Permit (176) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00261
Date Issued: 07/07/2020
T i G,AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101 BB01300
Jurisdiction: Tigard
Site address: 11950 SW GARDEN PL 100
Project: State of Oregon Employment Department Subdivision: CROW PARK 217 Lot: 1
Project Description: Cap(2)shower stalls and replace existing(2)shower stalls,(10)sinks.
Contractor: PMSI LLC Owner: BKM PARK BC 252 LLC
8295 NW EVERGREEN PKWY#204 1701 QUAIL ST STE 100
HILLSBORO, OR 97124 NEWPORT BEACH, CA 92660
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Quantity Description Date Amount
2 ea Fixture/Sewer Cap 07/07/2020 $50.04
Specifics: 2 ea Sink 07/07/2020 $50.04
8 ea Lavatories 07/07/2020 $200.16
Type of Use: COM 2 ea Tub/Shower/Shower Pan 07/07/2020 $25.02
Class of Work: ALT 1 12%State Surcharge- 07/07/2020 $39.03
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $364.29
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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / Permittee Signature: q
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 Ls::
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Building Fixtures �°'"®
City of Tigard J U N 1 b 2020 Received Permit N
• 13125 SW Hall Blvd.,Tigard. 97223 Datc/By �W2Q , �U'1 c 20 t Q Z4
:�/ Plan Review
' Phone: 503.718.2439 Fax: 503.5 '(r` i Other Permit No.:
Inspection Line 5p3.639.4175 ! If, y y, ® see Page 2 for
n Os.iic Ire.. ate Read/8 haic
t ltlAl2D Internet: www turd-or. uv t •'/ ' f� � ..f YI•.:.lt...
ba g MiCred/Method: Suppkmcntxl Information
( TYPE OF WORK I FEE* SCHEDULE
Far special in ormanon use checklist
0 New construction 0 Demolition -
--- Description city. Ea. Total
fil•Addition/alterationfreplaccment 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling Cammercialfindustriai 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. II.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address:11°ic)( . SG=' (..if,,;rJ, ,Th 3 //‘3,333,-4:7, Drywell,leach line,or trench drain 18.76
City/State/ZIP: 73 "?
�E i,,,,,,,,,A t Cif.? ..c..:.,..s Footing drain(no.linear ft.:_) Page 2
Suite/bldglapt.no.: Project name:` Manufactured home utilities 50.03
Cross street/directions to job site: /00 Si* s"- 0 0(Q. pa Manholes 18.76
��.-p(-0- 6.�T Rain drain connector 18.76
V Sanitary sewer(no.linear ft: ) 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.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
in,ia r, "'' „,, e.t,-,r,.k, )- Lc >rv,v-s,ctA ra..-se-1. r....-v r'r-SC`..-r Dishwasher 25.02
4- i r1,s4r%I e) s-hrl. (,,J�C .4- (.' Drinking fountain 25.02
1 Ejectors/sump 25.02
a PROPERTY OWNER '0 TENANT. Expansion tank 12.51
1 Fixture/sewer cap pL 25.02
Name:
1-1114 1 i ra r\-- )C i 1-.1_C Floor drain/floor sink/hub 25.02
Address: i 14a..)(T) Su) a t"1"7. p\rnC_c Garbage disposal 25.02
City/State/ZIP: --1"t, rk rA t 0:rsz_ ov-- ? «Z, Hose bib 25.02
Phone:( ) Fax:( ) lee maker 12.51
,ISrAPPLICANT. D CONTACT PERSON Interceptor/grease trap 25.02
Business name: 7M -T- j,.1-. Medical gas(value:$ ) Page 2
1 Primer 12.51
Contact name: I4rkr>ti ) ^°.'
�.t` C Roof dram(commercial) 12.51
Address:8 juE, errerc r'een sits. , -^i, Sink/basin/lavatory 25.02
City/State/ZIP: 1_411.\5 i OIL 4--i i zet4 Solar units(potable water) 62.54
Phone:(510 ) ' Fax::( ) Tub/shower/showerpan -2 12.51
Urinal 25.02
F-mail ,r. r'c
Water closet 25.02.
CONTRACTOR Water heater 37.52
Business name: pj`✓0*.,-k-I (* Water piping/DWV 56.29
Address: 2/r �./y.✓ �V�"r. r`c' ' �1CV j'. F�`St,C ZtC-{ Other: 25.02
_
City/State/ZIP: r`Cl 1 kv,e.,i,(-O (fix? t. -( 1z(,( Subtotal 32,5, 2
Phone:(G- -' -7 �7 7 , Fax:( )
Minimum permit fee: S72.50
� Plan review (25%of permit fee)
CCB Lic.. (-y -2 ts� Plumbing Lie.no.:eiozm . `ll
7 State surcharge(12°a of permit-fee) 39, CS
Authorized signature: 47 , ..2-t7 e . TOTAL PERMIT FEE 3Coq t
Print name: j �'�. Date: r 7„ y This permit application expires if a permit is nut obtained within 180 days
t>tti.C.. i 4C c--s 6„ii,t/.-C}..,b after it has beet:accepted as complete.
"t'cc methodology set by Tri-C runty Belding Industry Service Board.
t`:BuadingWermin'PLMU-Perm5App.Joe 1W01419 430-thl6T1 111/02/COMiWr:B)
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- 1"I00' i0.01 0 to 2,000 S 12I90
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 — -
$1.00to$5,000A0 ' 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) ?owl and including each $10.000ional 00 fraction thereof,to
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 lie 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 Replacer 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
Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure
Drive Tltru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial _ 0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain Submit 2 sets ofplans with anyof the above.
Eye Wash
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4„ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-rood
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 _fr -
.'�- r
-Stall tf�f/ ya.�
Sink: -Lav(Bar non-food related * lit lit; /Cn 'gv'' s* 7/7/+fGi
-Bradley i �a
-Com/Serv/Utit food related fLOG
-Service X,? ote: 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
Other Fixtures:
C\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
cum
II11111 .I Tenant Name: State of Oregon AcEmploymentulativ e Sewer Tally SWR# N/A
Site Address: 11950 SW Garden P1,#100 PLM# 2020-00261
TIGARD
Parcel#: 2S1 016801 300
Fixture Value Previous Previous Credits Capped Fixture Fixture New Ncw
# 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 I IP) 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 2 4 0 -2 -4
Sink:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-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 2 4 0 0 -2 -4
Current Fixture Value -4 divided by 16= -0.250 Current EDU 1 EDT..= 55,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -4 divided by 16= -0.250 over (under) S (1,450.00)
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: .25 EDU credit towards future fixtures added.
Authorized Name/Signature: Dianna Ornelas Date: 7/7/2020
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:Alluilding\Sewer Tally ASewerTallySheet_5800_070119.xlsx