Permit (6) CITY OF TIGARD PLUMBING PERMIT
11,„
COMMUNITY DEVELOPMENT Permit#: PLM2020-00010
T(GAR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/21/2020
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 400
Project: Miller Consulting Engineers Subdivision: ASHBROOK FARM Lot: 5
Project Description: Interior plumbing for TI: Capping(13)sinks and(2)water closets;Adding(1)dishwasher,(1)garbage disposal and
(1)shower stall; Replacing(2)floor drains, (2)sinks, and(1)water closet.
Contractor: JAMES ROOD PLUMBING INC Owner: PLAZA WEST OWNER LLC
125 S 1ST AVE#542 BY CHIEF FINANCIAL OFFICER
HILLSBORO, OR 97123 680 FIFTH AVE 20TH FL
NEW YORK, NY 10019
PHONE: 503-547-0491 PHONE: 503-542-5895
FAX: 503-547-0492
FEES
Quantity Description Date Amount
1 ea Dishwasher 01/21/2020 $25.02
Specifics: 15 ea Fixture/Sewer Cap 01/21/2020 $375.30
2 ea Floor Drain/Floor Sink/Hub 01/21/2020 $50.04
Type of Use: COM 1 ea Garbage Disposal 01/21/2020 $25.02
Class of Work: ALT 1 ea Ice Maker 01/21/2020 $12.51
Type of Const: 2 ea Primer 01/21/2020 $25.02
Occupancy Grp: 2 ea Sink 01/21/2020 $50.04
Stories: 1 ea Tub/Shower/Shower Pan 01/21/2020 $12.51
1 ea Water Closet 01/21/2020 $25.02
1 ea Water Heater 01/21/2020 $37.52
1 12%State Surcharge- 01/21/2020 $76.56
Plumbing
Total $714.56
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 totoOUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: /1 /'tl� ) Permittee Signature: �j/V ,. i,� ,�'�%7Cr
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 Application
' Building Fixtures 1 (m (1t FICE USE ON 1 l
Received
City of Tigard Date By: ) Permit No.: 0
w 13125 SW Hall Blvd.,Tigard.OR 97.:33,-,,:_,: t,..5,: i "" ' Plan Review
I Phone: 503.718.2439 Fax: 503.59R.Y960 /r� Other Permit No.:04,X/9`• Date/By: �✓ �4�:%9 X337
Inspection Linc: 503.639.4175 Date Ready/By: / �l , lnrn: See Pagc 2 for
TIG,\I [) Internet: www.tigard-or.gov Notified/Method: i/�/.�lJ / Supplemental Information
TYPE OF WORK iii��� ___ FEE SCHEDULE
For special information use checklist
0 New construction 0 Demolition
___- 4 Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling ACommercial/industrial
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.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 7400 SU b ' 543.01C-
' Catch basin or area drain 18.76
1well,leach line,or trench drain 18.76
City/State/ZIP: t't5 ti 4'' 9 7 2-3
Footing drain(no.linear ft.:_) Page 2
Suit Idg./apt.no.: A/QO Project name:M j 11pr 51;it Ce rt n5 Manufactured home utilities 50.03
ross street/directions to job site: Manholes 18.76
Rain dr tin connector 18.76
r Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: /5 /3_5-no Oa L 0(7) Lot no.: Fixture or item:
Tax map/parcel no.: Backtlow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
p / Clothes washer 25.02
I �L+.1►4 b� l4"rs :' t fl v/�D t Dishwasher .. // 25.02 2s-.0 2_
1. b recA5 d4*, S; , / P4-0.- ., 4 A4 Drinking fountain 25.02
oi
Int . / ,fh.4- Ejectors/sump 25.02
d PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap &/1.-./5*� 25.02 3 25:301
Name:
Floor drain/floor sink/hub / , 25.02 SO.69
Address: ✓J
Garbage disposal � 25.02 ,2 r 02_
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( I Ice maker / 12.51 /2.5/
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:S_) Page 2
�..-- Primer X 12.51 ,2 5.0 Z
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory ,/ ?1/4 25.02 sO,OY
City/State/ZIP: Solar u.uts(potable water) 62.54
Phone:( }
Fax::( ) Tub/shower/shower pan t/ 1 12.51 j)..S/
E-mail: Urinal 25.02
Water closet ,,/ ' / 25.02 .2 S„o 2.
