Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013-00411
Date Issued: 11/14/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136AD04000
Jurisdiction: Tigard
Site address: 11513 SW PACIFIC HWY
Project: Vine Gogh,LLC Subdivision: VILLA RIDGE Lot: 7
Project Description: Relocate existing fixtures to new location: (1)dishwasher,(4)non-food related sink/lays,and(1)water closet.
Contractor: CASCADE PLUMBING CO Owner: PACIFIC TERRACE COMMERCIAL LLC
2416 N HAYDEN ISLAND DR BY SMITH, EDITA M
PORTLAND, OR 97217 833 NW 170TH DR
BEAVERTON, OR 97006
PHONE:
PHONE: 503-289-7095
FAX: 503-283-9514
FEES
Quantity Description Date Amount
1 ea Dishwasher 11/14/2013 $25.02
Specifics: 3 ea Sink 11/14/2013 $75.06
1 ea Lavatories 11/14/2013 $25.02
Type of Use: COM 1
ea Water Closet 11/14/2013 $25.02
Class of Work: ALT 1 12%State Surcharge- 11/14/2013 $18.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $168.13
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.
i
Issued By: Permittee Signature: v t 42p,(....,/•/¢,-10,\/.
i(C
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.
...
• •• . -• • ••• •• •
Plumbin Pei1,._._2. ---lit A 'nation
' • RECEIVED
Building Fixtures FoR orncp: usv. om A
City of Tigard NOV 1 2 2013 R'elyed
Date/13y // /1 /3 444,---- Pormit 14.W.39/17.40 9//
ilh ■'4 13125 SW Hall Blvd.,Tigard.OK 0223
II Phone: 503.718.2439
Plan Revie
Fax: 5°3-598'MY OF TIGARD nawit ---- Other Permit 0?0/... -,d62/7
Inspection Line: 503.639.4175 Doe Reatiy/ey
.1-t c A RI) BUILDING DIVIS -PV ,s21,, .1.01"7:,n1 trformation
Internet www.tigard-or goy 10 IL Notifiedqvielhod:
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'''.....=1L'. :1...;.-;„..,,:. - ''''..'. 1.'•■•••- •,....4,.. ' ''
ion use eneexusz. _____.
0 New consmnirm 0 Demolitin o ---
informatl Qty. i ta. a
ddition/alteration/replacement .1_0 Other: —
New 1-2-family dwellings(includes 100 ti.Ibr midi utility connection)._
.•••••- •-7
,7.77,77,7,7,777777,77: 77.77777:,........ „, 77777777'nr,..,;„,,,...r.,,,...:,,=:::',;.:-,':',:.4::.,,i:,'J*,,::::.o.:,,,,!,,,!,: : snt(1)bath
.! :V:70;ii;.;;;;:;;:;;Z:,.7::.,,i,:■.;•:::..;;W;7:::,c,ATEGoRy:..prit,:it:ortg.vw":,.'/...,7:,.,,,::viv.:4.6,;g:,;,i..f:,.:,:,,-,,,:v., :.!.ii!'; ,..:, -.
EJ 1-and 2-fiunily dwelling
— 2 iommerrial/indusuial SFR(2)bath
0 Accessory building 0 Multi-family--- —--"-- S 1 -
--FR-0)bath -------------
—. 312.70
-
437.78
— ----
500.32
, __.. --_....-. ..ac a mit a i
IF h dd . nal Er th/Vtchen 4- 25.02
.----------------- .,
0 Master hMIder Other: Fire sprinkler( sq.ft.) Page 2 1
..1....- --...-■--1... -..-
13-: .......—.--
.'':'''',•'40SITE.:1NfORM.A.T.19r ANDAPCATII)N:'i:: :::,:,?: ::.,::!.•:',!.,..'4:::•:,•!•, ...- --- ----,----------r-----
Catch basin-or area diai31 18.76
Job site addre__SLII l')) ,7,) et,tit., ,r... ...ti,....,1 - _
Drywell,leach line,ca'trencb drain 18.76
.--- ---"7"ea." ';-----
City/State/ZIP: " " • .I,"....
