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Permit CITY OF TIGARD PLUMBING PERMIT 'IN ' ' ' COMMUNITY DEVELOPMENT Permit#: PLM2019-00224 T 1 I,E R.1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/10/2019 L Parcel: 2S101 DA00104 Jurisdiction: Tigard Site address: 13333 SW 68TH PKWY, STE#10 Project: Oregon Academy of General Dentistry Subdivision: VARNS ACRES Lot: 9 Project Description: Plumbing fixtures for TI for new tenant. CAP(2)sinks;ADD(1)clothes washer,(1)dishwasher,(1)drinking fountain,(2)2"hub drains,(2)hose bibs,(1)medical gas,(2)primers,(4)sinks,(2)lays,(2)water closets,(1) water heater,(1)vacuum pump,(1)air compressor and(1)amalgam separator. Contractor: VENNE PLUMBING LLC Owner: TRIANGLE POINTE TWO LLC 15145 SW DIVISION ST 901 NE GLISAN ST, STE 100 SHERWOOD, OR 97140 PORTLAND, OR 97232 PHONE: 503-624-9309 PHONE: FAX: 503-684-0940 FEES Quantity Description Date Amount 1 ea Clothes Washer 07/03/2019 $25.02 Specifics: 1 ea Drinking Fountain 07/03/2019 $25.02 2 ea Fixture/Sewer Cap 07/03/2019 $50.04 Type of Use: COM 2 ea Floor Drain/Floor Sink/Hub 07/03/2019 $50.04 Class of Work: ALT 2 ea Hose Bib 07/03/2019 $50.04 Type of Const: 2 ea Primer 07/03/2019 $25.02 Occupancy Grp: 4 ea Sink 07/03/2019 $100.08 Stories: 2 ea Lavatories 07/03/2019 $50.04 2 ea Water Closet 07/03/2019 $50.04 1 ea Water Heater 07/03/2019 $37.52 75 Misc Other Fee 07/03/2019 $75.06 1 ea Medical Gas 07/03/2019 $225.50 1 ea Dishwasher 07/03/2019 $25.02 1 Plan Review 07/03/2019 $197.11 1 12%State Surcharge- 07/03/2019 $94.61 Plumbing Total $1,080.16 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: I ,,"(7.....‘.. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. '' 1AvljjLA-1-- ...)e7 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. UPIe Tenant Name: Oregon DentalAAcademccumuylative Sewer Tally SWR# 2019-00159 TI G n R D Site Address: 13333 SW 68th Pkwy,Ste 10 PLM# 2019-00224 Parcel#: 2S101 DA00104 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 1 2 1 2 Drinking Fountain 1 0 0 1 1 1 1 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 2 4 2 4 -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 2 4 6 12 4 8 -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 1 6 1 6 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 0 2 12 2 12 Urinal 6 0 0 0 0 0 - -Previous-EDU Count..„__ , , - -_- 0 — — _ _ _0 — Capped EDU Credit 0 TOTALS 0 0 2 4 13 37 11 33 Current Fixture Value 33 divided by 16= 2.063 Current EDU 1 EDU= $5,650.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 33 divided by 16= 2.063 over (under) $ 11,639.00 Enter EDU Change Here 2.060 * *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: Dianna Howse Date: 6/13/2019 Building Division ote: 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. r I:\Building\Sewer Tally\SewerTallySheet_5500_070118.xlsx r is Plumbing Permit Applica e-EI Building Fixtures City of Tigard MAY 2 3 2019 DRie .S7Z.g /I A4-- Permit Ne.* t/`/.;20/9-067,2,,2y lig 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review S Phone: 503.718.2439 Fax: 501'4 l 610�'- t 1 GARL Date/By: ..b 6Ai s , G/cJi Other Permit N u/4j/5-©L7fS'Y TIC,�'`1 Inspection Line: 503.639.41751 I I 1 D;R i O [)I /1 S!O N Date Ready/By: 1.� .tuns Bf See Page 2 for Internet: www.tigard-or.gov 4J 1.iJ l k + V i J l lJ Notifed/Method4'.1.1. i. / ? Supplemental Informal oe TYPE OF WORK, 1o3!