Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00498
Date Issued: 12/17/2019
T f i RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11545 SW DURHAM RD B-2
Project: Spec Space Subdivision: 1998-128 PARTITION PLAT Lot: 1
Project Description: Interior plumbing prior to TI:Capping(5)sinks and relocating (1)water heater.
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:
PHONE: 971-275-6167
FAX:
FEES
Quantity Description Date Amount
5 ea Fixture/Sewer Cap 12/17/2019 $125.10
Specifics: 1 ea Water Heater 12/17/2019 $37.52
1 12%State Surcharge- 12/17/2019 $19.51
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $182.13
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 follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-009' •btain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: • E Signature: jA141' — -
i
011(
Call 503.639.4175 by 7:00 a.m.for the next available ins• c on :ate.
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 RECEIVED Date/By: /� // /y Permit No.: /0 ly_co(Killr
4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
II . ' Phone: 503.718.2439 Fax: 503.598.1 Other Permit No.:
E C 17 2019 Date By: 6)11/4l4 603/3
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: infix: ® See Page 2 for
Internet: www.ligard-or.gov Notified/Method- Supplemental Information.ii-t'LJ - ileAl r; f pP
TYPE OF wo1stiNG DIVISION FEE* SCHEDULE
El New construction 0 Demolition 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
❑ 1-and 2-family dwelling commercial/industrial SFR(2)bath 437.78
ID Accessory buildingSFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen _ 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMA ION AND LOCATION Site utilities: _
Job site address: //```""rrr'''""```"
� r. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: / �r
t%'7 / 7 '� � Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 13_2 I Project name: �//® 7 j _
anufactured home utilities 50.03
Cross street/directions to job site: 3/ 55
% 'Manholes 18.76
Fes" 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.: -,S a 0 L U,�' Backflow preventer 31.27
Backwater valve 12.51
I ' WORK
�/y �� - Clothes washer 25.02
l�i«4 -0 e>,/e°. // ,, Dishwasher 25.02X"eP - OGG� /- A t t A,eort f" Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
c Fixture/sewer cap X s 25.02 /au,/0
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
E-mail: Urinal 25.02
Water closet 25.02
/ CONTRACT Water heater X. / 37.52 37.S.'L
Business name:c-r/ qL%) - lir(.4.0 .05j�} Water piping/DWV 56.29
Address: /gi 74 �5J /09 �/ Other: 25.02
City/State/ZIP: �L 20raI / O� /'7 4J Subtotal / 6z
Phone: ✓-�f0 (p(
('//) 275-C//�/ Fax:( ) Minimum permit fee: $72.50
79/15 g _ 1P Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: �J
State surcharge(12%of permit fee) /If.5_1
Authorized signature: TOTAL PERMIT FEE / ebl)
Print name\/ ie i`a't Cam- Date:/a-/,►/�} This permit application expires if a permit is not obtained within 1 says
( / after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Buiiding0Pamiis\PLMU-PermitApp.doc 1001/09 440-4616T(10/02/lbM/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 ec Ins tions 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 1
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 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thin
Cuspidor Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 0 Any multipurpose fire sprinkler system.
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
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
-Stall
Sink: -Lav/Bar non-food related )( 6-
-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\Pennits\PLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
s Tenant Name: SPEC SPACE SWR# N/A
Site Address: 11545 SW DURHAM RD B-2 PLM# 2019-00498
TI CiARD
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 0 0 0 0
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 5 10 0 0 -5 -10
Current Fixture Value -10 divided by 16= -0.625 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -10 divided by 16= -0.625 over (under) $ (3,654.00)
Enter EDU Change Here -0.630 *
*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 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.xlsx