._...,;..) 7- Page 2 -
Suite/bldg./apt.no.: Project name: Vijiiii„ qyZill Manufbenircd home utilities 50.03
__...-„—.......--._- .... — --.•----------- ____________________-_—___--.- -
Cross strcet/directionstn job sue: _••
,,......_.......,......_.,...._ _.......
__., ,Manhol_es
Rain drain connector
--"------"------------- Sanitary sewer(no.linear ft.:___J Page
___-.-----__
-_____- "---------" -----"--"" Storm sewer(no.linear ft: )_ 1 Page 2_I
, Wnter service(no.linear ft.: / T 1- aiei 2 1----
Subdiv - _ -
ision: Lot
--.
1)34:know preventes.
Tax map/parcel no.: . _____,.. 1.12.2571..--)._,>____.z., _rn.......
" ''•..."'"":'%77.---7'.:Irrtn 7,17777,-7..n..,7•,.,•,-..:,• --. ,:,:,-;,rr77r77Trr77.rTr7T77.777.7;,v:, Backwater valve
.•::: 1N;Y:g.PF.,c140.0.0,ti!1#4,V,F)A:q•i;PI''.:•:k'':'iai..::''''''''':'! -.j.ToiT,-„*„lher .
....-
21.0?
/.'el.$ct ' -t
25,02 . ?•'' , .'
' .2 /16",Iiid IS ' !_'LL'S 1_134 LI ''. 1.,.., : pi,t) Drinking foontain 25.02
... i '' --- -
Ejectors/sump 25.02
._._..----. .„ —.
777:7:77.77.777. 7cr. ,7-57;-w;,77rz,,,,,77FTr,,3,.:.,;„,.„,,,,.,,,,.,,.,,.,-,,,,w...,,,..,,,,,,,,,,„,!(. : D,patssion tank 12.5 I
0'.' .'',;;\ ,'''...r.ail'111.9012:0:61191S17.g;';',:l.i'i%.Y:W:":..i':';:'';;',' '',,,,i.,','.): 1=4.42X,)F47!..,,..,,Xi',:!,';',•l.:',:!,,...'`,1:'.1'.0,y,l•li ,--------- • —.' _ ,
.'.1::Liiir. ',..,.,-- ,: :,:,... ', :.:.,,::,:- ..., ..:,_.:.. .-.:,....1.....-:-.... ..._-_
Fixture/sewer cap 25.02.
Name: _—_._.- ___—.......____. .
_-----___---,--,— - Moor drain/floar sink/hub 25.02
._-__--
Address: _______________ Garbage disposal 25.02
•• -
City/State/ZIP: llosc bib 25.02
- _.-.. ____,___....
Phone:( ) Fax:( ) Ice MAW 12.51
-___ -___ -
25.02
7,7,p)Wiii7i77.777M, „ , 773,,q51ziiiiVaiWN intercePter..nil_ ....__............_—_ --
,, ,,,,,,,L,,,,,...„.,,,.,,,,,,, ,,,,, ,,,.., "medical gas(value:s 1
Page
Business name;Same as below
-.----.,-. ---------" Primer 12.51
- ----.----._ -.- ----
Contact name!
......_ ......- Roof drain(commercial) 12.51
Addless: — k/basin/lavatory — /- 2.5,02
------ .--_.------- Sin
City/State/ZIP: Solar Ililit. (potable water) (a.54
p1-1,-)1"1.e.-:T. ) rub/showtx/show tar pan
12.51
.- ---_,
..-1).„-e;2 ----_..,-- , .
