Permit CITY OF TIGARD PLUMBING PERMIT
111 E
COMMUNITY DEVELOPMENT Permit#: PLM2019-00227
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/03/2019
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 250
Project: Good Life Company Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Plumbing fixtures for tenant improvement: ADD(1)dishwasher, (1)garbage disposal,(1)ice maker(no drain to
sewer),(1)expansion tank,(1)water heater and(1)break room sink.
Contractor: WESTERN PLUMBING Owner: G&S FC LLC
9460 SW TIGARD AVE SUITE 101 16083 SW UPPER BOONES FERRY RD,
TIGARD, OR 97223 STE
TIGARD, OR 97224
PHONE: 503-639-5296 PHONE: 503-684-6000
FAX: 503-684-9015
FEES
Quantity Description Date Amount
1 ea Dishwasher 05/29/2019 $25.02
Specifics: 1 ea Garbage Disposal 05/29/2019 $25.02
1 ea Ice Maker 05/29/2019 $12.51
Type of Use: COM 1 ea Sink 05/29/2019 $25.02
Class of Work: ALT 1 12%State Surcharge- 05/29/2019 $10.51
Type of Const: Plumbing
Occupancy Grp: 1 ea Expansion Tank 06/03/2019 $12.51
Stories: 1 ea Water Heater 06/03/2019 $37.52
0 12%State Surcharge- 06/03/2019 $6.00
Plumbing
Total $154.11
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 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:
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 ADDlicatifiECEIVED
Building Fixtures
City of Tigard MAY 23 2019 Receivad c- 6""31, ,c /- pen,*iviet a 0/,,a02. 7
prom, 7
I Phi _ 13125 SW Hail Blvd.,Tigard,OR 97223_. .
Phone: 503.718.2439 Fax: 503.5‘146V OF fIPlan
GARD Review
flaten3 • Other Permit lisgt,c/€Ai,•••••
Inspection Line; 503.639.4175 3UILD1NG DIVISIO . Date Reedyilly Ma RI Set Page 2 for
Internal: Nettfred/Methedi SappIemental InformationInternal: www3i ."°v--.----gerd :. ...i:` -4tir Se,„itb,rLV:"..1
I
For*pedal Wennalion use checklist.0 New construction 0 Demolition
- Description 1 oty7 Ea, I Total
VAddition/altcration/replacement 0 Other: New I-2-famIly dwellings(includes 100 R.for each utility connection)
SFR(1)bath afttivictiolit.-;-' . . , .r .,..
cATECORY Or , ,_- 312.70
SFR(2)bath 437.78
0 1-end 2-family dwelling ,'I Commercial/industrial
, SFR(3)bath 500.32
' 0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
. 0 Master builder 0 Other: Fire sprinkler( sq.ft.) 1 Page 2
St Nitatedwribt01011)ih(itilok ' ' - Site utilities: ...a-
1011; ,''',-,..:...- '- - - ' ' '" ' • ' '` - Catch basin or arca drain 18.76
0
Job site address; ,I,% 'ei 6 I), 411 eV 1• ,„' s,t . 11A1 I,
Drywell,leach line,or trench drain 18.76
City/Stater/JP: ,,,,, 1, . ,(• 03(1 „
Alk"..........¢...r Footin• drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: ', 0 Project name; lbs. , ; 1 Manufactured home utilities . 50.03
ti
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76 •
I Sanitary sewer(no.linear It:..,,..„) Page 2
Storm sewer(no,linear ft,:____)
Page 2
Water semi°.(no.linear ft:......)
Page 2
112011-°'l no.: - titals; (nL ,j=,_____,____________
Backflow preventer 3117
Tax map/parcel no.:
• • ' - 13sekwater valve
DIEBattitliCKetWORK ,,..;- . , .,,, 12.51
Clothes washer 25.02
Ohl.'
,% l .A9 At OA 4 Dishwasher i 25.02
PfkCit _TAYA._1 Nkl,c1-1si. ) 0 A,i'L,r...--,4Cr t---,t-51 I's 1.--:Drinking fountain 25.02
Ejectors/sump _ .. 25.02
Expansion tank
CI ~kali 0,00 .•' . ' ' --‘.--' : la TEIWANT' --
12.51 /..-1 . ' /
Fixture/sewer cap 25.02
._- - - Floor drain/floor sink/hub 25.02
Address:
. 1, Garbage disposal I 25.02
City/State/ZIP: I Hose bib I 25.02
Phone:( ) Eall=11111111111111111. Ice maker \ 12.51 1 Q 61
' APPLICANT,,,,, ,--- ,.,i..77,treittfitl,Figgpkwc-, _,, Interceptor/grease trap 25.02
_ _ , - _, - , •--, ' - ' - -•' ' " - • - . ' Medical gas(value:$____/ I Page 2
Business name:Vklisxy\Pkumil Vag.., ,
Primer 12.51
Contact nameTax\ *own .