`- gel'Y L FEE* SCHEDULE . or special information use checklist. ❑New construction ❑Demolition Description I Qty. I Ea. j Total IRT Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑1-and 2-family dwelling Int Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:t'9 VA (69.P\ cVNW'( Catch basin or area drain 18.76 ��yy �, Drywell,leach line,or trench drain 18.76 ,-1 City/State/ZIP:Ttoiar lJ p, ct'1 223 Footing drain(no.linear ft.:_) Page 2 / Suite/bld ./a t.no.:�) 1I Project name: �L g p 0 j �dn ` Manufactured home utilities 50.0 Cross street/directions to job site: `) Manholes 1&.776 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) lP ge 2 Storm sewer(no.linear ft.: ) \1/4Page 2 Water service(no.linear ft.: ) e Page2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer /.,; 31.27 Backwater valve V., 12.51 DESCRIPTION OF WORK t � Clothes washer 'i \ 1 ,••• 25.02 26.62 �,,/ ` ` SC-v1CO\ Dishwasher i. ,, 25.02 50,01-1 Drinking fountain st 1 i 25.02 2.02..Ejectors/sump , 25.02 0 PROPERTY OWNER 1 0 TENANT Expansion tank \ 12.51 Fixture/sewer cap : p„ 2 :r' 25.02 -CAA Name: Floor drain/floor„ 1 b µt1. 9_ / t 25.02 50.G -‘ - Address: Garbage dispo_J' ° t25.02 City/State/ZIP: Hose bib(, %to-12.4111, Z 25.02 5 Phone:( ) Fax:( ) Ice maker , / 12.51 Interceptor/ease 25.02 APFLICANT ..�CONTACT'PERSON � L . r ��K)\Lig' _ ,,, Medical gas(value%$t ,OCA") Page 2 2 f� Business name: V �jj�) l 2 Primer 12.51 25,t2, .- Contact name. Ckr‘ V\e„,100Roof drain(commercial) 12.51 Address: \S`LA ' 1/4/•3Or\`1S,CC\ c2,4-4- Sink/basin/lavatory i/}✓S 2. z 25.02 5® ®`-i City/State/ZIP: S,e-N eAte. V�+ 0 ik yam. 01 W'rkO Solar units(potable water) 62.54 Phone:563) &2_(.4l"1 �� Fax::( ) Tub/shower/shower pan 12.51 � -mail: `(1(�L11 , . CCT fY\ Urinal 25.02 E __ uG���1(��Lm�+r��� J Water closet Z / 25.02 60 G 4 CONTRAC R Water heater 1 37.523 1.52 Business name: ��` tL c)\,\fl(Y\tOi\ � Water piping/DW V 56.29 Address: k -3 1 S LAS t\(--) J'k c..., ), .-;:.. , Other: 25.02 City/State/ZIP: \e 1J O c C. CV.-4-it O Subtotal Phone:(503) Cj q 3O 1 Fax:( ) Minimum permit fee: $72.50 {Q LA Plumbing �� / Plan review (25%of permit fee) CCB Lie.: 1 \2_ Lic.no.: P 5W State surcharge(12%of permit fee) Authorized signature TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name: �c 1 S ..I v,a,v-v\k_ Date:5I 23`t ct after it has been accepted as complete, 1 *Fee methodology set by Tri-County Building Industry Service Board. I:\Bnilding\Pennils\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbiag Permit Application - City of Tigard • Page'2 - Supplemental Information Fee Schedule: Residential Fire Su 1 s ression S stems: Xaa R 3 '': 'r'3 •a" it g', _,+w€.. jp. ;.' ,.. c ®"r4-^ *nr.7., sa+n # u'r r F..0 1 _ �....L'r a...., .x & t.,. .£ 'it f: a 41 .irc ta.i-4.4 . ir i,II d _ .il_ , Footing drain-16'100' 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 S stems: Water Service-each additional 100' 37.52 , • t tr ; • , °, = ,-.4.,,,,,.-r 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 k t :, , j each additional$100.00 or fraction thereof,to . - l Fb,s. € ,'t. m - L.E. t< . -- 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 char:e-1/2 hour and includin:$25,000.00. Inspections outside of nominal 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 3 4 .,,6st„?„4,E €4�x y`lg 'u;€ R !,',1., � „ a,' € >;;kitr -, .,,� � -� Plan review is required for any of the following. ° " Please check all that apply. ' � -• 17";-' - 41A- ❑ 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 "-1`,,New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall % as defined in OAR918-780-0040. -Drive Thm r Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system. -Domestic 2- r LL )'. 