Permit (196) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
11p1
Permit#: PLM2019-00203
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/13/2019
Parcel: 1S 126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 555
Project: V-Tech Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Capping(1)dishwasher,(1)2"floor drain,and(1)sink;Installing(2)ice makers.
Contractor: GRIDLINE PLUMBING Owner: TOWMAN ONE EMBASSY CENTRE LLC
14844 SW 109TH AVE BY TOWMAN LLC
TIGARD, OR 97224 25425 BASCOM AVE STE 230
CAMPBELL, CA 95008
PHONE: 971-275-6167
PHONE: 503-595-9685
FAX:
FEES
Quantity Description Date Amount
4 ea Fixture/Sewer Cap 05/13/2019 $100.08
Specifics: 2 ea Ice Maker 05/13/2019 $25.02
1 12%State Surcharge- 05/13/2019 $15.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $140.11
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 wor. : started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to s ow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-009rJ. You may obt.in a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.3 4d
Issued By: •ermd3ee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available insp A. ..
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 SSE ON I.)
Cityof Tigard � g
Received
Date/By: j/;; / 097- Permit No.:
"4/%0 y- jt� ?• 13125 SW Hall Blvd.,Tigard,OR,'
= Phone: 503.718.2439 Fax: 503 +,{� Plan Review Other Permit No.: �7 /
4N 10 Date/By: 84/0„ C(IL 1- t i.
Inspection Line: 503.639.4175 t L
1 I G A R D 40 t\ r�, Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov �+ •5Ci SupplementalInformation
��� C,tIott ed/Method:
TYPE'OF WORK m. " t7+ XSNO 7,-:-.74-
k ., "S IIEDWI -7-;
❑New construction ❑D 1 t� For special information use checklist
Description Qty. Ea. 1 Total
71-''Addition/alteration/replacement ❑ cher: 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 Commercial/industrial SFR(2)bath 437.78
❑Accessory building ElMulti-family
SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION LOC TION Site utilities:
Job site address: j ( ,���( // p Catch basin or area drain 18.76
// Drywell,leach line,or trench drain 18.76
City/State/ZIP: /
6(,, 7 Q Footing drain(no.linear ft.:_) Page 2
L
Suite/bldg./apt.no.: 1 I Project name: Manufactured home utilities 50.03
Cross
street/directionsstrto jobb'e: Ti;��� Manholes 18.76
t //L'. eP/X 2(- . ) .11t-'7- l 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
CRIP'jIOj OF W011ie Backwater valve 12.51
V 40 r j f , /_ / 4 f_/- �t Z,), Clothes washer 25.02
/ 7 �,t), /�yy s Dishwasher 25.02
/ ' (� Li a- i,c. / �'/ -et-prinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ,� TENANT' £ Expansion tank 12.51
Name: Fixture/sewer cap 11
25.02 1(A) 0
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 0_. 12.51
APPLICANT ❑ CONTACT sPERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
"' Water heater 37.52
Business name(;‘�G /�p� /7tv %s�Y� �� Waterpiping/DWV 56.29
Address:/41�3 c Other:
J ��� ��%� 25.02
City/State/ZIP: je j/ ( g72.2 Subtotal 4237 4 L
Phone:(7 7/))7 /b. Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 79/ dipPlumbing Lic.no.:,'�.,-(��1�
Plan review (25%of permit fee)
< State surcharge(12%of permit fee) 15. ctf
Authorized signature: TOTAL PERMIT FEE /li/j; %
Print name: -' / JJ,) Dater.173%9 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology-set by Tri-County Badding I.dunby Sr,vice Boanl.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty, Fee(ea)y Total Square Footage: , Permit Fee: _<
Footing drain-1"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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: ,
$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�� o 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*. M ..a Plan R:,r w'for Plumbing Ins i tions
Qaaatity by Fixture Type Plan review is required for any of the following.
Fixture Type for Repine Please check all that apply.
Work Performed: capped Addy' 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 ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
-Domestic X / 0 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" X /
3" icon tic or Riser Diagram, .. ..,
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food 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.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related )( /
-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\Permits\PLMF PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
a Tenant Name:V-TECH SWR# N/A
Site Address: 9020 SW WASHINGTON SQUARE RD. PLM# 2019-00203
TIGARD
Parcel#: 1S126BC01506
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 1 2 0 -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 1 2 0 -1 -2
-3 inch 5 0 0 0 0 0
-4inch 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 1 2 0 -1 -2
-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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 3 6 0 0 -3 -6
Current Fixture Value -6 divided by 16= -0.375 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -6 divided by 16= -0.375 over (under) $ (2,147.00)
Enter EDU Change Here -0.380 *
*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: ***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 5/13/2019
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 Buildino Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\SewerTallySheet_5500_070118.xlsx