9T�4,4h„C,,,s f /// , /?.
Shower: -Gang
-Stall
Sink: -Lay/Bar non-food related 8
-Bradley
Com/Sere/l.itil food related
-Service "Note: If the fixt4tre work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-'toilet plumbing permit elan be issued.
l trin al
Other Fixtures:
1:`.Building\Pennits\PLMF_PermitApp.doc 08/04/2011 2
1
Accumulative Sewer Tally
Tenant Name: ZOOM+CARE SWR# 2022-00004
TIGARD Site Address: 11956 SW GARDEN PLACE PLM# 2022-00010
Parcel#: 2S101 BB01300
Fixture \attic 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 3 6 3 6
-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 8 16 8 16
-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 11 22 11 22
Current Fixture Value 22 divided by 16= 1.375 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 22 divided by 16= 1.375 over (under) $ 8,397.30
Enter EDU Change Here 1.380 *
*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 TAGGAR'I'X2449 Date: 1/10/2022
Building Division
ote: 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.
IN
I:\Building\Sewer Tally\SewerTallySheet_6085_070121.xlsx