Permit (169) CITY OF TIGARD PLUMBING PERMIT
.111 q
COMMUNITY DEVELOPMENT Permit#: PLM2019-00041
Date Issued: 04/29/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102AA00906
Jurisdiction: Tigard
Site address: 12084 SW MAIN ST
Project: Kimberly Berg's Rebel Fit Subdivision: Lot: 4
Project Description: Interior plumbing for TI:Adding(1)drinking fountain, (4)2"floor sinks, (2)shower stalls,(5)sinks,(3)water closets,
and(1)urinal; Installing (1)expansion tank, (1)water heater,and(1)water piping/DWV.
Contractor: EVOLUTION PLUMBING LLC Owner: BSM REALTY LLC
7715 NE 33RD DR SUITE D BY RITE AID
PORTLAND, OR 97211 PO BOX 3165
HARRISBURG, PA 17105
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 04/29/2019 $25.02
Specifics: 1 ea Expansion Tank 04/29/2019 $12.51
4 ea Floor Drain/Floor Sink/Hub 04/29/2019 $100.08
Type of Use: COM 1 ea Sink 04/29/2019 $25.02
Class of Work: ALT 4 ea Lavatories 04/29/2019 $100.08
Type of Const: 2 ea Tub/Shower/Shower Pan 04/29/2019 $25.02
Occupancy Grp: 1 ea Urinal 04/29/2019 $25.02
Stories: 1 ea Water Piping/DWV 04/29/2019 $56.29
3 ea Water Closet 04/29/2019 $75.06
1 ea Water Heater 04/29/2019 $37.52
1 12%State Surcharge- 04/29/2019 $57.79
Plumbing
Total $539.41
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 •: . .:::. 32.2344.
Issued By: e`mittee Signature:
r�ri_ .111111111111P1'“.-
Call
Call 503.639.4175 by 7:00 a.m.for the next available inspection d. e.
This permit card shall be kept in a conspicuous place on the job site until completion of e project.
Approved plans are required on the job site at the time of each inspection.
r Plumbing Permit Application Y. `,,,)j -
Building Fixtures Ftlli, oFFici: USI: tlnl.)
'eceived
City of Tigard c Permit No.: c
w 13125 S W Hall Blvd.,Tigard,OR 9722f E C E I V "'ate/By: 1 I t f�f�/pZL�( t E ."{
Plan Review )
II Phone: 503.718.2439 Fax: 503.598.1960Other Permit No.:: /9,0A)
Date/By: (f-�e973
T 1,, ',tt 3) Inspection Line: 503.639.4175 JAN 312019 Date Ready/By: Juris: Er See Page 2 for
Internet: www.tigard-or.gov Notified/Method: ' j Supplemental Information
❑New construction ❑
• 11 111 ' 10 r W ` For special information use checklist.
Description Qty. I Ea. I Total
❑Addition/alteration/replacement ®Other: Tenant Improvement New 1-2-family dwellings(includes 100 ft.for each utility connection)
tis
- 2 • ••• SFR(1)bath 312.70
❑1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
1 ) i 1 ; Qr1�_ - Site utilities:
Job site address: SW Main Street Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: B I Project name: Kimberly Berg's Rebel Fit Club Manufactured home utilities 50.03
Cross street/directions to job site: SW Main Street&SW Scoffins St 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.: 2S102AA00906 Backflow preventer 31.27
Backwater valve 12.51
Clothes washer 25.02
Construct two toilet rooms with 3 water closets, 1 urinal,4 hand sinks,1 drinking
fountain,break room sink Dishwasher 25.02
Drinking fountain 1 25.02 25.02
Ejectors/sump 25.02
- ;� Expansion tank 1 12.51 12.51
Name: BSM Realty LLC By Rite Aid , � ��� Fixture/sewer cap /}�/ 25.02
Address: PO box 3165 Floor drain/floor sink/hub it�.��IJ. 4 25.02 100.04
Garbage disposal �1 1111 25.02
City/State/ZIP: Harrisburg,PA 17105 y'
Hose bib 15.025.02
Phone:( ) Fax:( ) Ice maker 12.51
:..,''''''': ':::7'74::44,:,,,,,4o,, ,:7;!:::: '',. . Interceptor/grease trap 25.02
Business name: HG Kimura Architect,PLLC Medical gas(value:$ ) Page 2
Contact name:
Howard Kimura Primer 12.51
Roof drain(commercial) 12.51
Address: PO Box 59415 Sink/basin/lavatory 5 25.02 125.10
City/State/ZIP: Renton,WA 98058 Solar units(potable water) 62.54