— "• - -5 02
E-mail: ' -------i
1 . ...--
25.02 ci
,..i,..... 1oi..;.( 56.,2?;1!.M.V,.,',03.7.771:77.,„v ,,wiraki4,61100f.?,N.I.L%nt4)71!.,i,31.,,Y1,,14..0-;!0;?..(!ic.i.:'!1• ---------------
ogagMt• - 0 • :,.,.;.;,:k.3twoolitw,.,::,;,,,:.:,,,.9., %■!.,.; water ht2,,,,. 17.52
Business name:Cascade Plumbing Cu Water piping/DWV 56.29
Address:2416 N.Hayden Island Drive Other 25,02
__.--.-----____-.---._ - Subtotal 1ic, .i,1
City/State/ZIP:Portland,OR 97217 ..._— ---
- -
hone:(503)289-7095 Fax:(503)283-9514 —— MilliMUM permit fee: S72.50
--
A A Plan rc-view (25%of permit fee)
I CCB Lie.:120893 Plumbing Lie,no.:34-412PD ----- _ . ___ _ . .. . .. -,. _j
----- . ,. ----------- State surcharge(12%of permit fee) 1 f.) 1...,I
Authorized signature: k. "," 4../ ,•i ..1, .Q.,../.;) ---TOTAI..iiiiisAirFEE Iwi2_,Y_____.: I_ • ''
.- ..,. -, .- ----
This permit applicadou espii:m if;.pernilt is nOrabtained■%,11111O lag days
[Mint name:Crystal Jones iDate: after It Ims been accepted as complete.
--. ---------
rzt...... •Fee methodulogy set by Tri.Couray Building industry Service Board.
11/: IL)' i lik.`ft '...
-(rUisVetC:irs'IP‘Yi.P4,6p.Proc 4/0-' ' it)C. C.. 44-4616TMicrvCOWWEB)
TO'd tTS6C8ZCOS 03 buiturnTd aps3ss3 Wifet:LO CT/ZT/TT
PlumbinQPer.mit Application • City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression _
,: Fee,)„ ,' Oty1l i,,, St]UAr4� 0ot�4e", 1 eL'IIl�C' `717:77'i eir:Vi 'i,yt i
-:,$ice 'ti hies° i i ,.`, I' i' „,.,,:, U to 2,000 $121 90
50.03
Footing,chain 1 100 _- _ ..--_ _ ------
------w---^ :.OU! to 3,000 i 160,69
37.52 .. _.e.•—_.
Sewer-drain each additional 100' �.fi()1 to 7, E 11 $233.20 ..._.,., -- ,.
,--°-- ii2.,5A 701 ancllcreater - ._...._..— ..$327..54 .....,..,.. ___ ..... __ .
Sewer 1st 100 .. --- an . ,,.___..-
Sewer-each additional 100' 37.52_W
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service each additional 100' MI 37.52 ' S111at hill l'er V 0:,' r 1/ , ` l' 1
-
stmi Rain Drain-1st 100 61.54 w SI,U(1 to$5,000.0(1 Minitntun fee$72.50 _
Storm rm&Rain Drain•each additional 100' 37.52 $5,001.00 io$10,000.00 $72.50 fire the first t 55,000.00 and$1.57•too
each additional$100.00 or traction thereof;to
li:..: cete0 TU ah,r, _ and includin $10A00.U0, __—•--
Inspection of existing plumbing or for $10,001.00 to$25,00(1 U0 5148.50 for the first$10,000.00 and 51.54 fine
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to .-
and inclu_dina,$25,000.00.
(minimum seio outside 1/2 normal Inspections outside o1•nonrta{twsirtess 90.00/hr $25,001.00 to-50,(100.06 $379.50 for'the Fast$25,0(10.(10-and$1.45 for
?recurs(minimum charge_2 hours} —. --•-• each additional 5100,00 or fraction thereof,to��
90A0/1tr _ and incluch SS0,000,00.
Rei+tsluction Fees .�••- gSU,UUi.UU ar l up $742.00 for the first$50,000.00 attd$1.20 for
Additional plan review for revisions 90.00/hr each$742.00 51(10.00 or fraction thereof.
