Permit (89) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00431
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/11/2016
Parcel: 2S101AB01501
Jurisdiction: Tigard
Site address: 7555 SW HERMOSO WAY 120
Project: Whitney Green Acupuncture Subdivision: HERMOSO PARK Lot: 21
Project Description: Rough-in and install new hand sink
Contractor: THE PLUMBERS INC. Owner: LIONEL LLC
90 NW 150TH AVE 7555 SW HERMOSO WAY STE 010
BEAVERTON, OR 97006 TIGARD, OR 97223
PHONE: 503-519-6644 PHONE:
FAX: 503-684-1202
FEES
Quantity Description Date Amount
1 ea Sink 08/11/2016 $25.02
Specifics: 1 12%State Surcharge- 08/11/2016 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 08/11/2016 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 ::i. . .
Issued By: Si.nature: 24-el"'
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.
08/08/2016 09:30 5036841202 THE PLUMBERS INC PAGE 01
Plumbing Permit 4pCVation C • "
Buildin F' ,��
g ' (�(�0 (�cr' FOR OFFICE USE ONLY •
L" ) (�
`� t Received ��a
ipl
e
Building.
3 5 SW Hall lard.`�� ,OR 97223 Date/i3y: / Lam/ Permit No.: �` �` 3
�. Ilan Review G
Phone: 503.v Fax 98.1960 ' Other Permit No.614 66;O 1
Date By
TIGARD thspccuofl}i itis 503 v DateRcad By tens ® See Page21or
'g� Ready
'Ry:www.t10- ct ,-cri�Ij' tvotitied'4 thed Supplemental Information
❑blew construction %t�'', �� Forspecta!information use checklist __
`�% r�, � ❑Demolition
Description Qty. La. Total
dAddtuon/alter ttionfreplacement ❑Other: New 1-2-family dwellings(includes 100 11.for each utility connection)
CIA F1sCrOW% Qk Ct3'SI KIJCl[()N SFR(l)bath 312.70
❑ 1 and 2-fvmly develhng #�Commercial/industrial SFR 2 bath { 437.78
SFR(3)bath I 500.32
❑Accessory building , ❑Multi-family - --j
Each additional bath/kitchen i 25.02 '
❑Master builder ❑Other I +Fire sprinkler( sq.It) Page 2
JOBB $Cl & iii 4. i*iis Yl1 OACity€ Site utilities:
" A
Job site address C 1{ Catch basin or area drain 18.76
r� , ,,\:.:)
� 1 � C0 Drywell.leach line,or trench drain 18.76
City/State/ZIP: ^f 1 C OS-CA � (I--) ,rc /�
Footing drain(no.linear ft.: ) Page,2
Suite/bldg./apt.no.: / Q j Project name: ` Manufactured home utilities 50.03
Cross street/directions to,job site: 1.4.)ii-1-rnIt�J Cp tV Manholes -__-- 18.76
t A"C,uPu.N/Q 1-t Rain drain connector I8.76
Sanitary sewer(no.linear ft.._) Page 2
Storm sewer(no.linear ft.:_) Page 2 -mm
I Water service(no.linear ft.: ) Page 2
Subdivision: __ i Backflow Lot no.: Fixture or item: -
ax map/parcel no A.,-.-----/l f G/'/4"6d C'�d / ac owprcventer 31.27
' /
i SCIkIP .,4 flF 3�/ f*( - Backwater valve 1251
Clothes washer 25.02
2)U\It S� tt ,, t6V-\ �v l:1 t----
- 2; 2
U Dishwasher A
'r UJ S1 n CA.00 ii fl', 1 . Drinking fountain 25.02
Ejectors/sump 25.02
fl i'KOPEIZTY OWNtK Iji i Vr 1V i Expansion tank 12.51
-
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: ------. -
Garbage disposal 25.02
City/State/Zit': ---- ---- -I bib 25.02
Phone:( ) Fax:( ) E Ice maker 12.51
PP ICYT e CflAC PR [ Rr Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2 name: e- ' \�1 -3e \Y1C e
Contact name: Primer - !2.51
Address: " { Roof drain(commercial) I 12:51
_ k-) t 1�L Sink/basin/lavatory25.02 25,C)
City/State/ZiP: 1 e,, �- m C. ""')c b W Solar units ratable water I
Phone:( 3 lc{.... 't , L, Fax: ( )'7j) toy,LI-120-2.- I Tub/shower/shower pan 12.55
E-mail: rS' a , Urinal 25.02
. CONTR.CT()7i,, ater c osit25.02
1 .
.. ., �;,,,;, ... :.. ., max Water heater 37.52
Business name: I
Water piping/DWV 56.29
Address: Other: 25.02 j f
City/State/ZIP: i Subtotal
Phone ( ) Fax:( ) - -� Minimum permit fee,: $72.50 7,a:
I.ic.: /� ? P�F /f �-Plan review (25%ofpermit fee) i . -.
CCB
7/�1 Plumbing Lic,no.: / State surcharge(12%of permit feel g',70
Authorized signature: TOTAL PERMIT FEE F/.„9-01Prim name: MI\e.Cy«N� C -N.-- I Date:(8)C-3,)(4, This permit application expires if a permit is not obtained within 80 days
' -\ after it has been accepted as complete.
"1de methodoiogy set by Tri-County Building industry Service Board.
I.03uildmgWerntil3:P1,10(.:-PenniiApp.doc 1Q10I/0" 440.4516T(I E5'G2CObPWErt)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su I ression Systems:
itittitirtiiiieraliejKaziwirsizm ..,,,!,,A,,q,..ot,4,'''',,,,„:1,,,6,00,1,,,A„,.,.,,,,Ip,,,,
1 =a121111111111111111111=111111 0 to 2,000 $121,90
...,,.........
