Permit CITY OF TIGARD PLUMBING PERMIT
,•'' COMMUNITY DEVELOPMENT Permit A: PLM2020-00091
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/24/2020
T[[3t1R�7 9 Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY C
Project: Ace Hardware Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: Interior plumbing for TI: ADD(1)expansion tank,(3)3"floor drains,(2)hose bibs,(1)primer,(2)lays,(2)service
sinks,(2)water closets,and(1)water heater.
Contractor: REED PLUMBING LLC Owner: SN PROPERTIES PARTNERSHIP
PO BOX 2603 1121 SW SALMON ST
OREGON CITY,OR 97045 PORTLAND,OR 97205
PHONE: 503-572-3785 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Expansion Tank 02/28/2020 $12.51
Specifics: 3 ea Floor Drain/Floor Sink/Hub 02/28/2020 $75.06
2 ea Hose Bib 02/28/2020 $50.04
Type of Use: COM 1 ea Primer 02/28/2020 $12.51
Class of Work: ALT 2 ea Sink 02/28/2020 $50.04
Type of Const: 2 ea Lavatories 02/28/2020 $50.04
Occupancy Grp: 2 ea Water Closet 02/28/2020 $50.04
Stories: 1 ea Water Heater 02/28/2020 $37.52
1 12%State Surcharge- 02/28/2020 $40.53
Plumbing
Total $378.29
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.
Plumbing Permit Application
Building Fixtures FOR OFFICE ISE ONO
City of Tigard Ru" td z73/e7�/ m tt N �M�O�O 000�1/
13125 SW Flail Blvd..Tigard,OR 97223 �ntd6y. viV U p
B Plan Review Other P o2.2Q •-•000 0
II Phone: 503.718.2439 Fax: 503.598.1960 r,By; efm7�
Inspection Line: 503.639.4175 pate ReadyBy: r)/��/� / Judo El See Page 2 for
Internet: www.tigard-or.gn� ' Notified/MethodT / • mental Information
Pt. OF NORt:
❑New construction ❑ f) mnlitiun For special information use cheekhs&
DR
Description I Qty. I Ea. I Total
w Addition/alteration/replacement ❑Other New 1-2-family dwellings(includes 100 ft.for each utility connection)
rUFCU r ::� ...�_
11 SFR(1)bath 312.70
® SFR(2)bath 437.78
❑ 1-and 2-family dwelling Commercial(industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft) Page 2
s Site utilities:
Job site address: /(p o"t-U O S vv/ pa ci f/� /-1 , Y Catch basin or area drain 18.76
s Drywall,leach line.or trench drain l R.76
City/State/ZIP: --1--ir ICLr`d-- OYe--. liar Footing drain(no.linear ft.: ) Page 2
Suite/bldg;apt.no.: G, I Project name: A-6 E d wrii rr,..., Manufactured home utilities 50.03
Cross street/directions to job site: CO 161 Of /4U/ Manholes 18.76
C;1,v6-e_ --tb DWll aM---- ��.� Rain drain connector 18.76
1 I r t c 1]D/l 0. 4 J Sanitary sewer(no.linear ft.:_) Page
`� 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.: Backflow preventer 31.27
Backwater valve 12.51
Clothes washer 25.02
41 i/ 0( r'- to �p e-, C)-}�1.�41 L' . (SL/1J< Y' ��'� Dishwasher 25.02
1er 64.itx1 Lil�tIV1 h•2_Q QA) Drinking fountain 25.02
Ejectors/sump 25.02
® WR I - - C1 TE. Expansion tank / ✓ 12.51 /4 9 ,51
Name: Fixmrc/scwcr cap , 25.02
- -._- Floor drain/floor sink/hub 3 25.02 'J5. ob
Address: - Garbage disposal 25.02
City/State/ZIP: Hose bib eR. t✓ 25.02 So e 01
Phone:( ) Fax:( ) Ice maker 12.51
Intcrccptm%grutse trap 25.02
Business name: ill , . �0 9YC " "�T p-,LL Minimal gas(value:$_) Page 2
�u. l V Primer '� 12.51 /a• 5/
Contact name: X.J
Roof drain(commercial) 12.51
Address: P 0 gOX a40, 03 Sink/basin/lavatory(..J L*V do/'4.7/- ✓ 25.02 /DO t I
City/State/ZIP: 0 re6i dr) Cc. n / 704- S Solar units(potable waterk9 62.54
Phone:( •Sb 1)
) Sid- - 3 "gS 0 Fax::( Th) 6 56 -If'3 r Tub/shower/shower pan 12.51
E-mail: dl{6te$C-e✓tpz 'eeL6.(20-i erst•/1Pt._ Urinal p 25.02
/. _. Water closet . J 25.02 ✓7) . 0Y
Water heater f/- a
1/ 37.52 ,3 7.5g.
