Permit (4) IN CITY OF TIGARD PLUMBING PERMIT
Permit#: PLM2019 00423
COMMUNITY DEVELOPMENT Date Issued: 10/23/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S134B000300
Jurisdiction: Tigard
Site address: 12264 SW SCHOLLS FERRY RD
Project: Restore Cryotherapy Tigard Subdivision: None Lot: None
Project Description: Interior plumbing for TI:
Contractor: WESTERN PLUMBING Owner: FW OR-GREENWAY TOWN CENTER LLC
9460 SW TIGARD AVE SUITE 101 PO BOX 790830
TIGARD, OR 97223 SAN ANTONIO,TX 78279
PHONE:
503-639-5296 360-823-7223
FAX: 503-684-9015
FEES
Quantity Description Date Amount
1 ea Clothes Washer 10/21/2019 $25.02
Specifics: 1 ea Drinking Fountain 10/21/2019 $25.02
3 ea Fixture/Sewer Cap 10/21/2019 $75.06
Type of Use: COM 3 ea Floor Drain/Floor Sink/Hub 10/21/2019 $75.06
Class of Work: ALT 1 ea Sink 10/21/2019 $25.02
Type of Const: 1 ea Tub/Shower/Shower Pan 10/21/2019 $12.51
Occupancy Grp: 1 ea Water Closet 10/21/2019 $25.02
Stories: 1 12%State Surcharge- 10/21/2019 $31.53
Plumbing
Total $294.24
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.
Permittee Signature: // ,Jf
Issued By: Y / iC
40.
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 ECEIVE �°
City of Tigard OCT 14 2019 Received I f
- tate By: !d/�Ty;4., Permit No.: D/�4'��`L�_0(..)1,23
III
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review /��+r l'`
Phone: 503.718.2439 Fax: 503.598.IY Other Permit No. F' ICT
OF TIGARD Da'e/By. oddY
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: �----SToonnsrss�-, ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist.
0 Neve construction ❑Demolition
Description I Qty. I Ea. I Total
Z Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 Il.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial
SFR(2)bath 437.78
SFR(3)bath 500.32
0 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: 12264 SW Scholls Ferry Road Catch basin or area drain 18.76
Drywell.leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Restore Cryotherapy 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: /573/0(....a)
30.D I Lot no.: Fixture or item:
'Fax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer I 25.02 25.02
Interior TI Dishwasher 25.02
Building Permit#BUP2019-00200 Drinking fountain 1 25.02 25.022
Ejectors/sump 25.02
® PROPERTY OWNER l 0 TENANT Expansion tank 12.51
Fixture/sewer cap 3 25.02 75.06
Name:FW OR-Greenway Town Center LLC
Floor drain/floor sink/hub 3 25.02 75.06
Address:PO Box 790830 Garbage disposal 25.02
City/State/ZIP:San Antonio,TX 78279 (lose bib 25,02
Phone:(360)823-7223 Fax:( ) Ice maker 12.51
®APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:Western Plumbing,Inc.
Primer 12.51
Contact name:Dana Jensen Roof drain(commercial) 12.51
Address:9460 SW Tigard Street,Suite 101 Sink/basin/lavatory' I 25.02 25.02
City/Stale/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)639-5296 Fax::( ) Tub/shower/shower pan I 12.51 12.51
Urinal 25.02
E-mail:dana(a)westernplumbinginc.com
Water closet I 25.02 25.02
CONTRACTOR 37.52
Water heater
Business name:Western Plumbing,Inc. Water piping/DWV 56.29
Address:9460 SW Tigard Street,Suite 101 Other: 25.02 2L ,-Il
City/State/ZIP:Tigard,OR 97223 Subtotal �""V
or
Phone:(503)639-5296 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
C('13 Tic.:2439 Plumbing Lic.no.:3429PB
/ State surcharge(12%of permit fee) 31, 65-3
-lii
Authorized signature:r, 11' 1� TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180.days `.
Print name:Dana Jensen Date: 10/14/19 after it has been accepted as complete. st.
*Fee methodology set by Tri-County Building Industry Service Board.
I',nuilding\Permits\I'LMLI-Permit.App.doe 10/01/00 440-4414T110/02/COMTWBi)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee lea) Total Square Footage: Permit Fee:
Footing drain-I` 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 I 00' 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*.
Quantic by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required forof the following.
Work Performed: Capped Added Relocate 9 any owg
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/w'hirlp<,ol greater-except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 1 ❑ Any complex structure as defined in OAR918-780-0040.
Eve Wash
Floor Drain/sink -2" 3 Submit 2 sets of plans with any of the above.
3..
4.. Isometric or Riser Diagram •
Car Wash Drain
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-toad related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall I I
Sink/Lav -Non-food related I 1
-Bradley
-Commercial-food related
-Service
swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes I
Water Extractorincrease of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet I I fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
haps://www.tigard-or.gov/document_center/Building/PI,M F_PermitApp.ge