Permit s
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Building Fixtures Jio + E ,t
MAR I. 7 2020 Keem oat f
City of Tigard DaedBr: ,�4�� t I',1 Oil A i
! 13125 SW Hail Blvd.,Tigard,OR 93221
O�'TIAf� plan Review
g, Phone: 503.718.2439 Fax: 503.5� �) D0t0IB belE i /���
6-. .0 Inspection Line: 503.639.4175U1 �' DIVISION Dale Reedy/By: orris: h1`Sc'c`t{nae'2'"Por v
Intemet wwwtigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE' SCItEDU:E.
For special information use checliist
New construction 0 Demolition
hi �. p�>� Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: - 1 tisa j New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSiRUCTI a 3 a.... SFR(1)bath 312.70
❑ 1-and 2-family dwelling ,KCommerc; ndustrial •••JJJ SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Otter: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
7(`
Job site address: 6 1{ ,. 7217-1 kvDrywe�' Catch basin or area drain 18.76
City/State/ZIP: f tv d (x� Footing
1,leach line,or trench drain 18.76
i 1� !! 3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: A- Sy, 1? Lq tl'1 Manufactured home utilities 50.03
Cross street/directions to job site: CJ 3ridi - J Manholes 18.76
4.I1 , St- Rain dmin connector 18.76
tt Sanitary sewer(no.linear It,:___) Page 2
Storm sewer(no.linear ft.:____) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: 5/2 GAC I Lot no.: 4g Fixture or item:
Tax map/parcel no.: v V JQ)'�'/L�V Backllow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
.{^� Clothes washer 25.02
1,4 .k^bgI 'd AtP Dishwasher 25.02
_ Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.5I
Name: L � 4v"GI/I-VG e pc 4 Z.,/„., Floor sewcr cap 25.02
y, 1` f y� Floor drain/floor sink/hub 25.02 .2, ..614.
Address: tf o Al I l3� Yl L7L.V(2, .6to f
Garbage disposal 25.02
City/State/ZIP: (2p,,4^1.os cjt+ t 2.7-0{ Hose bib 25.02
Phone:( ) I Fax:( ) Ice maker 12.51
0 APPLICANT )(CONTACT PERSON- Interceptor/grease trap 25.02
Business name: K. (,4)C v.P. Medical gas(value:$_) P12. 2
' to. Primer 12.51
Contact name: 'za �/ .w .l1,+.ty Roof drain(commercial) 12.51
Address: 7 "--7 5 ,6W 4-kw W1O L"7 Sink/basin/lavatory 2_ 25.02 5c).Oil
City/State/ZIP: 'r'LyoveA. Ol- ca ' Z-2-3 Solar units(potable water) 62.54
Phone:(` zO) ate,t^-3.>3 7 Fax::(6173 613 t 5'50 a Tub/shower/shower pan 12.51
'f Urinal 25.02
E-mail:
�/0w ',Y1''," Ga-� Water closet 25.02 25 02--
CONTRACTO Water heater 37.52 z'T 7,G2
Business name:sj,.TI/'/.tyeO r:?(Iy},1-6:44 �Ui-,,r.- V6 Waterpiping/DWV c 56.29 56.•'
Address: 'ZZ 7 i i `j L"-) t.-1A�y-..4-.1'b� G`I Other. 25.02
rte�v�.l C1i2 ""7 i O Subtotal ��3r
City/State/ZIP: 5t
Phone:(503 -3 t L�-5-Li z,.� Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) ._
CCB Lic.: r.,0$5- , Plumbing Lic.no.: t`30I
State surcharge(12%of permit fee)J .23.2---
Authorized signature: 4,� TOTAL PERMIT FEE '"'
;/� j ��yJ 3!^y This permit application expires 1f a permit is not obtained thin 180 day -
Prittt aura.: . is 0.e el)M<7' Date: 7 1 ! after it bats been accepted as complete ' 02!7
`Fen methodology set by Tri-County Building Industry Service Board,
I �
Ltna7dmSlPamibtPlVitt-Permi[MP.doo I0A1A9 410-e6taT'(IaMLCOM/weBl ,...25--.' Eat `
4 .
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"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 Ins ections or Fees Qty. Fee' (ea) Total each additional$100.00 or fraction thereof,to
pand 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$50,060.00 $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: Copped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each
Stallal as defined in OAR918-780-0040.
-DrivCuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher. Coirato l ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain . Submit 2 sets of plans with any of the above,
Eye Wash
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
IceMach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower. -Gang
-Stall
Sink: -Lay/Bar non-food related
-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: 'tit/4 fro-(�u t,�l
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
= Tenant Name: DIRT BY DESIGN SWR# 2020-00062
Site Address: 11714 SW 72ND AVE PLM# 2020-00120
TIG A R I)
Parcel#: 1 S136DC03200
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 1 2 1 2
-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 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 Dram 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 0 2 4 2 4
-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 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 4 12 4 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:
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 3/27/2020
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:\-Building\Sewer Tally\SewerTallySheet_5800_070119.xlsx
CITY OF TIGARD PLUMBING PERMIT
II" COMMUNITY DEVELOPMENT Permit#: PLM2020-00120
Date Issued: 03/30/2020
T t t AR C3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 15136DC03200
Jurisdiction: Tigard
Site address: 11714 SW 72ND AVE
Project: Dirt By Design Subdivision: Lot: 8
Project Description: Interior plumbing for TI:Adding(1)2"floor drain/sink,(2)sinks,and(1)water closet;Replacing water piping/DWV;
Installing(1)water heater.