Footing drain-each additional 100' - ,INN 2.001 to 3,600
3.601 to 7,200 $169.69
i $233.20 ..,
Sewer- 1st WO' 1111511111111111111 7 201 and otreater i S327.54 .
..,,
Sewer-each additional 100' 37.52 1111.1
Water Service- 1st:1(10' -62.54 ME Medical Gas Systems:
Water Service-each additional 100' EMI 37 52 INN kiTilliriAgnalogi614.0111.1111112011121:
Storm ik Rain Drain-1st 100' ' 62.54
$1.00 to$5.00.00 Minimum fee S72.50
Storm&Rant Drain-each additional 100' 37.52 riTOO IOU to:§16.000:65 $72.56 lbr the first$5,000.00 and$1.52 lbr
!: ,iI'i :.,tlaiSI,I.WNNPIIMMVtl 1
1 each additional$100.00 or fraction thereof to
I and including$10,000.00. ,
Inspection of existing plumbing or Ida I $16:661.00 to$25,000.00 $148.50 foc the first$10,000,06 and$1.54 for
which no fee is specifically indicated 90 Oil additional$100.00 or fraction thereof,to
•
(minimum charge • 112 hour) and including s25,090.00. _
Inspections outside of normal business 90.00M r $25,001,06 to$50,000.00 r$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 lees 90.001hr and including$50,000.00.
Additional plan review for revisions 90.00/hr -- i $50,091.00 and up $742.00 for the first$50,000,00 and$1.20 for
i
(minimum charge-• 1/2 hour) La each additional$100,00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately,report fixtures could result in increased sewerfees'k. bigr,r7tgiwrW:*jiuxbttijtrggtoboxtirmjg2
avomegroogrz:Aricir::100.iiiwryilaittiwook. , I Plan review is required for any of the following.
mr.**Typospilr:--„tioloNiv.86,:momptiPlitigiMastIllilf*tiii Please check all that apply,.
81iiikiitaiiiiiiiii6gEnnekoMV-04414,N.0,40•40.r;io#10* !, El Any new commercial building with water service 2"and
Baptistry/Font greater.except systems designed and stamped by licensed
13arli: -Tub/Shower ngineer,
-Jacuzzi/Whirlpool El '$esx exterior plumbing site utilities for any complex structure
(..ar Wash: -Filch Stall
us defined in OAR9 I 8-780-0040.
-Drive"Choi
• El Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 2. '-
0 Any multipurpose fire sprinkler system.
l/ishwasher -Comniercial
UAny complex structure as defined i
'Domestic n OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
IZIM.,IllaitAtigr:„,iagkrg;ki'.krir5li.41,01119,61
new buildings
D Isometric or riser diagram is required for
-tar Wash Drain
that meet the qualifications above.
Garbage -Domestic non-rood
1./isposal -Domestic food related
-Commercial food related
-industrial Iliad related
Ice-MaohlRefrig.Drains Comments regarding fixture work: --LA°
Oil Separator(Gas Station) 0 t'W ths)C1.Qi, ‘fli.tric), ‘. ' -.• ' '',-• -- • • ,.
,
Ree.Vehicle Dump Station ,
V 00Q0C 6. k.r`i 0.06 \Crt;tr.A.4 k
Shower: -Gang ',...)
-Stall
Sink. -1.avil3ar non-food related
. ..F- 1 .
-Bradley
-ComiServilitil food related 4 ..
-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
Wa.sher-Clothes
fees assessed for the sewer increase must be paid before the
Water Extractor
Wines Closet-Toilet plumbing permit can be issued.
Urinal •
Other Fixturesi .
C:\llsers\Offi cc 1\AppData\LocafiMi crosoff.Wi n dows\Temporary I nternetyi lesCon tentlE5\A 15 MR9RPTINIF_PermitApp.doc 08/04/20.11
IIIIIImu
C ii
Tenant Name: Whitney Green
AccuAcupuncturelative Sewer Tally SWR# 2016-00281
r G A R D Site Address: 7555 SW Hermoso Way#120 PLM# 2016-00431
Parcel#: 2S101AB01501
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
-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 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 0 1 2 1 2
-Bradley 5 0 0 0 0 0
-Com/Sery/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 0 0 1 2 1 2
Current Fixture Value 2 divided by 16= 0.125 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 2 divided by 16= 0.125 over (under) $ 689.00
Enter EDU Change Here 0.130 *
*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: Debbie Adamski Date: 8/11/2016
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_5300_070116.xlsx
Debbie Adamski
To: info@theplumbersinc.net
Cc: #Building Permit Technicians
Subject: 7555 SW Hermoso Way
Attachments: PLMF_PermitApp.doc
Misty,
We have received your application for this address and we need some additional information before we can process this
application.
1. There are multiple suite numbers at this address. In which suite is this work taking place?
2. Is the tenant's name Bob Davidson, or is that the owner's name? If it is the owner, who is the tenant?
3. There is a second page to the plumbing application that needs to be filled out. I have attached a copy of the
plumbing application, please complete the Commercial Fixture Work table on the second page and email it back to me.
We need this information to determine if there are Sewer System Development fees to be assessed.
Let me know if you have any questions regarding this. Thanks.
Debbie Adamski
Senior Building Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
1
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7555 SW HERMOSO WAY 120, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00431
Don Sylvester
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7555 SW HERMOSO WAY 120, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00431
Don Sylvester
Violation Summary:
Inspector Contractor