CONTRACTOR Water heater 1 37.52 77" c.Z
Business name: Jar...,s htJ plKAbt► s-0,c, Waterpiping/DWV 56.29
Address: )al. S. 1st- Ga *5-9 2,.., Other:
Other: 25.02
City/State/ZIP:/t/j`biep0rr (,err, 5,11-3 Subtotal
Phone:(„'0) ) sty) 0149/ Fax:(,5'02) 519..0/$ 2.. Minimum permit fec: 572.50 (C 3f.,,-.9---
CCB Lie.: 11.'K Plumbing Lic.no.: i/S-459Plan review (2S®/°ofpemtit fee)
State surcharge(12%of permit fee)/
Authorized signature , .at TOTAL PERMIT FEFf?/l.1 .5 r.
Print name: '� Date: L f ) This permit appikatioa expires if•permit is not obtained within ISO days
' {,"� 'e, •0 s' eFV/V� after it has been accepted as compkte.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\HuiMing\Perm#s\PLMU-PennitApp.doc 10/01/09 410.46161)10/02/COM WEB)
Plambini Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fa(u) Total Square Footage: Permit Fee:
Footing drain-I" 100' 50.03 0 to 2.000 S121.90
Footingdrain-each additional 100' 37.52 2.001 to 3,600 $169.69
3,601 to 7.200 S233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service- 1st 10W 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Penult Fee:
Storm&Rain Drain-1st 100' 62.54 S1.00 to 55,000.("1 Minimum fee S72.50
Storm&Rain Drain-each additional 100' 37.52 $5.001.00 to$10,000.00 $72.50 for the first 55,000.00 and$1.52 for
Qtr. des(M) Tata each additional$100.00 or fraction thereof,to
Other Inspections or Feesand including$10,000.00.
Inspection of existing plumbing or for S10,001.00 to$25,000.00 S148.50 for the first S10,000.00 and S 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 525,000.00.
Inspections outside of normal business 90.00/hr 525,001.00 to S50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional S100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr 550,001.00 and up S742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional 5100.00 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*. Phe Review for ',-•• , . g�i �,, dons
Quaatiy by Fhtare Type Plan review is required for any of the following.
Fixture Type for Daae/ Please check all that apply.
Work Performed: Cad
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
as defined in OAR918-780-0040.
-Drive Thiry
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
-Domestic f 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
e Wash Submit 2 sets of plans with any of the above.
Floor Drat ink: -2" ,,
3' Is.etrk.or Riser 1,, g.
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage -Domestic non-food f that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehick Dump Station
Shower. -Gang
-Stall / ,
Sink: -Lav/Bar non-food related / 3 a.
-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
Water Closet-Toilet ?. / plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits1PLMF_PetmitApp.doc 08/04/2011 2
m
■ Tenant Name: MILLEREl nR I
uNlG• lative Sewer Tally SWR# N/A
TI G A K D Site Address: 9600 SW OAK ST. PLM# 2020-00010
Parcel#: 1S 135 B D00100
Fixture Value 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 1 2 1 2
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 1 16 1 16
-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 1 2 1 2
Sink:
-Lav/Bar-Non-Food Related 2 0 13 26 0 -13 -26
-Bradley 5 0 0 0 0 0
-Com/Sery/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 2 12 0 -2 -12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 15 38 3 20 -12 -18
Current Fixture Value -18 divided by 16= -1.125 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -18 divided by 16= -1.125 over (under) $ (6,554.00)
Enter EDU Change Here -1.130
*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: ***CREDI'TS***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 1/8/2020
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:ABuilding\Sewer Tally\SewerTallySheet_5800_070119.xlsx