Permit CITY OF TIGARD PLUMBING PERMIT
1111 I COMMUNITY DEVELOPMENT Permit#: PLM2014-00044
A R.O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/18/2014
Parcel: 2S 101 CA00500
Jurisdiction: TIGARD
Site address: 7960 SW HUNZIKER RD
Project: Potso Dog Park Subdivision: 2007-064 PARTITION PLAT Lot: 2
Project Description: Installation of(2)backflow preventers for irrigation system
Contractor: MILROY GOLF SYSTEMS INC Owner: TIGARD,CITY OF
1102 N SPRINGBROOK RD#206 ATTN:CITY MANAGER
NEWBERG,OR 97132 13325 SW HALL BLVD
TIGARD,OR 97223
PHONE: 503-538-3568 PHONE:
FAX: 503-538-2841
FEES
Quantity Description Date Amount
2 ea Backflow Preventer 02/18/2014 $62.54
Specifics: 1 12%State Surcharge- 02/18/2014 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 02/18/2014 $9.96
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 . • enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or d -ct questions to • NC • -/ling 503.232.1987 or 1.800.332.2344.
Issued By: 1 ,,.j , ,, j Permittee 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
Site`Utilities
RECEIVED City of Tigard Received /y /y ( PermitNo.: 13040/ '
• 13125 SW Hall Blvd.,Tigard,OR 9 B 18 2014 Plan Review
ilig a Phone: 503.718.2439 Fax: 503.598. b0 Date/By: Other Permit No.:MNao" 3-Oeto
T I G A R D Inspection Line: 503.639.4175 CI-Y OF TIGARD Date Ready/By: Jude: RI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
11 TYPE OF �1"'rf)i113�I I1' ]� ,- .a 1, ii,, T .,
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I 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
1:1 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:
Job site address:POTS()DOG PARK-7960 SW WALL ST Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD OR 97223 tiirebtJx► kti2 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:POTS()DOG PARK Manufactured home utilities 50.03
Cross street/directions to job site:SW HUNZIKER&WALL ST 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 2 31.27 62.54
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
IRRIGATION SYSTEM
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:CITY OF TIGARD Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13125 SW HALL BLVD
Garbage disposal 25.02
City/State/ZIP:TIGARD OR 97223 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:MILROY GOLF SYSTEMS INC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:TED SCRIVNER
Roof drain(commercial) 12.51
Address: 1102 N SPRINGBROOK RD#206 Sink/basin/lavatory 25.02
City/State/ZIP:NEWBERG OR 97132 Solar units(potable water) 62.54
Phone:(503)538-3568 Fax::(503)538-2841 Tub/shower/shower pan 12.51
E-mail:MILROYGOLF @FRONTIER.COM Urinal 25.02
F= Water closet 25.02
�. o CONTRA I OR.; Water heater 37.52
Business name:MILROY GOLF SYSTEMS INC Water PiP S/r in DWV 56.29
Address: 1102 N SPRINGBROOK RD#206 Other: 25.02
City/State/ZIP:NEWBERG OR Subtotal 62.54
Phone:(503)538-3568 Fax:(503)538-2841 Minimum permit fee: $72.50 72.50
CCB Lie.:121894 Plumbing Lic.no.:6968- Plan review (25%of permit fee)
g 3i Ay State surcharge(12%of permit fee) 8.70
Authorized signature t TOTAL PERMIT FEE 81.20
Print name:JAMES M , ROY / Date:2/17/14 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
t:\Budding\Pe mits\PLMU-PamitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
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- la 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 55,000.00 Minimum tee$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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is any for re
re ui of the following.Performed: Capped Added Relocate 9 y 8
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 diagram is required for new buildings
Garbage -Domestic-non-food
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:
C:\Users\Accounting\Documents\Potso Park Tigard Plumbing Permit.doc2
■ Site Utilities — Plumbing Permit Application
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
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
7960 SW HUNZIKER RD, TIGARD, OR, 97223
Commercial - Plumbing
395 Misc. inspection
2014-02-28 00:00:00
PLM2014-00044
PASS
1 1/2" Wilkins model 350, serial no. A318582
1" Wilkins model 350, serial no. A326439
Violation Summary:
Inspector Contractor