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Permit CITY OF TIGARD PLUMBING PERMIT ''1 a • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00144 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/27/2012 Parcel: 1 S 134AB03300 Jurisdiction: Tigard Site address: 10330 SW SCHOLLS FERRY RD Project: Muslim Educational Trust Subdivision: ENGLEWOOD Lot: 88 Project Description: Site utility work associated with new 2 -story building and parking lot. Contractor: DOW BROS INC Owner: MUSLIM EDUCATIONAL TRUST INC 1045 N 4TH AVE PO BOX 283 CORNELIUS, OR 97113 PORTLAND, OR 97223 PHONE: 503 - 357 -5804 PHONE: FAX: FEES Quantity Description Date Amount 6 ea Catch Basin or Area Drain 09/27/2012 $112.56 Specifics: 4 ea Drywell, Leach Line or Trench 09/27/2012 $75.04 Drain Type of Use: COM 1000 If Footing Drain 09/27/2012 $387.71 Class of Work: ALT 1 ea Manholes 09/27/2012 $18.76 Type of Const: 21 ea Rain Drain Connector 09/27/2012 $393.96 Occupancy Grp: 584 If Sewer Service 09/27/2012 $250.14 Stories: 1474 If Storm and Rain Drain 09/27/2012 $587.82 182 If Water Service 09/27/2012 $100.06 2 ea Backflow Preventer 09/27/2012 $62.54 11 ea Backwater Valve 09/27/2012 $137.61 1 Plan Review 09/27/2012 $531.55 1 12% State Surcharge - 09/27/2012 $255.14 Plumbing Total $2,912.89 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 Notificat'• • - - . 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 q - ions to OUN • callin• 03.232.1987 or 1.800.332.2344. Issued y: • / / Permittee Signature: Vs I II 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. V Plumbing Permit Applicatiod� CE vIRT-� _Lb Site Utilities • FOR OFFICE USE ONLY City of Tigard MAY 2 4 2012 Date/By: aceied h .1 /../.. • , Permit No.: e t o'/g- !JO /e/y 0 13125 SW Hall 13lvd., Tigard, OR 97223 Plan Review • Phone: 503.718.2439 Fax: 503.59 19 OF a Other Permit No.: TIs, fal�� Date/By: Q - /�/ -/ .� v j t: T I G A R D Inspection Line: 503.639.4175 B U JYL 1, D N C DIVISION Is ON Date Ready /By: / lurk: 0 See Page 2 for Internet: www.tigard - or.gov ll1 1 Notitied/Method•�R 1/6 Supplemental Information T TYPE OF WORK 4 & .G! FEE* SCHEDULE t-l ® New construction ❑ Demolition For special information use checklist �/ Description I Qty. I Ea. I 'Total ❑ Addition /alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 II. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 1 ❑ I- and 2- family dwelling Z Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 1 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site-utilities: � Catch basin area drain ^ 18.76 i f ,.. S�f Job site address: 10330 SW Scholls Ferry Road �� - Drywc11, leach line, or t rench dra 18.76 75.° O City/State /ZIP: Tigard, OR 97223 Footing drain (no. linear ft.: 1000 Page 2 387.71 Suite/bldg. /apt. no.: I Project name: MET Community Center Manufactured home utilities 50.03 Cross street/directions to job site: SW Scholls Ferry & SW Conestoga Drive Manholes / 18.76 I Sati Rain drain connector T I 18.76 Sets.46 4 Sanitary sewer (no. linear ft.:) 4 S Page 2 1 Ftl g.5 0. Storm sewer (no. linear ft.: /q7 it Page 2 5543, 1` 5� � t • Water service (no. linear ft.:�) j8,P.. Page 2 F95".18 I Subdivision: Lot no.: Fixture or item: I 4 • Tax map /parcel no.: I S134AB03300 B. kflow preventer 31.27 31 (a t DESCRIPTION OF W Back ater valve / / 12.51 I3 1. _ 'l • ith new site utilities, Dishwashe -i- 25.02 25.02 packiawkitrawkwg Drinking foun =in .4 25.02 100.08 Ejectors/sump 2 • 25.'_ 75.06 ® PROPERTY OWNER I ❑ TENANT Expansion tank ` F - _.5I 12.51 Name: Muslim Educational Trust Fixture/sewer cap 25.02 Floor drain /floor sink/hu ■ ....2.11 25.02 725.58 Address: 10330 SW Scholls Ferry Road Garbage disposal . 25.02 25.02 City /State/ZIP: Tigard, OR 97223 Hose bib 9- 25.02 175.15 Phone: (503)579 -6621 Fax: (503)590 -0201 Ice maker 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap ' 25.02 25.02 Business name: Otak Architects, Inc Medical gas (value: $ ) Page 2 Primer 12.51 100.08 Contact name: Jennifer Nye Roof drain (commercial) 12.51 25.02 Address: 17355 SW Boones Ferry RD Sink/basin /lavatory 54 25.02 1426.14 City/State /ZIP: Lake Oswego, OR 97035 Solar units (potable ater) 62.54 Phone: (503) 699 -2456 Fax: : (503) 635 -5395 'Tub /shower /show r pan -6 I 1 75.06 E -mail: jennifer.nye@otak.com Urinal 25.02 CONTRACTOR ' Water close e5 25.02 625.50 Water h to -it, 37.52 5.04 Business name: DO to hiedaS /3 0...,_ Wate•.iping/DWV -tf' 56.29 619. ' Address: /0 Ai N y/i(fenc Other. 