Contractor: SHERWOOD PLUMBING COMPANY Owner: 72ND AVENUE PROPERTY LLC
22718 SW MARTIN CT 4804 NW BETHANY BLVD STE 1-2
SHERWOOD,OR 97140 PORTLAND, OR 97229
PHONE:
PHONE: 503-349-5429
FAX:
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 03/30/2020 $25.02
Specifics: 2 ea Sink 03/30/2020 $50.04
1 ea Water Piping/DWV 03/30/2020 $56.29
Type of Use: COM 1 ea Water Closet 03/30/2020 $25.02
Class of Work: ALT 1 ea Water Heater 03/30/2020 $37.52
Type of Const: 1 12%State Surcharge- 03/30/2020 $23.27
Occupancy Grp: Plumbing
Stories:
Total $217.16
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: / 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.
I
t
Plumbing Permit Applica ' :, -..E
Building Fixtures l oR orhlci: ( si: oyLv
MAR 1 7 2020 //
City of Tigard DDate/BBY 3 L`d 2e) ��7,4.t " 1 2O1.)(/20
le 13125 SW Hall Blvd.,Tigard,OR 9 I r
Or T:,aARD Plan Review q
Phone: 503.718.2439 Fax: 503. DIVISION Date/By:
a6
Ins ction Line: 503.639.4175 °t- I�G DlVlot y e-e ffor
I I G n I t U Date Ready/By: Jaris. ager 2 for
Internet: www.tigard-or.gov Notified/Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist
New con.structi on I:1 Demolition
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
IDI-and 2-family dwelling 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:
l 5 VCJ 7 Z„� �.LJ' Catch basin or area drain 18.76
Job site address: 1 i 7 j
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -'r"i9 ,,,A. 4 tad_ G$7 2Z.'3
Vey Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Projectname: biN� � 19i1 Manufactured home utilities 50.03
Cross street/directions to job site: 5/..J v/0 s�af^ '17 Manholes 18.76
.�l✓l) L-11 w 5fi r Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: 425 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
f t.i/4 Till
illpv2:lti,Mt Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 7Z 1/41 AaleAL e- PeyPrY Li.- ..
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: ii.vozi iv W se,44n c K 13LV p, 5t� 1._2. Cmrbage disposal 25.02
City/State/ZIP: Pov4-t pi 0� q',Z7i01 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
i.tJe e/ G:�� p.
Primer 12.51
Contact name: V,� GlK V t.� irtphw Roof drain(commercial) 12.51
Address: ?Z' ' ii6l•✓ O* t"r l4( 4PW" Sink/basin/lavatory 25.02
City/State/ZIP: 'r'`CtC vn G 0 et 7 Z'y 3 Solar units(potable water) 62.54
Phone: Qa 1✓ ^"j,3 7 Fax::(,203 4'f ci 55 D 0 Tub/shower/shower pan 12.51
C,t,�i, jeL ,.�•'./G�.^f7 _•frC7t"6-
Urinal 25.02
E-mail: Q y
/yi Water closet 25.02
CONTRACTOR
� Water heater 37.52
Business name:Ch,� {,Td fr (vvy'�ivtt4 GGi`..pet % Water piping/DWV 56.29
Address: "Z 2 7 i/ 5(.^-) M�.1r Gfi ! Other: 25.02
City/State/ZIP: 5(r eot..Gc•-,L 6 i1 9,7 j 4 Q Subtotal
Phone:('Sn3 .3"�ie\ -344 ZA, Fax:( ) Minimum permit fee: $72.50
CCB Lie.: .,,a[%43 54 , Plumbing Lic.no.: it 0 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:`' / TOTAL PERMIT FEE
•
/ This permit application expires if a permit is not obtained within ISO days
Print name: yq l O 1 it"0. Date:3i/ i 7i/ZQ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
L.\Building\Parmits\PLMU-PermitApp.doe 10/01/09 440-4616T(10N2/COM/WEB)
• I
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"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
Baptistry/Font El Any new commercial building with water service 2"and
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
-Drive El Medical
defined in OAR918-780-0040.
Cuspidor/Water-D Asrve Medical gas and vacuum systems for health care facilities.
Dishwasher CoiretTator l El Any multipurpose fire sprinkler system.
Domestic El Any complex structure as defined in OAR9I8-780-0040.
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 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: -LavBar non-food related
-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: 7
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2