Permit (3) CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2019 00381
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/26/2019
TIGARDParcel: 1S135DD01800
Jurisdiction: Tigard
Site address: 11565 SW HALL BLVD 160
Project: Dr.John Chung Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Capping(11)sinks;Adding(6)sinks and (1)water closet; Installing (2)backflow
preventers.
Contractor: VENNE PLUMBING LLC Owner: TV5 LLC
15145 SW DIVISION ST 10855 SW CASCADE BLVD
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503-624-9309 PHONE:
FAX: 503-684-0940
FEES
Quantity Description Date Amount
2 ea Backflow Preventer 09/26/2019 $62.54
Specifics: 11 ea Fixture/Sewer Cap 09/26/2019 $275.22
6 ea Sink 09/26/2019 $150.12
Type of Use: COM 1 ea Water Closet 09/26/2019 $25.02
Class of Work: ALT 1 12%State Surcharge- 09/26/2019 $61.55
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $574.45
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.
,
PlPerm
umbht it Application
Building Fixtures
iik,:,,:,:,:,: Cid of Tigard r
e� Received
s 13125 SW I Blvd.,Tigard,OR 97223 E P 2 Q Date/D , j er zoo Permit No.: � �t1q dj, 7
,:'• Phone: 503.718.2439 Fax: 503.598.1960 Nan Review
TARlQ Inspection Line: 503.639.4175 t" w Datc/I3y; (blur Permit No.:/ /J . r J- -}�
Internet: www.yard-or.gov Y t F ) x )f 4 Date Ready/By: Jt!!�[ 0 See Page 2 for [a
Notified Method:
11.-=-1--le t.Supplemental Information
TYPE OF WORK FEE* SCHEDULE
New construction For eclat in ormarion use checklist
_❑Demolition , tl f; Total
-,1"-, cscription Qty, Ea, Tota
Other: ,, .1.-/ Y l 4 lsi - New 1-2-family dwellings(includes 100 R.for each utility connection)
CATEGORY OF CONSTRUCTION `. , SFR(l)bath 312.70
1-and 2-family dwelling SFR(2)bath 437.78
Commercial/industrial
Accessory building
❑ SFR(3)bath 500,32
Multi-family
Master builder
0Each additional bath kitchen 25.02
Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Job site address: Site utilities:
� 5 � (ql�� 'v C Catch basin or arca drain 18.76
City/State/ZIP. t-;
; [\-'�j` Drywcll,leach line,or trench drain 18.76
Suite/bldg./apt.no.: Footing drain(no.linear ft.: ) Page 2
Project name: , J C+^ L,��
Cross street/directions to job site: t 1 Manufactured home utilities 50.03
Manholes 18.76
Rain drain connector 18.76
H Sanitary sewer(no.Iinear ft.:
Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: Water service(no.linear ft.: ) Page 2
I Lot no.: Fixture or Item:
Tax map/parcel no.: s f- ;•''] %3,n . --v Backflow prcventer
a 31.27 1,.,y/. ,;-`1
DESCRIPTION OF WORK
' Backwater valve 12.51
Alai • Clothes washer 25.02
• r_ _ 'A w r 0 Dishwasher
w "� 1 • e 25.02
Drinking fountain 25.02
.________'---77 ❑ Ejectors/sump -
_I.PROPERTY OWNER 1 25.02
TENANT ' Expansion tank 12.51
Nie' 1 'Fixture/sewer cap
t` 25.02 "25-.
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal _
25.02
Phone:( ) Hose bib 25.02
• Fax:( ) Ice maker
ElAPPLICANT0 12.51
CONTACT PERSON Interceptor/grease trap 25.02
Business name: n (�,VYy�+^1�� Medical gas(value:S
r -) Page 2
� ��
Contact name: �`/ rt , e-an Primer
12.51
Address: ,�`Lt `(- V Roof drain(commercial) 12.51
S S\A) O1\‘S(-0,r\ Cj-} Sink/basin/lavatory
Co
City/State/ZIP: S�e��cx�d Oj 60.--//46 25.02 '�'.t.�
Solar units(potable water) 62.54
Phone:6.-03) / 4 Lj 9 30 q Fax::( ) Tub/shower/shower pan
k� 1 1 14
12.51
E-mail: vpyxlrltptun'3 19tmil`, m1 Urinal
25.02
1
CON 1 RA TOR Water closet , 25.02
Business name: U���1 P p Um `n9 Water heater 37.52
Address: Ii S 1L \S S(/o Y l t y
Water piping/DWV 56.29
vJ 1`J�o(\ S4- Other. 25.02
City/State/ZIP: 5kr) -t.3Cat3, °,Z \ 0 }
Phone:(5Q3) 2. x1309 Fax: Subtotal �,c.`FRµ
t ( ) Minimum permit fee: $72.50
S Plumbing Lic.no.: pe, Isco Plan review (25%of permit fee)
CCB Lic.: .iLiZ ci L.1
Authorized signature: - ....0' State surcharge(12%of permit fee) 51
TOTAL PERMIT FEE 11
Print name: L nM f t r1 Date: cli 7L1� 19 This permit application expires If a permit Is not obtained within 180 days
after it has been accepted as complete.
`Fee methodology sct by Tri-County Building Industry Service Board
440-46161(10102/COM/14E13)
l:lBuildingTermits\PLMU-PermitApp.doc I0/01/09
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule:
Site Utilities Qty. Fee(ca) Total
Footing drain-I"100' 50.03
Footing drain-each additional 100" 37.52
Sewer-1st 100' 62.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54
Storm&Rain Drain-each additional 100' 37.52
Other Inspections or Fees Qty. Fee(ea) Total
Inspection of existing plumbing or for
which no fee is specifically indicated 90.00/hr
minimum charec`1/2 hour
Inspections outside of normal business 90.00/lir
hours(minimum charge—2 hours)
Reinspection Fees 90.00/hr
Additional plan review for revisions 90.00/hr
,_(minimum charge—1/2 hour)
Subtotal:
Residential Fire Suppression Systems:
Square Footage: Permit Fee:
0 to 2,000 $121.90
2.001 to 3,600 $169.69
3,601 to 7,200 5233.20
7,201 and greater $327.54
Medical Gas Systems:
Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
$5,001.00 to 510,000.00 572.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
and including$10,000.00.
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
each additional$100.00 or fraction thereof,to
and including$25,000.00.
525,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 51.45 for
each additional$100.00 or fraction thereof,to
and including$50,000.00.
S50,001.00 and up $742.00 for the first 550,000.00 and 51.20 for
each additional$100.00 or fraction thereof.
Floor Drain/sink -2"
-3"
-4"
Commercial Fixture Work: Car Wash Drain
Are you capping,adding or replacing fixtures? If"yes", Garbage -Domestic—non-food
please indicate work performed by fixture. Failure to Disposal Domestic—food related
-Commercial—food related
accurately report fixtures could result in increased sewer fees*. -Industrial-food related
Quanti by Fixture Type Ice Mach./Rcfrig.Drains
Fixture Type for Replace/ Oil Separator(Gas Station)
Work Performed: Capped Added Relocate Rec.Vehicle Dump Station
Baptistry/Font Shower -Gang
Bath -Tub/Shower -Stall
Jaeuzzi/Whirlpool Sink/Lay -Non-food related
Car Wash -Each Stall
-Drive Thru Bradley
Cuspidor/Water Aspirator Commercial-food related
Dishwasher -Commercial Service
Swimming Pool Filter
-Domestic
Drinking Fountain Washer-Clothes
Water Extractor
Eye Wash _ Water Closet-Toilet
L\Building\PermitsWPLMF-PermitApp.doc 2
Accumulative Sewer Tally
Tenant Name: DR.JOHN CHUNG SWR# N/A
TIGARD Site Address: 11565 SW IIALL BLVD PLM# PLM2019-00381
Parcel#: 1S 135DD01800
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Dont 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 IIP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 FTP) 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:
-Lay/Bar-Non-Food Related 2 0 11 22 6 12 -5 -10
-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 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 11 22 7 18 -4 -4
Current Fixture Value -4 divided by 16= -0.250 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -4 divided by 16= -0.250 over (under) $ (1,450.00)
Enter EDU Change Here -0.250 *
*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: 9/25/2019
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:ABuilding\Sewer Tally\SewerTallySheet_5800_070119.xlsx