Phone:(425 ) 271-1875 Fax::( ) Tub/shower/shower pan 2 12.51 25.02
E-mail: hgkimura@comcast.net Urinal 1 25.02 25.02
Water closet 3 25.02 75.06
a+ 1 d
Water heater 1 37.52 37.52
Business name: t
�1�Lt,�Cktj a01.1K7,w> � Water piping/DWV 1 56.29 56.29
�/ 1
Address: 7g..) /tL 17,1.-/111/1 Other: 25.02
City/State/ZIP: ? y" Subtotal
()�r'..---'/C !- [ 7 IO 481,6 +
Phone:(l)) c,;-3----335--se- Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) ........12114.8----
/
CCB Lic.: !3-1i'7p Plumbing Lic.no.:
State surcharge(12%of permit fee) 57.79
Authorized signature: m TOTAL PERMIT FEE 6'
Print name: Howa Kimur. Date: 1-17-2019 This permit application expires if a permit is not obtained within 180cys
after it has been accepted as complete. l� 1
*Fee methodology set by Tri-County Building Industry Service Board. t 1
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su' s ression S stems:
._
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• eater $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 .>.
174
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
each additional$100.00 or fraction thereof,to
t > 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 char•e-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 charte-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 char_•e-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
accuratel re i ort fixtures could result in increased sewer fees*. �ro w
Esq t y'y F Plan review is required for any of the following.
4 Please check all that apply.
Baptistry/Font
0 Any new commercial building with water service 2"and
Bath: -Tu er greater,except systems designed and stamped by licensed
-Jac i 'rlpool r engineer.
Car Wash: -Each Stall ❑ 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.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash • i/ Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
4» k ', 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the •ualifications 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 1 ti3111.t S;7
-Bradley 1
-Com/Serv/Util food related
-Service L{y1Wp . ;n ) *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 j
Other Fixtures: ttJll 4i,,
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
v -
Plumbing Permit Applicatiop. .,
Building Fixtures i•O R ()) 1 R I t 1/4,1 ti y 1.1
City of Tigard Date/By:
D : Permit No.: /0 j l f-t`c.t,'/
ate/B
13125 SW Hall Blvd.,Tigard,OR 97723
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960. Datugy,. Otter Permit No.:
t Inspection line: 503.639.4175 ' ' Due Ready/By: furs: ®ace Pate 2 for
Internet: www.tigard-or.gov Notified/Method: S ., stat Iaformanoa
: `''F ' `'.' .,r. i*i7 . '7 °'''.?;,.sr-.1• • ! :,N rt,..7yi °,d *°'Ni 1,,,,.. 1 k'.",-,, "s kgtY e .j"'id"¢, .3. " .. . '71 ...... °1...1
❑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)
x ' : :' '''''''.1."'t'.:::.;y '' ''!•,•(",;;.-;"'''''' SFR 1 bath 312.70
❑1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
3
yah.'',"v; yet�'ra:,-."•';'. 4' ,...'i .'," ‘ A I., , .f ;, o, ..�.s"zi
' ''';:Sh'"'�"';€ii'`i` ::,t,:',, Site utilities:
lob site address:12080 SW Main Street Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Rebel Fit Club Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_J 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.: Backflow preventer 31.27
a°'":° .tr2 . 4,, a x' * aI t+ t ..,- \ " ...;.',.:1;14".,..,,k.::,?..,:,,,',
1 `n-4', Backwater valve 12.51
,� y ,, -.. ,,�... .- ' 1? ;,; 4
Cbthes washer 25.02
Install 2-restrooms and 1-breakroom for new fitness club. Dishwasher 25.02
Drinking fountain 1 25.02 25.02
Ejectors/sump 25.02
'''3 'y x +}tom } .1":',,t`--1,'.•:',. .--:•.''''
