Permit (201) CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM2019-00210
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/20/2019
Parcel: 2S112DA01200
Jurisdiction:
Site address: 15060 SW SEQUOIA PKWY
Project: Office Depot Subdivision: 1995-098 PARTITION PLAT Lot: 3
Project Description: Interior plumbing:Capping(1)dishwasher, (1)ice machine,(3)sinks,and (1)water heater.
Contractor: EVOLUTION PLUMBING LLC Owner: PACIFIC REALTY ASSOCIATES
7715 NE 33RD DR SUITE D ATTN: N PIVEN
PORTLAND, OR 97211 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
6 ea Fixture/Sewer Cap 05/17/2019 $150.12
Specifics: 1 12%State Surcharge- 05/17/2019 $18.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $168.13
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: fle,et..c .
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 4® FOR oriICE LSE ONL\'
City of Tigard �® Rece" Permit No.:
• 13125 SW Hall Blvd.,Tigard,t• %�� DatelBy: 5-7/3/i4 - ���'! {�
Plan Review
CI
' I Phone: 503.718.2439 Fax: 2� '.,1960 Date/B Other Permit No.• 1"."6/0(23
r l 1 It l� Inspection Line: 503.639.4175 P`� GPe`(* Date Ready/By: See Page
Internet www tigard-or.gov "(\ S\ Notified/Method: form n
,•n , .-,' ;ice� "�,. " . � �s ' ,, ..Wµi e ' :,
❑New construction ■..ti; . ttlon For special information use checklist
Description f Qty. I Ea. I Total
al Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
`' � r �'S•
?��➢'r*��, � sin, - s ,2 y v f - -
t S"M 111MWA1 ISI S ly FMt i - SFR(1)bath 312.70
❑ 1-and 2-famil y dwellin SFR(2)bath 437.78
g ®Commercial/industrial
El Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 OtherFire sprinkler( sq.ft.) Page 2
.,..,. ..r , . � � AI H r ' Vi'`'i Site utilities:
Job site address: t6(V1) \n' ,Gj1,u6t� p„r�i ` , Catch basin or area drain I8.76
t�+ �' fa
V� Drywell,leach line,or trench drain 18.76
City/State/ZIP: --road tK 'l722-
JFooting drain(no.linear ft.:,) Page 2
Suite/bldg./apt.no.: Project name: Cif)( �' .Q ''i "' 1 Ct}-4GIZ1 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.: t��/i Oji k4 j) Backflow preventer 31.27
' ''{g }-` 111K r ?a" .4.; Backwater 6 ve
1251
MiNAggamiamomXI Clothes was et 25.02
,tum ) remblAel of e-Xotino Sal ct' Dishwasher
25.02 22.
Drinking fountain 25.02
Ejectors/sump 25.02
MatigatliiiiMaitIOER,lgegn-MRFOPONtitititweinintet, Expansion tank 1 12.51
Name: Fixture/sewer cap /_ 25.02 1 �.,
Floor drain/floor sink/hub l�/ 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax ( ) Ice maker 12.51 '/
r
3 „( a .; * 4 '' 4 t 7. Interceptor/grease trap 25.02
Business name: v}i « �� Medical gas(value:$ ) Page 2
Contact name:&VA OA t I ' t/`� 'mom 12.51
Roof drain(commercial) 12.51
Address:"ID b '� �'1 Sink/basin/lavatory 25.02 2,,,1-,-(7:0
City/State/ZIP: 1(1,/A O( � Solar units(potable water) 62.54
Phone:(rjb ) Q -- 6,1't Fax::( ) Tub/shower/shower pan 12.51
E-mail:(SV ICIIYV/ . is( eVb 0 l�t m Urinal 25.02
s e W, ,.s i't..0 i'" Ar�71� �� g w Water closet 25.02
... / .+.`�,:n? .,,.r,..... ...t s..,..r'1...... ...M" .? ... .,v.'.a.x .^.<tN.k"-' Water heater ; }"
� �}.� �� 37.52 x,57'6t
Business name: \J 1 ) Umbi UL Water piping/DWV 56.29
Address:--121b i .E `i ,r J Other: 25.02
City/State/ZIP: :ty(VIM) 6 `lua Subtotal L504
Phone:( • ?g Fax:( ) Minimum permit fee: $72.50
CCB Lie.: I.78017-1(Q Plumbing Lic.no.:IS Li.
