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Permit
CITY OF TIGARD PLUMBING PERMIT 11111- 2 •� COMMUNITY DEVELOPMENT Permit#: PLM2020 00045 Date Issued: 01/28/2020 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135DD01800 Jurisdiction: Tigard Site address: 11565 SW HALL BLVD 180 Project: Paulson's Floor Coverings Subdivision: None Lot: None Project Description: Interior plumbing for showroom remodel: Capping (1)shower stall, (14)sinks, (1)clothes washer, (2)water closets,(1)urinal,and(5) manicure chairs;Adding(1)garbage disposal, (3)sinks,and(2)water closets; Replacing (1)ice maker. Contractor: VENNE PLUMBING LLC Owner: TV5 LLC 15145 SW DIVISION ST 10855 SW CASCADE BLVD SHERWOOD, OR 97140 TIGARD, OR 97223 PHONE: 503-620-7080 503-624-9309 FAX: 503-684-0940 FEES Quantity Description Date Amount 24 ea Fixture/Sewer Cap 01/28/2020 $600.48 Specifics: 1 ea Garbage Disposal 01/28/2020 $25.02 1 ea Ice Maker 01/28/2020 $12.51 Type of Use: COM 3 ea Sink 01/28/2020 $75.06 Class of Work: ALT 2 ea Water Closet 01/28/2020 $50.04 Type of Const: 1 12%State Surcharge- 01/28/2020 $91.57 Occupancy Grp: Plumbing Stories: Total $854.68 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: ' -.Rermittee Signature: 6 ' /> 4 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 �-,'1 FOR OFFICE USE ONLY RFL: 4 Cityof Tigard -" � s ti Received t g ' n I)_ , Pennit No.: i_Mh p_ y tis - • 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:v �7J ` t.N L Plan Review r, Phone: 503.718.2439 Fax: 503.598.1;(1:N 2 u 202 Date/By: Other Permit No.aU, ,f(1,...6)`32 Inspection Line: 503.639.4175 rL F2 V L T 1 C A R D Internet: www.tigard-or.gov f . I�/ fie Note Rd Juris: Supplemental See Page Informationfnr Notified/Method: .�ir� TYPE OF WORK FEE* SCHEDULE El New construction Ill Demolition For special information use checklist. Description Qty. Ea. Total XAddition/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 Commercial/industrial SFR(2)bath 437.78 buildingSFR(3)bath 500.32 ❑Accessory ❑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: I' 5(0c," 5 iV t G1%\ ,u L% Catch basin or area drain 18.76 City/State/ZIP: 1 and 0(z, Ct- ZL-2j Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: f 510 Project name: G�j t -t�l 1 s cIN S �o[)i Le/j, i"p SManufactured 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.:_) 1 Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: 1 Lot no.: Fixture or item: Tax map/parcel no.: i.5/3 5-,)0 0 i lUc9 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 t Clothes washer 25.02 c Pa U I S c S h.( (c m m -c. l,z\ Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap O`� 25.02 V 6).61 7 Floor drain/floor sink/hub ( 25.02 Address: Garbage disposal I 25.02 3_9 0), City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker ( 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: ve,An e P1VrrbinP\ Contact name: (� i , Primer 12.51 ` `�A t1 �/e h(1 Roof drain(commercial) 12.51 Address: '5 1 Li 5 S W 0 1 v+S l on S Sink/basin/lavatory 3 25.02 75 . 6(4" City/State/ZIP:CJV\t.c W OOC, 0 Ci - 4() Solar units(potable water) 62.54 Phone:( )3) Co 2 L. 61 O C. Fax::( ) Tub/shower/shower pan 12.51 E-mail: e i'- (x p\u'+M k i in OF' C) N Y a 1 ‘ •(ern Urinal 25.02 CONTRACTOR Water closet 2 25.02 5-C, Water heater 37.52 Business name: Ve\,nt 1,kv VY\ I c.LA Water piping/DWV 56.29 Address: 15 l t45 S v) 7 l v l S1 on S{- Other: 25.02 City/State/ZIP: S'n ect 3 006 O CZ c11-k4 ) Subtotal 7co3_i 1 Phone:(r ) (02 N "i ©Gii Fax:( ) Minimum permit fee: $72.50 CCB Lic.: g 2 y 9 LI Plumbing Lic.no.: q Gj Plan review (25%of permit fee) State surcharge(12%of permit fee) q/.P37 Authorized signature: TOTAL PERMIT FEE 2-5y 6,5 p This permit application expires if a permit is not obtained within 180 days Print name: (-Ip �y Date: l Z fj I ZG�ZG after it has been accepted as complete. t *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't 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 p 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 ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru ❑ Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic El 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 4" 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) (, '>)PICsN,`c*t cr GA eVe-'; C;'l ?::.e/ Rec.Vehicle Dump Station tiS �` 4� (L<-.v) YWC � 1`1tJ'''-•�1. /Z,:'�'T Shower: -Gang cry -Stall l/I et){) �.x j ��' - z S. C. a _� Sink: -Iav/Bar non-food related H -Bradley -Com/Serv/Util food related -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 Z. plumbing permit can be issued. Urinal Other Fixtures: /3 ,, j 4* r) I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Accumulative Sewer Tally III ■ m Tenant Name: PAULSON'S FLOOR COVERINGS SWR# N/A Site Address: 11565 SW HALL BLVD SUITE 180 PLM# 2020-00045 TIGARD Parcel#: 1S135DD01800 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 HP) 16 0 0 1 16 1 16 -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 1 2 0 -1 -2 Sink: -Lay/Bar-Non-Food Related 2 0 19 38 3 6 -16 -32 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-Food Related 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 1 6 0 -1 -6 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 2 12 2 12 0 0 Urinal 6 0 1 6 0 -1 -6 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 24 64 6 34 -18 -30 Current Fixture Value -30 divided by 16= -1.875 Current EDU 1 EDU= $5,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change -30 divided by 16= -1.875 over (under) $ (10,904.00) Enter EDU Change Here -1.880 * *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:***CREDTT*** (5)MANICURE CHAIR CAPS WERE ADDED TO(14)SINK CAPS FOR A TOTAL OF(19)SINK CAPS. Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 1/28/2020 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:A Building\Sewer Tally\Sewerl'allySheet_5800_070119.xlsx