�(rninimum charge-1/2 hour)-,. .» -_ . _-._-----•-- -- _,. _.•.-
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
could result in
increased sewer fees*
accurately report fixtures _ -- ,,,;;:;:,,,,,. a......, .,
` uanta by brxture Type:,',:••••:: ill'Revi1ew fbifilumbifA ii lid .
Worlq aerfor ivr+
1 ° flan t'eview is required for any of the following.
FaPP . A�0ed Please check all that apply.
Want(7'rrforrnsd.2 92L;sy/F<uu _ ..---- ❑ Any new commercial building with water service 2"and
Bath -Tu1t/Shower - greater,except systems designed and stamped by licensed
-la Cut__ thihi pr.2 } W ■ engineer.
Car Wash -Each Stall ❑ New exterior plumbing site utilities for any complex structure
DpiraTkt,!,_,-, as defined in f-1AR91S-780-0040.
Di,}iw or/Water Aspirator _� ❑ Medical gas and vacuum systems for health care facilities.
C)ishwaehcn -t'omesticial . - - —i ❑ Any multipurpose fire sprinkler system.
Domestic ---•- ❑ Any complex structure as defined in C)AR918-7S0•0040-
Drinl ing Faunwin ,,,,,,.,,--__,M t ---.
Eye Wash —_ -----+- Submit 2 sets of plans with any of the above.
Floor Drain/sink 2" -,•, —_.-
4" ..------ •,:;:7.77^" 177: 77,,..r_ "7 Tt i^r ;,'„.°'raven ra."' `'ii.d,,'I;j1,;,.{;','.iN'\':1;;1'd';;1!
4„ �._.._ ...___�_� ,:h,:i i ,,Isontetiit,,d ,RiserDiagrant a.,,1 ,, (�„,
Car wash Drain - �.--•-•- I Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food „-, —.,.,,M..--••••.-.---
Disposal )amestic food related that nc c t the qualifications above.
_ -
_,
^-
-Commercial-food related --------
-Industrial-food related __-.-_-___.___„
lee Matrh,/Reft;•-1i� ns ---- Comments regarding fixture work:
�,�__
nil separator(Gas Station) -•.--~
Rec..Vehicle.Dump Station - --" '"
S nk%l~av Nrnt-fotxirelated _.......---,--- "-- _-.
-Bradley . ^_,-,---.-,- '�,"..""."""�"".
•Coimnercial-food related „ .»,......- -- "'"" '"'""
-Service
S
wimrnin Pool ricer -- ----- *Note: If the fixture work under this permit results in an
Washer_Clothes _ _... -- increase of sewer El)Us,a sewer permit will be issued and
Water Extractor , fees assessed for the sewer increase must be paid before the
Wain C1nEtK-Tnilot _ - plumbing permit can be issued.
Urinal .......—.._.
Other Fixtures: .,. -•---••••-
C:\Users\Owner\DOWOl0ads\l'l.Mi*-PennitApp(1)_doc 7
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CITY OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171 AA,
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: / TIME: PAGE:
SITE ADDRESS: / n CLASS OF WORK:
SUBDIVISION: �/3 9 h/ #. TYPE OF USE:
1
PROJECT NAME:
DESCRIPTION:
OWNER: _ PHONE #:
CONTRACTOR:e M,961(3 - 0o / PHONE #:
• Inspection Request Scheduled For: Date: Pour Time:
• Code # Inspection Description Confirm # Contact # Message
32 a Pe,t()
Correction /Comments/Instructions.
.1 / Rj 5S
►N PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
= y'' • CALL.FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:
•
���, A Date: // ' S�/� Phone #: (503) 718-
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11513 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
2013-12-11 00:00:00
PLM2013-00411
FAIL
1. Hard cap,open sink drain at water heater location. 101.4.1.1.3
2. Correct leak on, handicap sink drain. 310.0
Recall
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11513 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
2013-12-12 00:00:00
PLM2013-00411
PASS - No C of O
Violation Summary:
Inspector Contractor