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Permit CITY OF TIGARD PLUMBING PERMIT II • COMMUNITY DEVELOPMENT Permit#: PLM2013-00391 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2013 TIGARD Parcel: 2S 102AA00905 Jurisdiction: Tigard Site address: 12000 SW MAIN ST Project: Sierk Orthodontics Subdivision: PAYLESS SHOPPING CENTER Lot: 5 Project Description: Medical gas only. Plumbing fixtures under separate permit. Contractor: VENNE PLUMBING LLC Owner: HAAGEN, GARY L&CANDACE C TRS 15145 SW DIVISION ST 2514 SE 112TH AVE SHERWOOD, OR 97140 VANCOUVER, WA 98664 PHONE: 503-624-9309 PHONE: FAX: 503-684-0940 FEES Quantity Description Date Amount 1 ea Medical Gas 11/12/2013 $81.62 Specifics: 1 Plan Review 11/12/2013 $20.41 1 12%State Surcharge- 11/12/2013 $9.79 Type of Use: COM Plumbing Class of Work: ALT g Misc Administration Fee 11/12/2013 $8.50 Type of Const: Occupancy Grp: Stories: Total $120.32 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 952-001-0090. 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: •ermittee 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. Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard Received �D/51/I C Permit No.: fijO/g,pp j� 1114 p 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 0 Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No. Date/By: ll/�1�� ro"Lr zvq.,Lf'04y t T f G ARD Inspection Line: 503.639.4175 Date Ready/By: Juris: Ei See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction 0 Demolition For special information use checklist Description I Qty. I Ea. Total Addition/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 Commercial/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 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: A Catch basin or area drain 18.76 \ O 1� ►IJ $T Drywell,leach line,or trench drain 18.76 City/State/ZIP: ( (A it, D dl °1. I I t o Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: 1 Project name: St a tuiC O 12,,r(4.0(D0 tr 1 LS 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.: Backflow preventer , 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 341MBI. _inu or.:ifial...=__-_g_ Dishwasher 25.02 p s�ar�'M t+�-- _-__�_ --ji '_ .4 Drinking fountain 25.02 ipe \7 I atA9-5 013 LY Ejectors/sump 25.02 14 ❑ PROPERTY OWNER // ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Q ��5 `� Medical gas(value:$2-O j Page 2 N ( G Isr�� Primer f 12.51 Contact name: f7 A R,t J aJ S K A Roof drain(commercial) i y 12.51 Address: 7 .L 6 S S,..0 p, 0 6,1.1,,,.,7 G-r Sink/basin/lavatory 25.02 City/State/ZIP: CJ id LtL •vn 0 Q VL. et�"T I - o Solar units(potable water) 62.54 Phone:(1-.3) G 3 o _. (Q 4.4 Q _I Fax: :( ) Tub/shower/shower pan 12.51 I� Urinal 25.02 E-mail: 'DA li.t N` L 1.+) - P c%-t'.C.t (J`f . (.v■r Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: VGti 1G (DL j w/1($, G Water piping/DWV 56.29 Address: 1 5 ( 4 5 s W -D1 al S f J ,j i 7 Other: 25.02 City/State/ZIP: s ego 4J„ t) It 4-Li ill Subtotal _ Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lie.: 1 Ck Z 0, 4 tubing Lic.no.:5 c1` P Plan review (25%of permit fee) `t State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: ' This permit application expires if a permit is not obtained within 180 days An_uj I 7 c:„.., Date:s lc A io h1 after it has been accepted as complete. "Fee methodology set by Tri-County Building industry Service Board. 1:\Building'Permits\PLMU-PermitApp doe 10/01/09 4404616T(10/02/COM/WEB) t26/" P/4A n�'1y�� lT r.,r! vCLJf� 3rZ 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 12000 SW MAIN ST, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal 2014-01-03 00:00:00 PLM2013-00391 FAIL 1. Correction #3 previous inspection not completed. (Provide identiﬁcation tags for rp's) 2. Correction #4 (1st one), vacuum pump not completed. Vac. Pump shows requirement for either a hydromiser or air water separator installed as part of vacuum system. Vac. pump is installed as a stand alone installation. If vac. Pump can be installed as stand alone, please provide installation instructions, if any. 3. Correction #4 (2nd one) provide controlled temp environment, is required to have a fresh air inlet, please provide approved documentation, from installer, showing that this requirement has been met. 4. re-inspection required when correction(s) have been completed 103.5.6.2 5. Re-inspection fee will be assessed if previous correction(s) are not approved on next inspection 103.5.6 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 12000 SW MAIN ST, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal 2014-01-03 00:00:00 PLM2013-00391 FAIL 1. Correction #3 previous inspection not completed. (Provide identiﬁcation tags for rp's) 2. Correction #4 (1st one), vacuum pump not completed. Vac. Pump shows requirement for either a hydromiser or air water separator installed as part of vacuum system. Vac. pump is installed as a stand alone installation. If vac. Pump can be installed as stand alone, please provide installation instructions, if any. 3. Correction #4 (2nd one) provide controlled temp environment, is required to have a fresh air inlet, please provide approved documentation, from installer, showing that this requirement has been met. 4. re-inspection required when correction(s) have been completed 103.5.6.2 5. Re-inspection fee will be assessed if previous correction(s) are not approved on next inspection 103.5.6 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 12000 SW MAIN ST, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal 2014-01-02 09:07:00 PLM2013-00391 FAIL 1. Complete model trimmer and plaster trap as per plans. 103.5.6.3 2. Correct RP backﬂow device, over 5' either lower or provide stand. 3. Identify backﬂow devices. 603.3.2 4. Complete air compressor and vacuum pump installations. 103.5.6.3 4. Provide controlled temperature environment as per manufacturers installation instructions page 3. 310.4 5. Provide air/vacuum labels at all locations. 5.3.11.1.4/ 5.3.12.2.5.11 6. accessible cleanouts shall be provided where necessary to clear the piping of obstructions. all locations. 5.3.10.10.10.5.3.11.1.4/ 5.3.12.2.5.11 Recall when completed NOTE air compressor backﬂow device: 1/2" watts model LF009QT SN 20083 Building backﬂow device: 1" watts model LF009M2 SN 014727 Violation Summary: Inspector Contractor