Permit INCITY OF TIGARD PLUMBING PERMIT
all COMMUNITY DEVELOPMENT Permit#: PLM2014-00026
T t G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/28/2014
Parcel: 25101 DC03700
Jurisdiction: Tigard
Site address: 7095 SW SANDBURG ST
Project: United Food&Commercial Workers Local 555 Subdivision: ROLLING HILLS NO.2 Lot: 44
Project Description: Replacing 180'of sanitary sewer line.
Contractor: ANYTIME PLUMBING&DRAIN CLEANING Owner: UNITED FOOD&COMMERICAL WORKERS
3333 NW 35TH AVE, BLDG C UNION LOCAL#555
PORTLAND, OR 97210 PO BOX 23555
TIGARD,OR 97281
PHONE: 503-598-6354
HONE: 503-432-8275
FAX: 971-255-1965
FEES
Quantity Description Date Amount
180 If Sewer Service 01/28/2014 $100.06
Specifics: 1 12%State Surcharge- 01/28/2014 $12.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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
Utili • ca io :• er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
o effect questions to OU • by - •• 503.232.1987 or 1.800.332.2344.
Issued By: , 1111 . Permittee ignature: /"
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.
Jan. 28. 2014 9:02AM No. 8517 P. 1
P1umbin2 Permit "licatRECEIVED .
Building Fixtures rulz OiF10E USf; Om,).
City of Tigard JAN 2 8 2014 Date : fig /4 API Permit No-A-t e/17-ex,..7
• P13ho2n5 S5W 0 3H.63all 9 B.411v7d1.,TiFraxd:,5O0R 5 9diti�T GARO plea Review
DafeJgy: Other Permit No.:
T I G A it P Inspection Line: 503.639.4175 BUILDING GIISIM Data Rzad yBy' torts: P1 See Page 2 for
Internet: www.tigard-or.gov Notified/method:. Supplemental Information
TYPE OF WORK FEE* SCHEDULE .
❑New construction CI Dcmolitiorl For special l,Lformado t use checklist.
Description I Qty. I Pa. I Total
p Addition/alteration/replacement 1■ • New 1-2-family dwellings(includes 100 ft.for each utility connection)
OF e a SFR(1)bads 312.70
fIl't S FR(2)bath 437.78
SFR(3)bath 500.32
Each additional bath/kitchen 25-02
Master builder LI • Fire sprinkler( ,sq.ft.) Page 2
.JOB SITE INFORMATION AND LOCATION . utilities:
Job site address: 10 61S S w l3 kl V' Q,U ell ,•r, Catch basin or area drain 18.76
• Drywall,leach line,or trench drain 18.76
City/State/ZIP: 11(A. 'D, 0 K. q12//)7
Footing drain(no.linear ft.: ) Page 2
Suite/bldgJapt.no.: Project name: ki 1/•\) L0(AL <sS Manufactured home utilities 50.03
Cross Street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: (bU) 1,,, Page 2_ I 0 0 t Oto
Storm sewer(no.linear ft.:, ) Page 2
Water service(no.linear ft.;, 1 Page 2
Subdivision: j Lot no.: Fixture or item;
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
• DESCRIPTION OF WORK Clothes washer 25.02
WU U,VI(\ \ g d t 'I/I_ L N e-
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑'PROPERTY•OWNER g TENANT Expansion rank 12.51
Name: i cW CA-L 'S5s Fixture/sewer cap 25.02
1 Floor drain/floor sink/hub 25.02
Address: 1 Das Sw ,� brj Garbage disposal 25.02
City/State/ZIP: ` b , 0 "ii Hose bib 25.02
Phone:('S p1) S (p-11 Fax:( ) Ice maker 12.51
APPLICANT RI, CONTACT PERSON Interceptor/grease trap 25.02
Business name;A N I fi MC P L4 M NI NV{ -I' bA/-i n f C�N I Nt j Medical gas(value:$�) Page 2
s f Primer 12,51
Contact name: Si, </ ,/ µRoof drain(commercial) 12.51
Address: 27� NW 04 kV - S(I I LDI N q G Sink/basin/lavatory 25.02
City/State/ZIP: pp IZf i AN D r Q IL , Solar units(potable water) - 62.54
Phone:(j(J'?/) • Z Fax::(011)' )- j el 1, Tub/shower/shower pan 12.51
•
E-mail: 1((10 c kN • i' - •- !>?k y , Urinal 25.02
Water closet 25.02
• CONTRACTOR Water heater 37.52
Business name: ANN/ri n 1( P UU iW t b?*iN asANINt', Water piping/DWV 56.29
Address: ?�' ' ' N YY 51) Y 0L i (, Other. 25.02
City/State/ZIP: Po i21-LAN I), p� I112i Q r Y Subtotal 1 d lo
Phony(SO.?� 7~
� S 216 Fax:(411) 265_ i q 6,S Minimum permit fee: $72.50
`�-- r�, Plan review (25%of permit fee)
CCB Lie.: 1 g I Z�1 a Plumbing Lic,no.: 17 V 31 /el C I
� Slate surcharge(12%of permit fcc)
Authorized signature; (MA TOTAL PERMIT FEE (
Print name: As Pfbq m I bt _Date: 114 C I ff This permit application expires Ira permit is not obletued within IB0 day ' )
r after it has been accepted as complete. //;'
*Fee methodology set by Tri-County Building Industry Service Board. ('}�
I:■8aildtns\PermItstPLMU-permirApp.doc 10!0109 440-4616TpW02/COMIWEO) C-?