Plan review (25%of permit fee)
Authorized signature: State surcharge of permit fee) l
• TOTALTAA PERMIT FEE el, f /(4 (3
Print name: kciivi
t 7aS I Date:OS•13. ThisTpermit application expires if a permit is not obtained within 181 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:1 Building\Permits',PLMU•PermitApp.doc 10101/O9 440-4616T(10/02/COMM1VEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
':Y n_ ".s'.�-°4 "t a.^ 7 wrw.fi^' 1 r' r s...e _a w--e .c.. . .SG '-r" ._
r ,,,,,,,,,,pm---yo, ,�r Su,F�t a 4:`,� .. .... ' i .a ,, it r - s 2 s rr
.. .a.. ....`s;., r.2 ;;, t m,..:,..rn:'..3 ,.,1 ,�'�.'„a s ... `.s,),,p t'e� �.a 51 u:. :c, �, � f t
Footing dram-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 -
Sewer-each additional 100' 37.52 -
7,201 and greater $327.54
Water Service-1st 100' 62.54Medical Gas Systems:
Water Service-each additional 100' 37.52 9�. x ,-£ 0..:-..4 h,
$1 3 t. ..5..000.,',16.,.�.".�>wr � ..":.:. .xt'� Sil r. ? .4:
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
d each additional$100.00 or fraction thereof,to
�#. „,-,e. i' i:::-:la,...,;-„,%.0A,„ 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/lu $50,001.00 and up $742.00 for the fust$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*.
Qnant y by Flxture'1'ipe c ~ �` ,y�:.:� f .
F:ixtute Type for Plan review is required for anyof the following.
'VVnrk rertormea..°::. ... C4PP4t[ !latdea 3tetxats e9 $•
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -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 J 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 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"
x
Car Wash Drain - -`ti„4r -...nr.t .i1� 41A.,r x...........'A
Garbage -Domestic-non-food [1 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) i Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
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: V4-leal() 1
C:\Users\evo\Downloads\PLMF_PermitApp(1).doc 2
IIIAccumulative Sewer Tally
>: Tenant Name: OFFICE DEPOT SWR# N/A
TIGARD Site Address: 15060 SW SEQUOIA PKWY PLM# 2019-00210
Parcel#: 2S112 DA01200
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 1 4 0 -1 -4
-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 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 1 1 0 -1 -1
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:
-Lay/Bar-Non-Food Related 2 0 3 6 0 -3 -6
-Bradley 5 0 0 0 0 0
-Com/Sere/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 5 11 0 0 -5 -11
Current Fixture Value -11 divided by 16= -0.688 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -11 divided by 16= -0.688 over (under) $ (3,898.50)
Enter EDU Change Here -0.690 *
*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: 5/16/2019
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 Buildin: Division to redeem credits towards future astern development charges.
I:\Building\Sewer Tally\SewerTallySheet_5500_070118.xlsx
•
MVOLLITION
COMMERCIAL RL UMB/NG
OR CCB#189876`WA Lic#EVOLUPL908DK
FAX COVERSHEET
Date: May 13,2019
To: City of Tigard
From: Shaine Pasi
Fax: 1-503-598-1960
Subject: Plumbing Permit Application
Address: 15060 SW Sequoia Pkwy,Tigard,OR 97224
************************************************************************
To Whom This May Concern:
The following is the plumbing permit application for the above mentioned address.
Please email me at shaina.pasiPevoplumbing.net with any questions or concerns or call
our office between 9am-3pm, Monday-Friday. Thank you.
Sincerely,
Shaina Pasi
Office Manager
Total#of pages (including coversheet)3
Office 503-655-3388 1 Fax 503-305-8373 1 7210 NE 47th Avenue,Portland,OR 97218
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15060 SW SEQUOIA PKWY, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2019-00210
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Final plumbing for new sink-Approved
Violation Summary:
Inspector Contractor