0 Any complex structure as defined in OAR918-780-0040. Drinking Fountain i Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" i-'-vi L-3 2-) ,/ k 0 Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the I ualifications above. Disposal: -Domestic food related U omwercial food related 71 -Industrial food related ,1 IceMach./Refrig.Drains r\ Commen s regarding fixture work: Oil Separator(Gas Station) (4.? ( 2) /.i/L&-et- /ZOOM •C/°V/GS Rec.Vehicle Dump Station /9-A6 (Z) L/}-vs Shower: -Gang /\ l -Stall - Sink: Lav/Bar non-food related i 1 I -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-ClothesI ' fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet 2 ✓ plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Plumbing Permit Application S'�ti' " ��V',....-_---7,,/ Al d 7 t y A. Building Fixtures FOR OFFICE 1.SE 011.1 City of Tigard Received Permit No.: pipf,2014,.....00‘24 Ill13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: Phone: 503.718.2439 Fax: 503.598.1960 Plan Review _ Clef Other Permit No.: Date/By: b �-- T t G A H D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information ❑New construction ❑Demolition For special information use checklist Description I Qty. I Ea. Total Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) - CATEc µ., TRUCTION SFR(1)bath 312.70 ❑ 1-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 r'41'1''''''''71';'{ ' JOB SITE 1T IlO i M TION AND LOCATION utilities: k Job site address: 13333 .5.1j, 6 o P6 t(wc1 Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: "'C-: r-4C)t2, q 9 a a3 1 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: l a Project name: eY'Q• D.Qt1TiA Cad, 'rw,s Manufactured home utilities 50.03 Cross street/directions to job site: j Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Stone 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 § I. +' € Backwater valve 12.51 _. u � rw= .. -., Clothes washer / 25.02 ts�, .s0.2 mo w' - s ci_01.( Dishwasher ft-P-- 1,',,'51v f 25.02 cid,04 Drinking fountain / 25.02 25,02 Ejectors/sump 25.02 L ,x,❑ lrni" ! § ] TENANr;. Expansion tank 12.51 Name: Fixture/sewer cap g 25.02 5dt,o¢ Floor drain/floor sinke& a 25.02 .50,, `tr�/ Address: Garbage disposal 25.02 City/State/ZIP: Hose bib ,3 25.02 5040 4' Phone:( ) Fax:( ) Ice maker 12.51 ApI! AtV • l +'! �, ,,........-, 1.4‘.'`l Interceptor/grease trap 25.02 ,r. Business name: Medical gas(value:$J5,600) ` Page 2 22.5.50 Primer a. 12.51 g SO a Contact name: ` - - Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 6 25.02 /SQ,/2 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet d 25.02 501,0,'F , Vii\ Water heater f 37.52 39,52_ Business name: Water piping/DWV 56.29 _ Address: Other: j .p�,„,t Pia/ 4;r 3 25.02 95.0(0 City/State/ZIP: _ 00 w.f..a/ Am al j lwt SQ Po.Yoko.r f Subtotal 813.414 Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) ;.OS,317 CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) Q7,6a Authorized signature: TOTAL PERMIT FEE 1114,45 Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 1Ott)S L S:tiles2. 4 Plumbing Permit Application - City of Tigard , Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities - y,. Qty. 1H C(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 Storm&Rain Drain-1st 100' 62.54 luutio : Permit Fee: $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 Other Inspections or Feesr � Total Qty. 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/hrand 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 Quantityby FixtIeTYPe Plan review is required for any of the following. iOr PPeci a to Please check all that apply. Work rformed:" 0 Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator 0 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 Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" t}u b -3" 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 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 L. V -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 a / plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2