Jan. 28. 2014 9:02AM No. 8517 P. 2
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
.Site Utilities . • Qty. Fee(e9 Taal Square Footage: Permit Fee:
Fooling 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 (ii St4 7,201 and greater $327.54
-
Sewer-each additional 100' I 37.52 M 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 8c 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
Qt Fee(CO . Total each additional$100.00 or fraction thereof,to
y,
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 includin_$50 000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the rust$50,000.00 and S1.20 for
v(minimum charge-1/2 hour)
each additional$100.00 or fraction thereof.
Subtotal: I 0 8 ,bi,
•
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
Quantity by(Fixture)Work Performed ❑ Any new commercial building with water service 2"and
Fixture Type: Replace greater,except systems designed and stamped by licensed
Previous Capped Added Exisdoe engineer.
Baptistry/Font
Bath -7Lb/Shower El New exterior plumbing site utilities for any complex structure
as defined In OAR918-780-0040.
-Jacuzzi/Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall
-Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in 0AR918-780-0040.
Dishwasher -Commercial
Domestic Submit sets of plans with any of the above,
~
Drinking Fountain
Eve Wash Isometric or Riser Diagram
Floor Drain/sink -2" ❑ Isometric or riser diagram is required for new buildings
-3" - - that meet the qualifications above.
_
Car Wash Drain
Garbage -Domestic
Disposal -Commercial
-Industrial Comments regarding fixture work:
Ice Maclt/Rcfrig,Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station - -
Shower -Gang
-Stall
Sink -Bar/Lavatory
-Bradley _
-C,ommereial *Note. If the fixture work under this permit results in an
-Service increase of sewer EDUs,a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer-Clothes
Water Extractor plumbing permit can be issued.
Water Closet-Toilet
Urinal -
Other Fixtures:
httpJ/www.tigard-or.gov/eity_hall/departments/cd/do cs/PI.MP-PermitApi2doc
Jan. 28. 2014 9: 03AM No. 8517 P. 3
City of Tigard
i 11 IA1 v Building Division
131.25 SW Hall Blvd.,Tigard,OR 97223
Phone: 503,639.4171 Fax: 503,598,1960
Inspection Line; 503.639.4175
TI G A R I) Internet: www.tigatd-or,gov
PAYMENT AUTHORIZATION FORM
Permit No. (if available):
Job Site Address: -I ()6k S 1i A b J r
Project Name: Vkf G\N
Cred.t Card Information:
�
VISA [] MasterCard I'h AY ` /312- (MP(p g 14 S
❑ Discover (Credit Cud Account Number)
Expiration Date: 01 1 _.(t)
Cardholder Name (on card): dknt 'ail
Contact Phone No.: 'WV c‘PR- S.141
Address for this card is: 92/2�jjj N W 1791 bl Q, Co v-1-L AM
Zip code for this card is: 6h/i1 0
Electrical Trust Account Information: For electrical permit applications only.
Trust Account (CCB) No.:
Contractor Business Name:
Contact Phone No.:
I hereby give the City of Tigard permission to pay for the above referenced
permit with the credit card or electrical rust account number provided above.
Authorized Signature:
A/
Name Printed: V tk, & '116
Date: l lea\ I
Please FAX this completed and signed form to 503.598.1960.
To protect credit card information, do not email this form. .
This form will be destroyed after your payment has been processed.
I=\Building\Porn s\PaymentAuthorizatior4doc.03/03/10
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
7095 SW SANDBURG ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
2014-02-13 00:00:00
PLM2014-00026
FAIL
1. Expose 2-ea cleanouts, noted in previous inspection, one in lawn area (was a non-
approved 2-way) and one in parking lot, and bring to grade. Items #1,2 and 4.
2. Correct back grade of sewer at approximate 2:00 minute time on DVD provided.
718.1
3. Re-camera sewer, with water running, to verify grade and installation of piping, from
building to property line. 301.2/310.4 /708.0 /718.1
4. re-inspection required when correction(s) have been completed. 103.5.6.2
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
7095 SW SANDBURG ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
2014-01-29 00:00:00
PLM2014-00026
FAIL
1. Provide traffic rated box/cover for sewer cleanout in parking lot paved area. 719.5
2. Provide camera of 4" sewer pipe with water running, to verify grade and installation of
piping for sanitary sewer from building outside cleanout to tie-in to old existing sanitary
sewer pipe in parking lot. 301.2/310.4 /708.0 /718.1
3. Cleanout plugs need approved thread sealant. 316.1.1
4. Remove 2-way cleanout (not permitted for use on sewers) and install a Y and 1/8
bend drainage fitting. 707.4 (4)
5. Re-inspection required when correction(s) have been completed. 103.5.6.1 103.5.6.2
Violation Summary:
Inspector Contractor