Permit (8) „01CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
Permit#: PLM2019-00416
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439Date Issued: 10/15/2019
TIGARD 13125 1S135DD05106
Jurisdiction: Tigard
Site address: 11995 SW PACIFIC HWY
Project: Reclaimed Hair Salon&Spa Subdivision: None Lot: None
Project Description: Interior plumbing: Capping (8)hand wash sinks, relocating(2)hair wash sinks, and replacing (1)utility sink.
Contractor: TRUE BLUE PLUMBING LLC Owner: CCC PROPERTY MANAGEMENT LLC
3300 NW 185TH AVE#311 BY CHERI LETHIN
PORTLAND, OR 97229 2137 NW CEDAR VIEW LN
PORTLAND, OR 97229
PHONE: 503-747-9989 PHONE:
FAX:
FEES
Quantity Description Date Amount
8 ea Fixture/Sewer Cap 10/15/2019 $200.16
Specifics: 3 ea Sink 10/15/2019 $75.06
1 12%State Surcharge- 10/15/2019 $33.03
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $308.25
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: 9'`� ., ,.-�" Permittee Signature: Imo”
f
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 RECEIVE., FOR OFFI( F. I SI. OyI.1
•
City of Tigard OCT 1 Received
g Permit No.:
ig 13125 SW Hall Blvd.,Tigard,OR 97223 ZQ�g Date/By: /4)// 7/M �-- /4/13).417d�)�
S Plan Review
Phone: 503.718.2439 Fax: 503.598.1p�q�y,� r, Date/By: Other Permit No.:
Inspection Line: 503.639.4175 ESI I I OF ��r „ Date Read/B kris: H See Page 2 for
TIGARD � ��l +"�l101 Ready/By: g
Internet: www.tigard-or.gov 11i1 T Notified/Method: j?c Supplemental Information
TYPE OF WORK FEE* SCHEDULE
I]New construction 111 Demolition For special information use checklist.
Description Qty. 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
El1-and 2-family dwelling t Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
r Catch basin or area drain 18.76
Job site address: 1 1 995 rj 7 pL (_' 6. 14-4, )
City/State/Z1P: `�; �Qp r d 0'� 9zZZ3 Drywell,leach line,or trench drain 18.76
c J Vat
drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: A&L 13.li+'l:e'e1 tta}I- Vat Manufactured home utilities 50.03
Cross street/directions to job site: ST2 Manholes I8.76
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: /5 If 3.;--60J', /ti(p I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
_ j, Clothes washer 25.02
--{'t S'faj( 11 r3:.(1 t,30.. ti' 5 'P1 1f5 •-� Dishwasher 25.02
• \
‘ Ct ( 1--F-I r vt is
A. .� Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap g 25.02 960. I t
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
e �(c
Business name: r�'-(�(e 13((,I .(04i l, Medical gas(value:$ ) Page 2
n fS R 1 '1 Primer 12.51
�
Contact name: !; /
_ A Roof drain(commercial) 12.51
Address: 3 300 ,N W f b /`f-(147). 1 f Sink/basin/lavatory 25.02
City/State/ZIP: 'CJI'-1-1-da,
j) , O < 9722 9 Solar units(potable water) 62.54
Phone:( ) 3 �6 2 Fax::( ) Tub/shower/shower pan 12.51
E-mail: J-(`C i [.�C G Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: 57 Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: A „..--
Subtotal pC 7s,jk
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: l 97 9/Cj 0 Plumbing Lic.no.: F5 i 2c9 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 33 t'3
Authorized signature: TOTAL PERMIT FE 306
�� This permit application expires if a permit is not obtained wi n 180 days
-0-a �M
Print name: " .c -tJ l e{� Date: 1C)- ( (� 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-1S1 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 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
l� 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Anynew commercial buildingwith water service 2"and
❑
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
111Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 111 Any multipurpose fire sprinkler system.
Domestic 111 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"
3" Isometric 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 A7-e t'MTE- `�) /! f2. S S�ti'�S
fe-EY'[1
-Stall 9-C� ' r1 /G c. r 7'7" Sin im
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related j
-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
Tenant Name: RECLAIMED ILUR SALON&SPA SWR# N/A
TIGARD Site Address: 11995 SW PACIFIC HWY PLM# 2019-00416
Parcel#: 1S1 35DD051 06
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 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 FIP) 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 8 16 0 -8 -16
-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
'I'OTA]S 0 0 8 16 0 0 -8 -16
Current Fixture Value -16 divided by 16= -1.000 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -16 divided by 16= -1.000 over (under) $ (5,800.00)
Enter EDU Change Here -1.000 *
*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: 10/15/2019
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:ABuilding\Sewer Tally\Sewer 1'allySheet_5800_070119.xlsx