Permit CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM2019-00499
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/17/2019
TIGARD Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11525 SW DURHAM RD D-6
Project: Spec Space Subdivision: 1998-128 PARTITION PLAT Lot: 1
Project Description: Interior plumbing work prior to TI:Capping(1)shower stall and(5)sinks.
Contractor: GRIDLINE PLUMBING Owner: HIP WILLOWBROOK LLC
14844 SW 109TH AVE BY HARSCH INVESTMENT CORP
TIGARD, OR 97224 PO BOX 2708
PORTLAND, OR 97208
PHONE: 971-275-6167 PHONE:
FAX:
FEES
Quantity Description Date Amount
6 ea Fixture/Sewer Cap 12/17/2019 $150.12
Specifics: 1 12%State Surcharge- 12/17/2019 $18.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $168.13
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 foil. - . adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obt-'n a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Por-mittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available insp-cti. d e.
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 FOR OFFICE USE ONLY
City of Tigard �gp
�, Received
• 13125 SW Hall Blvd.,Tigard,OR 97273 sECEI�ED Davy: /� /7 (�/ far/ Permit No.:� �1 1_lAJ/y
.74
Plan Review `t
Phone: 503.718.2439 Fax: 503.598.1960 DEC2019 Date/By: Other Permit No.: /� AJ^��f('_ �//1
Inspection Line: 503.639.4175 E 1 v /`Pf�
1 I C A It D Date Ready/By: k ® See Page 2 for
Internet: www.tigard-or.gov ` )i }qL Notified/Method: 1 ' .. Supplemental Information
TYPE OF WORK D�1 Ni
(�1)f11NG DIVISION FEE* SCHEDULE
❑New construction 0Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
U 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
ID Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB TEINFORMATI AND L AT1ON �� Site utilities:
Job site address: , ) /� ' ,L Catch basin or area drain 18.76
City/State/ZIP: 7l 6.ezi- B/e 9'7Z _4 Drywell,leach line,or trench drain 18. 6
ling drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Dr4, I Project name: Ali//ipw le--, ufachved home utilities 50.03
Cross street/directions to job site: -€ 5 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:
Tax map/parcel no.: (9.-S/ e i), is Backflow preventer 31.27
Backwater valve 12.51
I 0 I rth i' Clothes washer 25.02
Dishwasher 25.02
Siv ^""r Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap X 6 25.02 /� r/.2.,,
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
1< , U APPLICANT ■ CONTACT PERSONInterceptor/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(
E-mail: Urinal 25.02
CONTRACT Water closet 25.02
/ t ,11
ig\ Water heater 37.52
Business name:/y v r h1! Vm i n
(� '`f, f� 9 Water piping/DW V 56.29
Address: /% - 7� 4' Al f/ 1. _ J , Other: 25.02
City/State/ZIP: 77: /69.1e �y7Z4rr Subtotal /50./Z
Phone:(ft,/) a.; / Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 7lf,O.Sr Plumbing Lic.no.:e24 - 999,iti Plan review (25%of pennit fee)
State surcharge(12%of permit fee) /r. 0
Authorized signature: . .f . TOTAL PERMIT FEE /6 L 2
Print name: t ��to r/C•FV Y Date:/a�-/7 This permit application expires if a permit is not obtained within 180 Yays J
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Bolding\Pemi[s1P1.MU-PermItApp.doc 10 01 09 440-46161(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
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 I 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 El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
Domestic 0 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" ❑ 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 work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related X.
-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 plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
al
-III Accumulative Sewer Tally
Tenant Name: SPEC SPACE
SWR# N/A
TIGARD Site Address: 11525 SW DURHAM RD D-6 PLM# 2019-00499
Parcel#: 2S110DCO2300
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
-4inch 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 1 2 0 -1 -2
Sink
-Lav/Bar-Non-Food Related 2 0 5 10 0 -5 -10
-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 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
TOTALS 0 0 6 12 0 0 -6 -12
Current Fixture Value -12 divided by 16= -0.750 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -12 divided by 16= -0.750 over (under) $ (4,350.00)
Enter EDU Change Here -0.750 *
*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: ***CREDTIS***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 12/17/2019
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:\Building\Sewer Tally\SewerTallySheet_5800_070119.xisx