Permit (2) CITY OF TIGARD PLUMBING PERMIT
INCOMMUNITY DEVELOPMENT Permit#: PLM2019-00393
Date Issued: 10/17/2019
T i(1 A if.f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S115BA00100
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY N
Project: Planet Fitness Subdivision: None Lot: None
Project Description: 10 feet of a new 2-inch water service and(1)backflow preventer.
Contractor: WILLAMETTE CONSTRUCTION Owner: TECOLOTE RESOURCES INC
8823 NORTH HARBORGATE ST KELLY'S LEGACY LLC, ET AL
PORLAND, OR 97203 BY HESSLIN HOLDINGS INC
23421 SOUTH POINTE DR STE 270
LAGUNA HILLS, CA 92653
PHONE: 503-239-6858 PHONE: 503-764-7595
FAX:
FEES
Quantity Description Date Amount
10 If Water Service 10/17/2019 $62.54
Specifics: 1 ea Backflow Preventer 10/17/2019 $31.27
1 12%State Surcharge- 10/17/2019 $11.26
Type of Use: COM Plumbing
Class of Work: ALT 1 Plan Review 10/17/2019 $23.45
Type of Const:
Occupancy Grp:
Stories:
Total $128.52
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 ad.pted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-90 Yo may ob .in a copy of the rules
or direct questions to OUNC by calling 503.232.19 or 1.801 332. 44. C--! r
t
Issued By: �/ Permittee Signature: '- v.._
ti
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.
9' -Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLY
rip: Received Permit N C- n
City of Tigard CE � DateBy: !L" /i ��� � o�G'/� ��5%�
III
n 13125 SW Hall Blvd.,Tigard,OR 97 2 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 C 2 6 2Q�g Date/By: 10*.fU Alf /0Other Permit No.:
.
Inspection Line: 503.639.4175 SGP Date Ready/By: /, Juris HI See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: %f 15.714 /37r Supplemental Information
TYPE OF WORK- x FIE* SCHEDULE
tvatt.„. ,,,
t For special information use check[isG
❑New construction e o Ikon Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
437.78
0 1-and 2-family dwelling ® SFR(2)bath Commercial/industrial SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address:16200 SW Pacific Highway Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97204 / 't4- /LF T /=%T/si&-S Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: A/ I Project name: i own quare Manufactured home utilities 50.03
Cross street/directions to job site:HWY 99 and Durham RD
Manholes 18.76
Shopping Center
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:80 Page 2 62.54
Subdivision: Lot no.: Fixture or item:
Backflow preventer 1 31.27 31.27
Tax map/parcel no.: Backwater valve 12.51
DESCRIPTION OF WORK Clothes washer 25.02
Install New 2-inch domestic Water Service and Meter Dishwasher 25.02
Drinking fountain 25.02
_
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT
Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( )
Ice maker 12.51
® APPLICANT 0 CONTACT PERSON
Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:WCSI DBA Laneco Primer 12.51
Contact name:Mike Moore Roof drain(commercial) 12.51
Address:8823 N Harborgate Sink/basin/lavatory 25.02
City/State/ZIP:Portland OR 97203
Solar units(potable water) 62.54
Phone:(503)239-6858 I Fax::(503)232-6130
Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:mike.moore@lanccoinc.com Water closet 25.02
CONTRACTOR Water heater 37.52
Business name:WCSI DBA Laneco Water piping/DWV 56.29
Address:8823 N Harborgate
Other:Meter 1 25.02 25.02
Subtotal 118.83
City/State/ZIP:Portland OR 97203 Minimum permit fee: $72.50
Phone:(503)239-6858 Fax:(503)232-6130 Plan review (25%of permit fee) _ 29.71
CCB Lic.:221268 - PI bing Lic.no.:PB2067 - State surcharge(12%of permit fee) 14.26
1 TOTAL PERMIT FEE 16
Authorized signature: ����
This permit application expires if a permit is not obtained within 180 days
Print name:Michael G.Moore Date:Sept 26,2 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
440-4616T(10/02/COM/WEB) f I 50.1'
I:\Building�Permits�PLMU-PermitApp.doc 10/01/09 '4
f Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ca) 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' 1 62.54 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 t, f' *at
eachadditional
10,$10.00 or fraction thereof,to
� � nG e� 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
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 ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay -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:\t.4c.,Ve \ .
J:\2.CURRENT CONTRACTS\195460-CIV-TIGARD TOWNE SQUAIE\PERMITS\PLMU PermitApp.doc
Plumbing Permit Application
Site Utilities FOR OFFICE I SE O\1.A
City of Tigard ReceivedB / fll 1 J,1(/ 347.1
g Date16111" // Permit No.:1 `{v l( / J
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �t`'p
I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: to--to"1 ( C Other Permit No.:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: iZi See Page 2 for
Internet: www.tigard-or.gov Notified/Method: it / t.1 Supplemental Information
TYPE OF WORK 8' `w"114 t t ny,tre. FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-and 2-family dwelling X Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: i b s i0_ per, LLL. Catch basin or area drain 18.76
Y'L_ ct! Drywell,leach line,or trench drain 18.76
City/State/ZIP: -rierk i 9') Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Ni. I Project name: Pt GIiA.Qt r {Ae,s 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.: IU') I Page 2 6;..54
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31,lii
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
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: 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
Urinal 25.02
E-mail:
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal x{3.8
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) 013.45
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee) a I.2 Es
Authorized signature: TOTAL PERMIT FEE i28.$a
Date: This permit application expires if a permit is not obtained within 180 days
Print name: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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) 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 $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' / 62.54 4,;,,,$y 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: r?(11-54
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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for anyof the following.
Performed: Capped Added Relocate �1
Baptistry/Font Please 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.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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 Isometric or Riser Diagram
Car Wash Drain
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 Mach./Refrig.Drains
Oil Separator(Gas Station) 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:
I:\Building\Permits\PLMU_PermitApp.doc 2
•
Site Utilities — Plumbing Permit Application
III
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map& tax lot# El project name ❑ site address ❑ suite number
El zoning El applicant name El phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS -Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Permits\PLMF-PermitApp.doc 12/30/05