Permit �� u CITY OF TIGARD PLUMBING PERMIT
F'! *; COMMUNITY DEVELOPMENT Permit #: PLM2013 -00429
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/11/2013
Parcel: 2S102AC00201
Jurisdiction: Tigard
Site address: 9356 SW MAPLEWOOD DR, BLDG# J
Project: Main Street Village Subdivision: BURNHAM TRACT Lot: 9
Project Description: Building J - Installation of double check valve for fire supply line.
Contractor: REA MECH INC Owner: CASA LA VETA ASSOCIATES
30330 SW GRABEL RD. HIGHLANDS ASSOCIATES LTD ET AL
HILLSBORO, OR 97124 BY AFFINITY PROPERTY MANAGEMENT
111 SW 5TH AVE #3690
PORTLAND, OR 97204
PHONE: 503 - 969 -6252 PHONE:
FAX: 503 - 640 -9344
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/11/2013 $31.27
Specifics: 1 12% State Surcharge - 12/11/2013 $8.70
Plumbing
Type of Use: MF 41 ea Minimum Fee Adjustment - 12/11/2013 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 No on 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 dire questions to OIJNC by ca . I! 503.232.1987 or 1.800.332.2344.
Issu d By: ! , 1 Permittee Signature: /��
/ 1.—..4( .. 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
Site Utilities FOR OFFICE USE ONLY
dE City of Tigard VE iv ,[� R ece DateB e y d ��' � // /3 l Perms No.: iJLi /6 1y- 1_44A6
• 13125 SW Hall Blvd., Tigard,OR 97223 r r Plan Review
l I Phone: 503.718.2439 Fax: 503.598.1 'L 1 1 2013 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 B y lu ris See Page 2 for
s '
Internet: www.tigard or.gov f� F rr /��n D Notifi Date Ready/By: Supplemental Information
TYPE OF Wo n r LD DIVIS Ins, FEE* SCHEDULE
❑ New construction ❑ Demolition i7 I For special information use checklist
Description 1 Qty. 1 Ea. I Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- 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:
Catch basin or area drain 18.76
Job site address: 935 (Q s W leapt Fywat9f)
Drywell, leach line, or trench drain 18.76
City /State /ZIP7T T Arlo Oa_ , / Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: T Project name: �AI N sr VI, I s I �q-trs, 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 IL: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow prevente 31.27 31.2. ?
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
I f■• ir,q -ty 22 2..... pc Dn ,,.i/ rv,r -r� E 11.41t o r Dishwasher 25.02
S �4�v 1 C_e_ Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ 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: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: 14 • �C t:�-1 Water piping/DWV 56.29
.
Address: 3 S t. �yt L. 0..D Other: 25.02
City /State /ZIP: Subtotal
jftwg� i 0 2 9 7123
Phone: L5�) 742? _ <d52 Fax: ( ) Minimum permit fee: $72.50 7a -TO -
Plan review (25% of permit fee)
CCB Lic.: / leg-93) Plumbing Lic. no.: 3y- 3 Pe,
/ State surcharge (12% of permit fee) g. 70
Authorized signature: �taiti ��a =�y� TOTAL PERMIT FEE g 1 . 9.Q
Print name: � Date: / Z , �� r 3 This permit application expires if a permit is not obtained within 180 days
�! yMS �v4 rl�Li.; S? Hgfr�ft • after it has been accepted as complete.
/ "Fee methodology set by Tri- County Building Industry Service Board.
L\ Building \Permits\PLMU- PermitApp.doc 10 /01/09 440- 4616T(10/02/COM/WBB)
A
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' 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' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) 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
Quantiy by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ d f
Plan re is required any of following.
Work Performed: Capped Added Relocate q y g.
Baptistry/Font Please check all that apply.
Bath Tub /Shower El 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"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic - non - food s
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/Lav - Non -food related
- Bradley
- Commercial- food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
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:
I:\Building \Permits \PLMU_PermitApp.doc 2
1.
Plumbing. Permit Application - City of Tigard
Page 2 - Supplemental Information t '
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. 1 Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1" 100' . 50.03 0 to 2,000 $121.90
Footing drain - each additional • 37:52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' - 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service.- each additional 100' 37.52
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000100 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 '$5,001.00 to $10,000:00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) ' 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 foi the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) cach 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:
. .1
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 Review' for Plumbing Installations . ,
Fixture Type for Replace/ Plan review is required for any of the following. •
Work Performed: Capped Added Relocate ;
Baptistry/Font Please check all that apply. '
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" .. , .
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser s diagram is required for new buildings
•
Garbage - Domestic-non -food g q g
Disposal - Domestic -food related that meet 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/Lav - Non -food related
- Bradley '
- Commercial- food related '
- Service
Swimming Pool Filter - • *Note: If the fixture work under this permit results in an
Washer - Clothes `• - -
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:
I:\Building\Permits\PLMU _PermitApp.doc 2
J
t
7
Site Utilities — Plumbing Permit Application
0
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS - Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Permits\PLMF- PermitApp.doc 12/30/05
CITY OF TIGARD
BUILDING DIVISION PERMIT#:
13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171 I '�
Inspection Requests (24 Hrs.): (503) 639-4175 ''L
INSPECTION WORKSHEET FOR DATE: 11 ! TIME: PAGE:
SITE ADDRESS: 7 *pi D CLASS OF WORK:
SUBDIVISION: LOT#: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
jl-f 2I fir,?e /1' IA- / ' C, ;
Corrections/Comments/Instructions:
r • / ,
/ �tl u "4/ ��� "PT jm C%� �� III
,t} P Ce4iL.
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date:/ /41 Phone #: (503)-71&
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
9356 SW MAPLEWOOD DR BLDG J, TIGARD,
OR, 97223
Commercial - Plumbing
399 Plumbing final
2014-02-25 00:00:00
PLM2013-00429
PASS - No C of O
2" watts model 007, serial no 00127
Violation Summary:
Inspector Contractor