Permit (2) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00004
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/06/2020
Parcel: 2S112DB00300
Jurisdiction: Tigard
Site address: 7257 SW KABLE LN 100
Project: Trane Subdivision:HERN PACIFIC TIGARD INDUSTRIAL Lot: 5
Project Description: Interior plumbing for TI:Capping (1)2"floor drain,(3)sinks, and(3)water closets;Adding(1)drinking fountain,(1)
shower stall,and(1)sink; Relocating(1)2"floor drain,(3)sinks,(1)water closet,and(1) urinal; Installing(1)water
heater.
Contractor: ALWAYS FAITHFUL PLUMBING LLC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 757 ATTN: N PIVEN
WILSONVILLE, OR 97070 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-780-9486 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 01/02/2020 $25.02
Specifics: 7 ea Fixture/Sewer Cap 01/02/2020 $175.14
2 ea Floor Drain/Floor Sink/Hub 01/02/2020 $50.04
Type of Use: COM 4 ea Sink 01/02/2020 $100.08
Class of Work: ALT 1 ea Tub/Shower/Shower Pan 01/02/2020 $12.51
Type of Const: 1 ea Urinal 01/02/2020 $25.02
Occupancy Grp: 1 ea Water Closet 01/02/2020 $25.02
Stories: 1 ea Water Heater 01/02/2020 $37.52
1 12%State Surcharge- 01/02/2020 $54.04
Plumbing
Total $504.39
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: a�^ 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 Application
Building Fixtures ECEi jE FOR OFFICE USE ONLY
!� Received
City of Tigard Date/B : /l ' - Permit No.: ;_t-Oak)L1
• 13125 SW Hall Blvd.,Tigard,OR 97223 ' Plan Review fJ T7 L �TJ c/ "v
Phone: 503.718.2439 Fax: 503.598.19<n' NA 2 LOU3Other Permit No.:
"YJQIV Dale/By: 6410a2dm-0
6)
943
T I G A R D Inspection Line: 503.639.4175 r� .�y t Qrt Dale Ready/By: lurk: ® See Page 2 for
Internet: www.tigard-or.gov _,a,:,,ii i�, OF , f + �t-` Notified/Method- - Supplemental Information
TYPE OF w ldILUINGIiivL 1t, N FEE* SCHEDULE
❑ New construction El Demolition For special information use checklist.
Description i Qty. I Ea. I Total
VIAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
El1-and 2-family dwelling In 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:
Job site address: 9-d5-3.- 5 .3 6-Q_. Li‘.-) .* 1'a Catch basin or area drain 18.76
City/State/ZIP: Ti('t(}` , b 1G.�r 9 Drywell,leach line,or trench drain 18.76
1 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: l JD(/) I Project name:-.1"Q 4r)C 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: I Lot no.: Fixture or item:
�.:5 i j Backflow prevents 31.27
Tax map/parcel no.:
:�-0 u
O Backwater valve 12.51
,. ,,,._n.,:>�.. .: DESC i�,, WORK
3 jam � aa8 PeMo Clothes herwas 25.02
7 � 3 CC.L � �j l �•D') I �5"` Dishwasher / 25.02
it ' I 1 C..i 3 L 1405 l I -r•D ! l 5 t,�L! I iiel/ 4 L !I ra,El Drinking fountain ✓ 1 25.02 G,�,
SNS71-U_ NeL3 1. 5i4o I500pirgit. Ejectors/sump 25.02
PROPERTY OWNER , : ,w ' ` ❑ TENANT Expansion tank / 12.51
C Fixture/sewer cap ✓ 7 25.02 j 75 f
Name: PHe 2u,S 1K
Address: 15350 ® 00 / - P 3 av1C GFarbage
drain/floor spo sink hub / 25.02 ,( t
� `�' l nnn x{�I-� Garbage disposal 25.02
City/State/ZIP:` (z r4-r_/ a g_ a }d a Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
4 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
% ,`C �n Medical gas(value:$ ) Page 2
Business name: R 1 r`6(J ITjt t i �l (!v C�
Primer 12.51
Contact name: Coe v( (1-1(}(y j ,0i Roof drain(commercial) 12.51
Address: Po $pk '5. - Sink/basin/lavatory ✓4 25.02 L Od), t
City/State/ZIP: 1,311_a 4 U i LLcJ_ OR- 9-3 Z,"3( ) Solar units(potable water) 62.54
Phone: J q c(J /_ Fax: : Tub/shower/shower pan
r� Urinal t/ I 25.02 a.5,6),
E-mail: ku.,3�-``scpi Fukupt,Aint3IN C (}f-{c}.CD✓`--\_
CONTRACTOR Water closet I 25.02 as,(�
r1 Water heater ✓✓✓/I 37.52 17.51
Business name: pt((.il F'A 1-kkki P(�LWIl�l'3 U Waterpiping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 415-6,3.5
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: a'-3Q.=cg eLA f/ /011 Plumbing Lie.no.:Ve)Ic(qo Plan review (25%of permit fee)
State surcharge(12%of permit fee) .„51-1.01 j
Authorized signature:if Q--- ((���_ TOTAL PERMIT FEE/5 L e/r
Print name: CO2E (',� dQ-(�1ece i.rt Date: This permit application expires if a permit is not obtained wi him 180 days
Yafter it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I^9uiidiog\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-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' 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
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
lCar Wash: -Each Stall New exterior plumbing site utilities for any complex structure
-)hive Thm as defined in OAR918-780-0040.
ElCuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El 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" I i
3" Isometric or Riser Diagram
4„ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture worrkk::`
Oil Separator(Gas Station) LGvrGvf foie" (srrr l/y/h' • 1h S k' '
Rec.Vehicle Dump Station C�, , d f /i, �� .� Anes
Shower: -Gang y 1 ��'""""^""'"""��, �.
-Stall `�j /fit W� C3J sr, <,c.. ,� /J•J
Sink: -Lav/Bar non-food related y( /
-Bradley
-Com/Serv/Util food related
-Service I *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 Extractorplumbing permit can be issued.
-Water Closet-Toilet 3
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
IN
e
II Accumulative Sewer Tally
Tenant Name: TRANS SWR# N/A
T i r n k D Site Address: 7257 SW KABLE LN SUITE 100 PLM# 2020-00004
Parcel#: 2S112DB00300
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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 1 2 0 -1 -2
-3inch 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 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 1 2 1 2
Sink:
-Lav/Bar-Non-Food Related 2 0 2 4 1 2 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 1 3 0 -1 -3
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 3 18 0 -3 -18
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 7 27 3 5 -4 -22
Current Fixture Value -22 divided by 16= -1.375 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -22 divided by 16= -1.375 over (under) $ (8,004.00)
Enter EDU Change Here -1.380 *
*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: ***CREDITS***
Authorized Name/Signature: BRANDEN TAGGART X 2449 Date: 1/2/2020
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.
1:\Building\Sewer'Pally\SewerTal lySh eet_5 800_070119.xlsx