Permit (79) CITY OF TIGARD PLUMBING PERMIT
.- COMMUNITY DEVELOPMENT Permit#: PLM2019 00298
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/24/2019
Parcel: 2S 115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 140
Project: Home Street Bank Subdivision: 2004-015 PARTITION PLAT Lot: 2
Project Description: interior plumbing for TI:Capping(2)2"floor drains/sinks; (4)sinks,and (1)water closet;Adding(1)dishwasher, (3)
sinks,and (1)water closet.
Contractor: D& F PLUMBING Owner: SN PROPERTIES PARTNERSHIP
4636 N ALBINA AVE 1121 SW SALMON ST
PORTLAND, OR 97217 PORTLAND, OR 97205
PHONE: 503-282-0993 PHONE:
FAX: 503-288-0604
FEES
Quantity Description Date Amount
1 ea Dishwasher 07/24/2019 $25.02
Specifics: 1 ea Expansion Tank 07/24/2019 $12.51
7 ea Fixture/Sewer Cap 07/24/2019 $175.14
Type of Use: COM 2 ea Ice Maker 07/24/2019 $25.02
Class of Work: ALT 2 ea Sink 07/24/2019 $50.04
Type of Const: 1 ea Lavatories 07/24/2019 $25.02
Occupancy Grp: 1 ea Water Closet 07/24/2019 $25.02
Stories: 1 ea Water Heater 07/24/2019 $37.52
1 12%State Surcharge- 07/24/2019 $45.03
Plumbing
Total $420.32
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 952-001-01', You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.8.o. - .2344-7----,
Issued By: ---'Per-mitte nature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 1
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 e $,,,,p' FOR OFFICE USE ONLY �y�{fir �(
City of Tigard i LiiL 2 4 2019 Received
y: /it/tt
PermitNo.:314 0 13125 SW Hall Blvd.,Ti ard,OR 97223 Plan Ry: G/
Tigard, Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:1 � `(�-0)li�
6,�F- � f �s'. Date/By: ) if
TI G A R D Inspection Line: 503.639.4175 d r Date Read /B Juris: ® See Page 2 for
Internet: www.tigard-or.gov . Notified/Method: ,e .. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑ Demolition For special information use checklist
Description 1 Qty. Ea. Total
iSiddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling ommercial/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
MB SITE IG JA31IE/ • ;4 i/ S �/' Site utilities:
Job site addressaip
: Catch basin or area drain 18.76
-td S I ' Drywell,leach line,or trench drain 18.76
City/State/ZIP: / -�,
y9 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: / Project name:/ 6/' �� Manufactured home utilities 50.03
Cross street/directions to job site: 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: Lot no.: Fixture or item:
Tax map/parcel no.: 2 ),)--_ I_ ,-,.`.1. Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
.�_ �• t 't °""` T"„'. '.' Clothes washer 25.02
/�/ "1") i
%Z� ' Dishwasher / 25.02 r i eV
;.
T-11//1/
/ fI C� � 77 / --7//'
Drinking fountain 25.02
� � Ejectors/sump 25.02
/(4` 0 PROPERTY OWNER 0 TENANT Expansion tank �� / 12.51 /061
1
Name:
ettne5 /G "1Si./ _7 25.02 /' 'i
Floor drain/floor sink/hu s 25.02 �>
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker/G -- 12.51 ,al
i./„//r Interceptor/grease/ 25.02
A�)•I � ❑ CONTACT PERSONtrap
�'� Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name: �t Roof drain(c cial) / 12.51
Address: If . �� � Tiil -- Sinkbasi lavato ����1, ��ij�� 25.02 ] s,���,r ,
City/State/ZIP: ide 7 r / t775) Solar units(potable water) 62.54
3
, *► - o 4 Tub/show r/shower nan 12.51
Phone:( ��" � Fax::( ) � 1 - _�
'04/ 2, _ f1 25.02
E-mail:��l�.�z+"' !�� ,r f----- ti/�,/-�/1�>��
Water closet I 25.02 06-,Z:7(
CONT' •CTOR r,
.. .,..,u, Water heater 37.52 /`59
Business name: V--1-- t! Water piping/DWV 56.29
Address: ,. �� r4 i44Other: 25.02
City/State/ZIP: /., / / / 7,,I� Subtotal ¶3i5
Phone:K 3 l a, �,ri�% Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: lumbing .no.:L'. )
k State surcharge(12%of permit fee) �,,�rj.la; J
y)116
Authorized signature: TOTAL PERMIT FEE ✓Q .391
.
^ This permit application expires if a permit is not obtained within 1liu days
Print name: j/Ge. , Date: �._`�^I/ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:Building Permits PLMIJ-t'ermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 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-I'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*.
Quantity by Fixture Type Plan Review for PlumbingInstallations
Fixture Type for Replace/ .,.
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower 111 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 Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ' ❑ Any multipurpose fire sprinkler system.
Drinking Fountain _ ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash _ _ _
Floor Drain/sink 2" /2 Submit 2 sets of plans with any of the above.
3„
-4" - Isometric or Riser Diagram
_ __ Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related f that meet the qualifications above.
0-Commercial-food related _ -
-Industrial-food related - -
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) - Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall -
Sink/lav -Non-food related l
t
-Bradley
-Commercial-food related cj i _ _
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
_water Extractor - increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet f }_ fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\vince\AppData\Local\Temp\PLMF PermitApp.doc 2
1111
Accumulative Sewer Tally
= Tenant Name: HOME STREET BANK SWR# N/A
Site Address: 16230 SW PACIFIC HWY PLM# PLM2019-00298
TIGARD
Parcel#: 2S115BA02600
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 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 2 4 0 -2 -4
-3 inch 5 0 0 0 0 0
-4inch 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 1 2 2 4 1 2
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 3 9 1 3 -2 -6
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
. . - Extractor_ 6 0 0 0 0 0
Water Closet-Toilet 6 0 1 6 1 6 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped I';DU Credit 0
TOTALS 0 0 7 21 5 15 -2 -6
Current Fixture Value -6 divided by 16= -0.375 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -6 divided by 16= -0.375 over (under) $ (2,204.00)
Enter EDU Change Here -0.380 *
*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: ***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 7/24/2019
Building Division
INote: 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