. .- : *��„ ,'.' rt „�' @• ' ••-*`1'57-`'
*v1'4, ,4'Y Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 3 25.02 75.06
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
` " �� 'f `:, Intelceptorlgrease trrp 25.02
Business name:Rvolutlon Plumbing LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Shama Pasi Roof drain(commercial) 12.51
Address:7210 NE 47th Avenue
Sink/basin/lavatory 5 25.02 125.10
City/State/ZIP:Portland,OR 97218 Solar units(potable water) 62.54
Phone:(503)655-3388 Fax::( ) Tub/shower/shower pan 2 12.51 25.02
E-mail:shaina.pasi®evoplumbing.net Urinal 1 25.02 25.02
, : " 1c �, Water closet 2 25.02 50.04
Water heater 1 37.52 37.52
Business name:Evolution Plubming LLC Waterpiping/DWV 56.29
Address:7210 NE 47th Avenue Other: 25.02
City/State/ZIP:Portland,OR 97218 Subtotal 362.78
Phone:(503)655-3388 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:189876 Plumbing Lic.no.:PB834 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: y � TOTAL PERMIT FEE
Print name:Shaina Pas! Date:4/26/19 This permit application expires If a permit is sot obtained within 180 days
after it has been accepted as compkte.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permts\PLMU•PemiApp.doe 10/01/09 440-4616T(IO/02/COM'WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Su a a ression S stems:
Footing drain-I"100' MINI 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 S233.20
Sewer-1st 100' 62.54 7,201 and ter $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
Medical Gas S stems:
Water Service-each additional 100' 111111 37.52
Stone&Rain Drain-1st 100' _ 62.54 111111 SI.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
t " each additional$100.00 or fraction thereof,to
and includin:$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 ch •e-12 hour and includin:$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 ch• _e-2 hours each additional$100.00 or fraction thereof,to
Reinspection Fees _ 90.00/hr and includin:$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 ch- le-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*.
�. `ta, �., ....�- ''� 1'x t=a�,.¢, ;a'* -.,"' ash 'e,..,5.
6 r r� ,� d°..A.~ 2 s, -44,A2
.�. . '�:e l ;, ... r•.��r_
Plan review is required for any of the following.
t.r, s . `,.., _.�
Baptisuy/Font Please check all that apply.
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive'I]uu 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 1 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" 3 Submit sets of plans with any of the above.
-3"
-43t » fiefs
Car Wash Drainer
Garbage Domestic-non-food • Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the a ualifications above.
-Commercial-food related
-Industrial-food related
Ice MachiRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall 2
Sink/Lav -Non-food related 5
-Bradley
-Commercial-food related
-Service
Washer
Swimming
Filterl *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet 2 fees assessed for the sewer increase must be paid before the
Urinal t plumbing permit can be issued.
Other Fixtures: 1
C:\Users\evo\Downioads\PLMF_PermitApp.doc 2
parr
Branden Taggart
From: Branden Taggart
Sent: Wednesday, February 27, 2019 3:33 PM
To: hgkimura@comcast.net
Cc: #Building Permit Technicians
Subject: Kimberly Berg's Rebel Fit Permit Fees: PLM2019-00041 &SWR2019-00017
Attachments: Kimberly Berg's Rebel Fit Plumbing & Sewer Fees.pdf
Hi Howard,
Per our phone conversation, the plumbing and sewer permits for Kimberly Berg's Rebel Fit are ready to issue. I have
attached invoices above for you to reference, and the fees due are as follows:
Kimberly Berg's Rebel Fit
Permit# Fees Due
PLM2019-00041 $ 539.41
SWR2019-00017 $ 16,950.00
Total: $ 17,489.41
You can pick up these permits between the hours of 8:00 a.m. and 4:30 p.m., Monday through Thursday. We are closed
on Fridays. You are welcome to pay the fees in person or online through our website. To pay fees online,you can go to
our website: https://aca.accela.com/TIGARD/Default.aspx. From there, click on the Building tab, enter the permit
numbers in the Record Number field, and click Search. If you pay online, please notify us at
tigardbuildingpermitsC«@@tigard-or.gov. Also, both permits will need to be paid in full before either of them can be
issued. Please let us know if you have questions.
Thank you,
Brandon Taggart
N City of Tigard
Senior Permit Technician
Community Development
Tic Alta
13125 SW I-tall Blvd
Tigard,OR 97223
(5031718-2449
b randent@tigard-o r,gov
1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12084 SW MAIN ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2019-00041
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Plumbing final approved.
2. Note: wet spot under drinking fountain,may have a small leak, check it out.
Violation Summary:
Inspector Contractor