25.02 ^ 1* � ,f City /State /ZIP: 06,IJ9.1,/!a5 O'- ?7//3 Subtotal ,,S44.6•15 01 Phone: (5 ) 3 5 7 _ 6 Fax: ( ) Minimum permit fee: $72.50 1.1 6 6 Plan review (25% of permit fee) 1354 -1 19 y �- CCB Lic.: , 90,9 Plumbing Lic. no.: 83 7r/41 6 ' , State surcharge (12% of permit fee) (y�.�' Authorized signature: ' TOTAL PERMIT FEE 7 3"' Print name: WAJDI SAID Date: 5/24/12 This permit application expires if a permit is not obtained within IRO days e q 6 after it has been accepted as complete. 4' i'll �( •Pee methodology set by Tri- County Building Industry Service Board. I : \Ituildinp\Pcrm its \PI.N(J- PcrmitApp.doc 10/01/09 440- 4616'r(10 /112 /COM/WIiIti 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 - 1 100' I 50.03 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 9 37.52 337.68 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' I 62.54 62.54 7,201 and greater $327.54 Sewer - each additional 100' 3 37.52 112.56 Water Service - 1st 100' 1 62.54 6254 Medical Gas Systems: Water Service - each additional 100' 2 37.52 75.04 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 1 62.54 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 13 37.52 487.76 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Q ty. Fee (ea) Total each additional $100.00 or fraction thereof, to Other Inspections or Fees 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: I Other Fixtures: I I I 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 Fixture Type for Replace/ Plan Review for Plumbing Installations Work Performed: Capped Added Relocate g Baptistry/Font Plan review is required for any of the following. Bath - Tub /Shower PI a check all that apply. - Jacuzzi/Whirlpool y new commercial building with water service 2" and Car Wash ::ch Stall greater, except systems designed and stamped by licensed -I) 've Thru / engineer. Cuspidor/Water Aspi or / ❑ New exterior plumbing site utilities for any complex structure Dishwasher -Co •ercial 1 / as defined in OAR918- 780 -0040. -Domes .*c / ❑ Medical gas and vacuum systems for health care facilities. Drinking Fountain /4 ❑ Any multipurpose fire sprinkler system. Eye Wash / I ❑ Any complex structure as defined in OAR918- 780 -0040. Floor Drain/sink - 2" ' 3" / 29 Submit 2 sets of plans with any of the above. 4 / Car Wash .: in Isometric or Riser Diagram Garbage - Domestic- non -food Disposal - Domestic -food related ❑ Isometric or riser diagram is required for new buildings - Commercial - food related I that meet the qualifications above. - Industrial -food related Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall 6 Sink/Lay - Non -food rela a 52 - Bradley -Commerci: food related 4 - Service 1 Swimming Pool Filter 1 Washer - Clothes I Water Extractor *Note: If the fixture work under this permit results in an Water Closet - Toilet 25 increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the F: \MF.T\MF.T Community Center\Technical Committee\City of Tipard \Minor Modification Ruilding Permit Annlications May 2012 \PI .M11- Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10330 SW SCHOLLS FERRY RD, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2012-00144 George Heimos 1. Provide freeze protection for both the building and lawn irrigation backﬂow devices. 313.5 2. Provide 2" RP for maim water supply pipe to building in hot box at meter llcation with freeze protection. Required because there is an active well on property. If well is disassembled and capped 2" existing Double Check can remain. Table 6-2 THE FOLLOWING ARE BACKFLOW TEST RESULTS: 1" Watts model 007M1QT Serial number 435414. Lawn irrigation device 2" Watts model 007M1QT Serial number 197421 Building main device 3/4" Wilkins model 950XL Serial number 3653565 FIRE In vault behind meter. 6" Wilkins model 350ADA Serial number V34061 FIRE Vault behind meter 1 1/2" Watts model LF009M2QT Serial number 020465. P.O.U. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10330 SW SCHOLLS FERRY RD, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2012-00144 George Heimos 1. Not ready for inspection, recall when ready Rooms ok for temporary use, no plumbing health hazard: 1st ﬂoor: 121,122,123,124.125,126,128,129,130,132,133,135,136 and 139 2nd ﬂoor: 210,211,212,213,214,215,217,218,219,220,221,222 and 224 Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10330 SW SCHOLLS FERRY RD, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O December 11, 2015 at 9:48:49 AM PLM2012-00144 Don Sylvester 1. Corrections from inspection dated 11-16-2015 have been made. Note: provide freeze protection for RP back ﬂow device. Violation Summary: Inspector Contractor