Permit CITY OF TIGARD PLUMBING PERMIT
111
COMMUNITY DEVELOPMENT Permit#: PLM2018-00041
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/29/2018
Parcel: 1 S126DC80001
Jurisdiction: Tigard
Site address: 9385 SW LOCUST ST
Project: Halsey Street Professional Center LLC Subdivision: LOCUST OFFICE PARK CONDO Lot: 1
Project Description: CAP(6)exam sinks and replace/relocate water heater for tenant improvement for new tenant.
Contractor: POWER PLUMBING CO Owner: LOCUST STREET CLINIC LLC
PO BOX 19418 9385 SW LOCUST ST
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
6 ea Fixture/Sewer Cap 01/29/2018 $150.12
Specifics: 1 ea Water Heater 01/29/2018 $37.52
1 12%State Surcharge- 01/29/2018 $22.52
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $210.16
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:
0-4/
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 ► + ', FOR OFFICE ESE oN►.v
City of Tigard
JAN
3 Received s� M G
IIil 13125 SW Hall Blvd.,Tigard,OR 97223 /}1 i l 2018 Plan R Date/By: ��j /� Permit No L-� / �r7 poo�i
• Phone: 503.718 2439 Fax: 503.59 Plan Review
{ , Date/By: Other Permit No.:
i I v It D Inspection Line: 503.639.4175 ' -
Internet www.tigard-or.gov j 4 p i t`.', 9'` r Date Ready/By: Juris: H See Page 2 for
Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description I Qty. I 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 0 CommerciaVindustrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
0 Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9385 SW LOCUST ST Catch basin or area drain 18,76
City/State/ZIP:TIGARD,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldgiapt.no.: I Project name:18-835 S 7z�L ...3-j=7")-(:._ 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
Clothes washer 25.02
Dishwasher 25.02
TENANT IMPROVEMENT Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:
Floor drain/floor sink/hub 25.02
Fixture/sewer cap 4 /
25,02 5 el,Ip-
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO Medical gas(value:$ ) Page 2
Contact name:CHARLIE HALL Primer 12.51
Roof drain(commercial) /i.,�ay 12.51
Address:P.O.BOX 19418 Sink/basin/lavatory ,`f. ,.,1"' 25.02 '
City/State/ZIP:PORTLAND,OR 97280 Solar units(potable water) 7t 62.54
Phone:(503)244-1900 Fax::(503)244-8825 Tub/shower/shower pan 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 1 37.52 37.52
Business name:POWER PLUMBING CO Water piping/DWV 56.29
Address:6611 SW MULTNOMAH BLVD. Other: 25.02
City/State/ZIP:PORTLAND,OR 97223 Subtotal 187.64
Phone:(503)244-1900 Fax:(503)244-8825 Minimum permit fee: $72.50
CCB Lie.:52378 Plumbing Lic.no.:34-150PB Plan review (25%of permit fee)
`G ,�� State surcharge(12%of permit fee) 2.2131-
Authorized signature: _ `ft'(a- c. �L�r1
TOTAL PERMIT FEE 2..1-015-7-
Print name:KRISTI BRAMWELL Date:1-23-18 This permit application expires If a permit is not obtained within 180 days
after it has been accepted as complete. �y /�
*Fee methodology set by Tri-County Building industry Service Boar ,IO r/`°
1:4BuildingWermits5PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02ICOMJWEB)
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-l'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*.
an by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for anyof the following.
Work Performed: Capped A ded Relocate Please check all that apply.
g
Baptistry/Font I
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
Jacuzzi/Whirlpool r greater,except systems designed and stamped by licensed
CarWash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4"
Car Wash Drain Isometric or Riser Diagram
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice MachfRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related 6
-Bradley
-Commercial-food related Fl
-Service Fl
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: kt (.€f/ 1
C:\Users\Laura\Desktop\TIGARD PERMIT APP.doc 2
Accumulative Sewer Tally
i Tenant Name: Halsey Street Professional Center,LLC
TIGARD
Site Address: 9385 SW Locust St. SWR# N/A
Parcel#: 1S 126DC80001 PLM# 2018-00041
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 0 0 0
Drinking Fountain 1 0
Eye Wash 1 0 0 0 0
0 0 0 0
Floor Drain/Sink: -2 inch 2 0
0
-3 inch 5 0 0 0 0 0
-flinch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0
0 0 0 0
-Commercial(to 5 HP) 32 0
-Industrial(over 5 HP) 42 0
I 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 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
-Stall 2 0 0 0 0 0
Sink: 0 0 0 0
-Lay/Bar-Non-Food Related 2 0
-Bradley 5 6 0 -6 -12
0 0 0 0
-Com/Sery/Util-Food Related 3 0
0 0 0
Swimming Pool Filter 1 0 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
Urinal 6 0 0 0 0 0
0 0 0
Previous EDU Count 0 0
0
Capped EDU Credit 0
TOTALS 0 0
0 6 12 0 0
Current Fixture Value -12 -6 -12
divided by 16= -0.750 Current EDU
Previous Fixture Value 0 divided b 16 1 EDU= $5,500.00
Y = 0.000 Previous EDU
Change -12 divided by 16= -0.750
over (under) $ (4,125.00)
Enter EDU Change Here -0.750 *
*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: ***EDU CREDIT***
Authorized Name/Signature: Dianna Howse
Date: 1/29/2018
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
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
r
L\Building\Sewer Tally\SewerTallySheet_5500_070117.xlsx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9385 SW LOCUST ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00041
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Replace water heater-approved
Violation Summary:
Inspector Contractor