Business name: 1.P�_� f 1 k ni KJ//1 Li_ (') Water piping/DWV56.29
J
Address: To dO>< a/Ou 3 Other: 25.02
City/State/ZIP ore me c' e,H- j 0/6-2._ 9.701. S subtotal 337, 74,
Minimum permit fee: $72.50 •
Phone:(513) ,j7d- , 3 785 Fax:( sa ) 65b - /5 3CY - ,
�p
g / Plan review (25%of permit fee) b?Itq
CCB Lie.: /ic b 3 b /3 S Plumbing Lie.no.: ,{ o
State surcharge(12/o of permit feCt
Authorized signature: 9/4 Ite /7"1jR_-e0 ��' /// TOTAL PERMIT FEE .#y-�-i-f9^
Print name: J Li C y 1 �t --1f) Date: 2/ 2-4/20 Thin permit appgearbn expim If a per�s net nbtatae htn da7p ,
I ogy s h has been atte as cwn
*Pee methodology set by Tri-County Building Lodusity Service
I-'Budding/vmrtsNUftl-PetmitApp.do< 1OOI109 440.4616T(tot)2/COM/WPB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su t t ression S stems:
'
Footing drain-Ia 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 i 2,001 to 3,600 $169.69 i
3,601 to 7,200 S233.20
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 S stems:
Water Service-each additional 100' 37.52
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 S5,000.00 and$1.52 for
Qty `.,) 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 S25,000.00 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 S50,000.00 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*.
Quantity by Fixture 1111111r Plan review is required for any of the following.
Fixture Type for I Replace/ Please check all that apply.
wurk grolu > tin Capped Added I Relocate 0 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 0 New exterior plumbing site utilities_for any complex structure
Car Wash: -Each Stan as defined in OAR918-780-0040.
-Drive Tiro
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
❑ 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" 1
3„ 3- ✓
-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
-Industrialg.Drains food related
flig.Ice MachJRe Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower. -Gang
-Stall
Sink: -Lav/Bar non-food related I a-
-Bradley
-Com/Serv/Util food related
-Service oZ ✓ *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 a-- ✓ plumbing permit can be issued.
Urinal
Other Fixtures:
l:\Building\Pemvts\PLMF_PermitApp.doc 08/04/2011 2
;' • Tenant Name: Anytime Fitness
A ccumulative Sewer Tally SWR# N/A
Site Address: 16200 SW Pacific I Iwy A,Tigard OR 97224 PLM# 2013-00053
I GAI:U
Parcel#: 2S115AB01900
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 1 4 0 -1 -4
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 1 1 1 1 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 4 8 3 6 -1 -2
-3 inch 5 0 6 30 0 -6 -30
-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 1 1 0 -1 -1
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 2 4 2 4
Sink
-Lav/Bar-Non-Food Related 2 0 4 8 3 6 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 6 18 1 3 -5 -15
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 6 36 3 18 -3 -18
Urinal 6 0 2 12 0 -2 -12
Previous EDU Count 0 0 0
Capped EDU Credit 0
TOTALS 0 0 31 118 13 38 -18 -80
Current Fixture Value -80 divided by 16= -5.000 Current EDU 1 EDU= $4,665.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -80 divided by 16= -5.000 over (under) $ (23,325.00)
Enter EDU Change Here -5.000
Notes: ***CREDIT*** 2/19/20:APPLIED 1.63 CREDITS TO SWR2020-00039. 3.37 CREDITS REMAINING B.T. 3/24/20:APPLIED 2.19
CREDITS TO SWR2020-00048. 1.18 CREDITS REMAINING B.T.
Authorized Name/Signature: Shirley Treat Date:_ 2/14/2013
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
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\SewerTallySheet-4665.xls 07/01/12