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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2014-00032 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/18/2014 Parcel: 1 S126DB02800 Jurisdiction: Tigard Site address: 9370 SW GREENBURG RD A Project: Dr.Gebeau Dental Subdivision: 1991-018 PARTITION PLAT Lot: 1 Project Description: Interior plumbing:Capping(4)2"floor drains, (3)sinks,(1)water closet,and(1)drinking fountain,and adding(1) 2"floor drain,(12)sinks,(1)clothes washer,(2)water closets,and(2)backflow preventers. Contractor: NOLAN PLUMBING Owner: FRANKLIN COMMONS ASSOCIATES, LLC PO BOX 671 BY NORRIS&STEVENS WILSONVILLE, OR 97070 621 SW MORRISON STE 800 PORTLAND,OR 97205 PHONE: 503-267-4646 PHONE: FAX: 503-678-6959 FEES Quantity Description Date Amount 2 ea Backflow Preventer 02/18/2014 $62.54 Specifics: 1 ea Clothes Washer 02/18/2014 $25.02 5 ea Fixture/Sewer Cap 02/18/2014 $125.10 Type of Use: COM 1 ea Floor Drain/Floor Sink/Hub 02/18/2014 $25.02 Class of Work: ALT 12 ea Sink 02/18/2014 $300.24 Type of Const: 2 ea Water Closet 02/18/2014 $50.04 Occupancy Grp: ea Water Heater 02/18/2014 $37.52 Stories: 1 ea Fixture/Sewer Cap 02/18/2014 $25.02 1 12%State Surcharge- 02/18/2014 $78.06 Plumbing 1 ea Fixture/Sewer Cap 02/18/2014 $25 02 3 12%State Surcharge- 02/18/2014 $3.00 Plumbing Total $756.58 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 oil.Finn 447 7344. Issued By: Permittee Signature: ins_ Call • .• 9.4175 by 7:00 a.m.for the next available ins.=ction date. This permit card shall be kept in a conspicuous place on the job site until co = '•• • the project. Approved plans are required on the job site at the time of each inspection. CITY OF TIGARD SEWER CONNECTION PERMIT 114 COMMUNITY DEVELOPMENT Permit#: SWR2014-00008 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02!18/2014 T t'A R.L7 9 Parcel: 1 S 126DB02800 Jurisdiction: Tigard Site address: 9370 SW GREENBURG RD A Project: Dr.Gebeau Dental Subdivision: 1991-018 PARTITION PLAT Lot: 1 Project Description: 1.75 EDU increase. Contractor: Owner: FRANKLIN COMMONS ASSOCIATES, LLC BY NORRIS&STEVENS 621 SW MORRISON STE 800 PORTLAND,OR 97205 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 02/18/2014 $6,912.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: 1.44 Total $6,912.00 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 952-01 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 1987 or 1.800.332.2 Issued By: Permittee Signatur . ' t�k. Cal`�� .•-.. 5 by 7:00 a.m.for the next available i pection date. This permit card shall be kept in a conspicuous place on the job site u ' ompletion of the project. Approved plans are required on the job site at the time of each inspe . Plumbing Permit Application !AIL, j; ,, �„4 tdi Building Fixtures tV I ()12 OI I It I I ,I OBI City of Tigard DateBved , / Permit No.: i a - _ III u 13125 SW Hall Blvd., ai• • Fd M23 Plan Review ■ . Phone: 503.718.2439 503.598.1960 b Date/By: Other Permit No.: - • A Inspection Line: 503.63'.4175 c1�Q1 Date Read B Juris: ® See Pa e 2 for It 1 Internet: www.ti ardor. ov `� y y g S g (C� � Notified/Method: Jr Supplemental Information TYPE OF WO• ` A�G -� Q FEE* SCHEDULE ❑New construction Mi. i, ipt• For s,ecial in orntation use checklist u.'Als Descri•tion 043,. Ea. Total ❑Addition/alteration/replacement Va New 1-2-family dwellings(includes 100 ft.for each utility correction) CATEGORY OF CONSTRU il A SFR(1)bath 312.70 El 1-and 2-family dwelling LI Commercial/industrial SFR(2)bath 437.78 Accessory building SFR(3)bath 500.32 ❑ ry ildin g ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION 41„..rt 4 Site utilities: Catch basin or area drain 18.76 Job site address: g -. 1 ' /,II Drywell,leach line,or trench drain 18.76 City/State/ZIP: ---rie_ >4t2-tom ( t2_. 9 22 3 7 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: 4 Project name: , r / _ ix. 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 L7 31.27 O _5-1 f DESCRIPTION OF WORK Backwater valve 12.51 w� Clothes washer 25.02 / `1hir.L, .g-jfrrif/ Z,/-.476-1� Dishwasher 25.02 Drinking fountain lc/i 0T 25.02 Ejectors/sump .I ! 40 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12-51 Fixture/sewer cap � tr��r�� 25.02 0 Name: 5• Ili Floor drain/floor siridhub / 25.02 °y!• 0a Address: Garbage disposal J/ +H+• 25.02 City/State/ZIP: Hose bib Pl k.ck 25.02 Phone: Fax: v ( ) ( ) Ice maker . 'la`�,e/M 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap. : 25.02 Business name: Medical gas(value. i-..%:��.�' � a �ifiiiSZi�i=w2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 goo,a(t 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 Sp_01 > Water heater 37.52 a Business name: (�//4.V /ui,t7 1 iv C,3 JA Water piping/DWV -- 56.29 Address: IligiI ,■ is Other: 25.02 City/State/ZIP: AJ, l J //, d Y7D7 d Subtotal 15(v sati L. 2 `" Phone: ) 7 -+/6 !f Fax: j) 670._ 6 5• Minimum permit fee: $72.50 CCB Lic.: o i v �/ Plan review (25%of permit fee) AO IP ._ i1)4115 Plumbing Lic.no.: 07 j �L State surcharge(12%of permit fee) 77 tJ Authorized signature: /` ' I 1' TOTAL PERMIT FEE S?j ±3 Print name: ` Date: /L�� This permit application expires if a permit is not obtained within 180 ire.,. M t C u,14,E� /�/Q J,,,2J ,7^3_ after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I\Building\Permits\PLMU-PermitApp.doc 10/01/09 440.4616T(10/02/COM/WEB) V SOc r t/ + Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(u) 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 r7 -7 0 ✓ each additional$100.00 or fraction thereof,to / 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*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. _ -Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain ! ye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -27 1/ 3" Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Macn./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related 5 d� -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter - increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes / Water Extractor ■ fees assessed for the sewer increase must be paid before the (!)Water Closet-Toilet )-\ plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 ciDe ( � __ poi 107- 1 — u 2 J f� 1 - 1 vs `Di' )0 ;A.) 1 - d E915 '°N INC0:9 17106 '8l '(Pd Accumulative Sewer Tally f Tenant Name: DR.GEBEAU DENTAL SWR# SWR2014-00008 'r:c,ARD Site Address: 9370 SW GREENBURG RD PLM# PLM2014-00032 Parcel#: 1S126DB02800 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count_capped#s value count_ added# added value total#s total values Baptisery/Font 4 0 0 0 0 _ 0 Bath: -Tub/Shower 4 0 0 0 0 0 -Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash: -Each Stall 6 0 0 0 0 0 -Drive through 16 0 0 0 0 0 Cuspidor/Water Aspirator 1 0 0 0 0 _ 0 Dishwasher. -Commercial 4 0 0 0 0 0 -Domestic 2 0 0 0 0 _ 0 Drinking Fountain 1 0 1 1 0 -1 -1 l:ye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 4 8 1 2 -3 -6 -3 inch 5 0 0 0 0 0 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 HP) 16 0 0 0 0 0 -Commercial(to 5 HP) 32 0 0 0 0 0 -Industrial(over 5 HP) 42 0 0 0 0 0 Ice Machine/Refrigerator Drain 1 0 0 0 0 0 Living Unit 16 0 0 0 _ 0 0 Oil Sep(Gas Station) 6 0 0 0 0 0 Rec.Vehicle Dump station 16 0 0 0 0 0 Shower: -Gang(per head) 1 0 0 0 0 0 -Stall 2 0 0 0 0 0 Sink: -Lav/Bar-Non-Food Related 2 0 3 6 12 24 9 18 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-Food Related 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 1 6 1 6 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 1 6 2 12 1 6 Urinal 6 0 0 _ 0 _ 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 9 21 16 _ 44 7 23 Current Fixture Value 23 divided by 16= 1.438 Current EDU I I:l)l = $4,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 23 divided by 16= 1.438 over (under) $ 6,912.00 Enter EDU Change Here 1.440 Notes: Authorized Name/Signature: Branden Taggart X2449 Date: 2/3/2014 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges. 1:\Building\Sewer Tally\SewerTallySheet_4800._070113.xlsx Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9370 SW GREENBURG RD A, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2014-00032 George Heimos Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9370 SW GREENBURG RD A, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2014-00032 George Heimos 1. Provide permanent labels for backﬂow devices identifying each. 603.2.7 2. Provide solids trap at model trimmer. (Gelco) 310.4 3. Expose island #3 cleanout ﬁtting. 103.5.1.4/103.5.1.3/315.3 4. Recall when corrections have been completed. 103.5.6.1 All else ok. Backﬂow test results Model trimmer: 1/2" Watts model LF009QT, serial no. 27629 Suite Backﬂow: 1" Watts model LF009MZQT, serial no. 016787 Violation Summary: Inspector Contractor