Roof drain(commercial) 12.51
Address:0 , .b ' .... ci. op, %1 i2.._ Sink/basin/lavatory k, 25.02 ,Z,(:)"1._
City/State/LI : _LILIWIFFAIMI Solar units(potable water) 62.54
I Phone:giA)(v -.•.524(0 Fax::( ) Tub/shower/shower pan 1 12.51
Urinal 25.02 . ,
i E-roail:CWIC LLIQ. tPc.ilnQ..
Cccrr water closet 25.02
Water heater --, i
37 ,.,.52 ,.., , 5"kr-
,
Business name:Western Plumbing,Inc. . Water piping/DWV 56.29 4.....;
. ,
Address:9460 SW Tigard Street,Suitt 101
1 _ _ . I Other
... 25.02-fff7).51
i City/State/ZIP:Tigard,OR 97223 _ Minimum permit fee: $72.50 Subtotal kgrosj5--
. „,.
"Aacg3
Phone:(503)639-5296 Pax:( ) . , ,
Plan review (25%of permit fee) , 11,,,„S'Iir
CCR Lie.:2439 Plumbing Lie.no.:3429P8
State surcharge(12%of permit fee)
Authorized signature: e' aipAtstuSsI9 TOTAL PERMIT FEE 9: C1/5
-
r
[ Print name: .)a_rck_ ! Date: This permit application expires if a permit is not obtained withinIOAsiys,a4
\,. flIA •1,1rA 810%1nafter it has bees accepted as complete.
*Fee methodology set by Tri-County Building Industry Senice agf
4 , //
I liwidingTermitslPLMV-PerrnitApp doc 10/01/09 440-4616T(10/02ROWWEB) /...., .
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Piummbi gittatt Aoatication - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Su ression S stems:
Site Ut;ta, :4* ` ("p,‘ at
Footing drain-1"100' 50.03 0 to 2.000 $121,90
rooting drain•each additional 100' 37.5220_,_0119.1,600 $169.44
3,601 to 7.200 .3233.20
Sewer-1st 100' 62,54 7101.and greater $327.54
Sewer-each addhiimal 100' 37.52
Water Service•1st 100' 62.54 Medical Gas Systems:
Water Service•each additions)100' 37.52 .. 11 _. — -1
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 510000.00 $72.50 for the first$5,000,00 and$1.52 for
each additional$100,00 or fraction thereof to
Other�ttit�li�str�' � :Hi*9' t�a I
and including$10,000,00..
Inspection()resisting plumbing or for S 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
Wu lmenimum charge-2 hotr8) 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 f'a con thereof.
I 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.
O ussi tl btFixtstre Tye*
Fixture Type Sr
Work Performed: Cupped Added Meeaa Plan review is required for any of the following.
Baptistry/FontPlease check all that apply.
Bath -Tub/Shower 0 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 0 Medical gas and vacuum systems for health care facilities.
-Qomestic 1 0 Any multipurpose fire sprinkler system.
kt k n____twin _ __ 0 Any complex structure as defined in OAR918-780-0040.
- Wash. . _
Floor Drain/sink -2" Submit 2,sets of plans with any of the above.
•3"
•4N s,
( Car Wash Drain d�t' U Isometric or riser diagram is required forw buildings
I garbage •Domesticnon-food r iv ' g
Disposal •Domestic-taxi related t t" that meet the qualifications above.
-Commercial-food related
•nd , fal•fbod
Ice Mack/Retie.Drains - - . . . . _
Oil Separator teas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station0�
Shower -Gang a�
-stag . C
Sink/l.ev •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 Extractorincrease of sewer EDUs,a sewer permit will be issued and
i
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: _ _
http:i/www.tigard-or.govidocument_eenteriisutlamg/Pale PermitApp.dtg
III Tenant Name: Good Life ComApanyccumulative Sewer Tally SWR# 2019-00168
TI C;A K D Site Address: 16083 SW Upper Boones Ferry Rd,Suite 250 PLM# 2019-00227
Parcel#: 2S113A B 00500
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
-3inch 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 0 1 2 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 I 0
TOTALS 0 0 0 0 2 4 2 4
Current Fixture Value 4 divided by 16= 0.250 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 4 divided by 16= 0.250 over (under) $ 1,412.50
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:
Authorized Name/Signature: Dianna Howse Date: 5/29/2019
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 Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\SewerTallySheet_5500_070118.xlsx
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
16083 SW UPPER BOONES FERRY RD 250, July 8, 2019 at 11 :33:57 AM
TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2019-00227
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor