Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00220
Date Issued: 09/21/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S101A600100
Jurisdiction: Tigard
Site address: 12023 SW 70TH AVE
Project: Red Rock Center, Phase II Subdivision: Lot: 0
Project Description: Site utilities
Contractor: BONES CONSTRUCTION CO Owner: FRY, DOUGLAS
3508 S 209TH AVE 23077 SW NEWLAND RD
ALOHA, OR 97007 WILSONVILLE, OR 97070
PHONE 503 - 649 -5682 PHONE
FAX:
FEES
Quantity Description Date Amount
10 ea Catch Basin or Area Drain 09/21/2011 $187.60
Specifics: 3 ea Manholes 09/21/2011 $56.28
3 ea Rain Drain Connector 09/21/2011 $56.28
Type of Use: COM 43 If Sewer Service 09/21/2011 $62 54
Class of Work: ALT
904 If Storm and Rain Drain 09/21/2011 $400.22
Type of Const: 931 If Water Service 09/21/2011 $400.22
Occupancy Grp: 1 ea Backflow Preventer 09/21/2011 $31.27
Stories:
1 Plan Review 09/21/2011 $298.60
1 12% State Surcharge - 09/21/2011 $143.33
Plumbing
Total $1,636.34
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 -0n0. Yo ay obtain a copy of the rules
or direct - ions to • • • - • calf -. '03 232 1987 or 1.800.332 2344
Issue By: I -/It., Permittee Signature: /1111
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 projec.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLY .
� f / `/
City of Tigard R eceived Per mit No
r 13125 SW Hall Blvd Tigard,OR 97223
U PI
� , Date /By V r oft... .:...d. .:...d. Phone• 503 718 2439 Fax. 503 598 1960 Plan Review it L
Date /By : t Other Permit No / to , i , 1 .
TIGARD: inspection Line • 503 639 4175 Dat Ready /By lures H See Page 2 for
Internet www.tigard - goV '� � Noufied/Method 8la 3�n( ,�j �f Supplemental Information
1 FEE * ; SCI3EDULE 'rt
®
New construction I t For special information use checklist.
` . .1- Description Qty Ea Total
❑ Addition/alteration /replacement ❑ Other: ® w - 2-family dwellings ( dudes 100 ft for each utility connection)
1 2 it in a y c ion )
- g ,,,. � ' _ l4' SFR (1) bath 312 70
' CATEG = ORY =OF,�,CONSTRUCTI - -
❑ 1- and 2- family dwelling ®Conuner /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
' `E ; JOB `SITE.'iNFORMATION AND PLA . CATION ,' .:, ;1zc,u Ei Site utilities:
Job site address: SW 72 " Ave. and SW Dartmouth Ave. eii.,l1 • et Catch basin or area drain V 18 76 a 7. ��
f +.`' ) d tt�L Drywell, leach line, or trench drain 18 76
City /State /ZIP: Tigard, Oregon
Footing drain (no. linear ft . ) Page 2
Suite/bldg. /apt. no.: 1 Project name: Red Rock Center Manufactured home utilities 50.03
Cross street/directions to job site: Manholes Z 18 76 5
SW Corner of SW 72 Ave and SW Dartmouth Ave. Rain drain connector , 3 18 76 yo. 4
Sanitary sewer (no linear ft.. _ Lf Page 2 &2. .91
Storm sewer (no linear ft • 0 4 Page 2 *6. . .2
Water service (no linear ft — c3 1 Page 2 44 • � -
Subdivision: Lot no.: Fixture or item: cJ
Tax map /parcel no.: Backflow preventer + 31.27 'W. 9-7
^�� Backwater valve 12.51
), DESCRIP,T ION OF WORK 4; ''
=:t, nI, , ' "' ' ' Clothes washer 25.02
Installation of Site Utilities
Dishwasher 25.02
Drinking fountain 25 02
Ejectors/sump 25 02
" Expansion tank 12 51
i 7 -' OWNER =, ' I �; ®s° '> ' y >` ,; p
Name: Doug Fry Fixture /sewer cap 25 02
Floor drain /floor sink/hub 25 02
Address: 908 Deborah Rd
Garbage disposal 25 02
City /State /ZIP: Newburg, Oregon 97312 Hose bib 25 02
Phone: (503)348 - 2237 Fax: ( ) Ice maker 12 51
„0-'41 ®.
�;� ��;` ; ARPLICANT ' "Yii , CONTACT , PERSON Interceptor /grease trap 25 02
Business name: Bones Construction Medical gas (value. $ ) Page 2
Primer 12 51
Contact name: Matt Ekerson , 6` ?- J
` 1/ "' �fi Roof drain (commercial) 12 51
Address: 3508 SW 209th Sink/basin/lavatory 25 02
City/State /ZIP: Aloha, Oregon 97007 Solar units (potable water) 62 54
Phone: (503) 649 - 5682 I Fax: : (503) 649 - 1717 Tub /shower /shower pan 12 51
E -mail: matt @bonesco.com Urinal 25 02
,. ,..�_ ,,� Water closet 2502
,,x a . , ° , .
Water heater 37.52
Business name. Bones Construction Water piping/DWV 56 29
Address: 3508 SW 209th Other. 25.02 '/� J
City /State /ZIP: Aloha, Oregon 97007 Subtotal //9`/ •
Phone: (503) 649-5682 7 Fax: (503) 649-1717
Minimum permit fee. $72 50
Plan review (25% of permit fee) a9 g .
CCB Lic.: 00734 /' / Plumb' i . Lic. no.: 34 - 204PB
........i. State surcharge (12% of permit fee) / y5.33
Authorized signature: �i ��� TOTAL PERMIT FEE r / 34. 3y
Print name. Mall Ekerson Date: 7/12/11 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by TN- County Building Industry Service Board
1 \Building\Perm ts\PLMU- PcnmtApp doe 10/01/09 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
o fool age, e
;_�; ..... _
, •, . a (e
Square` a e Permit F e: . ;�
Footing drain - 1 s' 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' I 62 54 7,201 and greater $327 54
Sewer - each additional 100' 37 52
Water Service - 1st 100' I 62 54 Medical Gas Systems:
Water Service - each additional 100' q 37 52 __
Valuat °Permit F
Storm & Rain Drain - 1st 100' 62.54 $1 00 to $5,000.00 Minimum fee $72 50
Storm & Rain Drain - each additional 100' 1 37 52 $5,001 00 to $10,000 00 $72 50 for the first $5,000 00 and $1 52 for
Other Ins eCtionS' O1';,FeBS, Q�'' -u' '`Fee (ea)m Total each additional $100 00 or fraction thereof, to
p 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 :Reviiew for Pluinb`ing�.I•nstallat ons , .
Fixture Type for RepIacel Plan review is required for any of the following. Per - formed: Capped ,Added_ Relocate
Please check all that apply.
y g
Baptistry/Font
Bath Tub /Shower ❑ 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" Submit 2 sets of plans with any of the above.
-3"
46metric or Riser'Diagram x.
Car Wash Dram ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic non - food g q g
Disposal - Domestic - food related that meet the qualifications above.
- 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/Lay - Non -food related
- Bradley
- Commercial- food related
- Service
Swimming Pool Filter
washer Clothes *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 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures.
2
This form is recognized by most Building Departments in the Tri -County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
q City of Tigard
o Building Buildin Division -
TIGARD
• • TRANSMITTAL LETTER •
TO: 6ce o e DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
MAR 8 2012
FROM: °''r- er.� ` e� CITY OF TIGARD
COMPANY: BUILDING DIVISION
1/4 / 6 rye ✓S
PHONE: .sv 3 6-9"7- 3 2 2 2-
RE: � P url ` bra - GC�ao(
( ite Address) (Permit Num. er)
(Pro ect name or su rvision name an" number)
ATTACHED ARE THE FOLLOWING ITEMS: Alijp Co
Copies: I Description: I Copies: I Desfcription: (/
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis. .
•
Floor /roof framing. Basement and retaining walls:
Beam calculations. Engineer's calculations.
Other (explain):
REMARKS: -
•
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Description: Amount Due:
$
Special •
Instructions: '
Re •rint Permit •er PE : • Yes El No • Done
Applicant Notified: Date: Initials:
•
1:\Building\ Forms \TransmittalLetter - Revisions.doc 02/08/2011
This form is recognized by most Building Departments in the Tri- County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
1111 City of Tigard
= Buildin g Division
TIGARD
TRANSMITTAL LETTER •
TO: � ! DATE RECEIVED:
DEPT: BUILDING DI ISI •dt RECEIVED
FEB 14 2012
FROM: CITY OF TIG
COMPANY: _ BUILDING DIVlSI
/ C e �- h� i� ee ✓f �n c
PHONE: 6 5 - Z B y:
97 3ZZ
RE: Zed Rock - Ski Pa (r ow -ood o
(Site Address) (Permit Number)
�OG .
ro�ec name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: I Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and /or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain):
REMARKS: .�,L.e); Dph -•1_ et-r) tef-e,d-i .4121
QA�
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Description: Amount Due:
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
1:\Bwlding\ Forms \TransmittalLetter - Revisions.doc 02/08/2011
•
EW
BACKFLOW ASSEMBLY TEST REPORT E E NG
REMOVED
i d C �� ❑ REPLACED
OWNER:
PROPERTY G PHONE:
L
MAILING if 0 �) r 1 - - V ' 2 01' 6' -
ADDRESS: J 7 •
CITY T 7 Ord STATE 0 /l? ZIP /� o 3 Sly ! ��/4-
ASSEMBLY
ADDRESS 5 el ' C / /� / �� / /— O� ��� •
3 :41 . I.P.B.A. la D.C.V.A DR.P.D.A. ED.C.D.A. ❑ P.V.B.A. DS.V.B.A. DA.V.B. DAIR GAP L�
SIZE: 2 MAKE: kV; f i fGif MODEL: c 7 2.5 Xc
WATER d SERI
PURVEYOR UM BER: 3 y 2 5 7 a
� PI r NUM AL
� /
LOCH ION / - 6o t—Lv b i .-/9 - A K / r . 1 .. ter d�
I REDUCED PRESSURE ASSEMBLY P.V.B.A. / S.V.B.A. INITIAL TEST
#1 Check DOUBLE CHECK AIR CHECK PASSED N
Press. Drop 2 i / Check # 1 INLET ❑
mm. 5 psi Opened at: Press. Drop FAILED
INITIAL Opened at: Tight
o at: � • Date:
RESULTS min. 2 psi Leaked P5� I
RESULTS A - B = . Check # 2 psid psid 1, // ? /1
A -8=
Tight SYSTEM a
RELIE VALVE psid DID NOT FAILED PSI
PASS FAIL n Leak ❑ OPEN II ® r
I
Comment -
Repairs
and/or •
Parts •
' Reduced Pressure Assembl : Double Check " P.V.B.A. / S.V.B.A. AFTER REPAIRS
Check #1 !Check # 1
TEST Press. Drop min 3 psi Tight ❑ psid Opened at: Press. Drop Date:
j AFTER Relief /
REPAIRS opened ( Check # 2
min. 2 psi
Buffer 'Tight ❑ psis psid paid PASSED D
A -B= I -,,
In completing and submitting this test report, the tester certifies that the assembly
has been tested and maintained in accordance with all applicable rules and
regulations of the water system. and state regulations.
GAUGE CALIBRATION DATE 02 -16-12 DETECTOR METER READING
CERT a 0823 & 1129
TESTER SIONRURE
TESTER IW EP D GENE HIGGINS GAUGE a 1189
J
TESTER ADDRESS BRUSH PRAIRIE WA cce a NA
COMPANY NAME AM Drilling, Clackamas OR PHONE a 503-284-3701 .
* SERVICE RESTORED
' REPORT RECEIVED BY (REPRESENTATIVE OF OWNER)
ow- T er Page i of 1
WNIE - wdR Sys!. Cow PINE - fuGmw Copy