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Permit
CITY OF TIGARD PLUMBING PERMIT ' COMMUNITY DEVELOPMENT Permit#: PLM2014-00050 T I G A R f? 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/03/2014 Parcel: 2S110DB01300 Jurisdiction: Tigard Site address: 15298 SW ROYALTY PKWY Project: EyeHealth Northwest Subdivision: 1996-010 PARTITION PLAT Lot: 2 Project Description: CAP(1)water closet,ADD(1)water closet,RELOCATE(1)drinking fountain,(16)sinks,(5)lays,and(4)water closets. Contractor: CASCADE PLUMBING CO Owner: TIGARD INVESTMENT PROPERTIES LLC 2416 N HAYDEN ISLAND DR 11086 SE OAK ST PORTLAND, OR 97217 MILWAUKIE, OR 97222 PHONE: 503-289-7095 PHONE: FAX: 503-283-9514 FEES Quantity Description Date Amount 1 ea Drinking Fountain 02/26/2014 $25.02 Specifics: 1 ea Fixture/Sewer Cap 03/03/2014 $25.02 16 ea Sink 02/26/2014 $400.32 Type of Use: COM 5 ea Lavatories 02/26/2014 $125.10 Class of Work: ALT 5 ea Water Closet 02/26/2014 $125.10 Type of Const: 1 12%State Surcharge- 03/03/2014 $84.07 Occupancy Grp: Plumbing Stories: Total $784.63 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 952-001-010. 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: //L 1 Call 503.639.4175 by 7:00 a.m.for the next available inspec ion date. / This permit card shall be kept in a conspicuous place on the job site until completion o the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application . Building Fixtures j FOR oI t lcl: I Si: ()NIA 1111 City of Tigard rt�,!!�, is ' iivi, Permit No/DUy�/y 000 g, • 13125 SW W Hall Blvd.,Tigard,OR 97. ' _Ply Review li Phone: 503.718.2439 Fax: 503.598.1.• 1. _; 'al I.__ , ° e/By. Other Permit No.: T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: suns: la See Page 2 for Internet: www.tigard-or.gov NI A,±, - ' 2014 Notified/Method I Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction ❑Demo . ° I' For special in ormation use checklist. Slift,D 11i1'SOlk Descri.tion MIIII Ea. Total 11, ddition/alteration/replacement ❑ Ohe New 1-2-family dwellings(includes 100 ft.for each utility connection) i CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling cmmercial/industrial SFR(2)bath 437.78 ❑Accessory building SFR(3)bath 500.32 ry g Each additional bath/kitchen 25.02 ❑Master builder ❑Other Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMA N AND LOCATION Site utilities: r 5-'a q g , prokivaq Catch basin o r area drain 18.76 Job site address: C(�(.t N_ JJ Drywell,leach line,or trench drain 18.76 City/State/ZIP: �g. ri l O Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: ` _( Project name: .'.4 / 4 A W 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: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 3127 DESCRIPTION OF WORK Backwater valve 12.51 �f Clothes washer 25.02 rat) h `a^ ' � i Dishwasher 25.02 Drinking fo untain / 25.02 L57 QZ Ejectors/sump 25.02 ❑ PROPERTY OWNER 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap ' 25.02 25. 01 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:Same as below Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: R f drain(co. ,.-cial) 12.51 Address: asinRava.ry o2/ 25.02 5"Z5./,/ City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet .9 25.02 f 26, /0 CONTRACTOR Water heater 37.52 Business name:Cascade Plumbing Co Water pi i m WV 5629 P Address:2416 N.Hayden Island Drive Other: 25.02 City/State/ZIP:Portland,OR 97217 Subtotal , 7U0:tj Phone:(503)289-7095 Fax:(503)283-9514 Minimum permit fee: $72.50 CCB Lic.:120893 Plumbing Lic.no.:34-412PB Plan review (25%of permit fee) State surcharge(12%of permit fee) ?Li,07 Authorized signature: a�4��,/sA /1 9.01-LO TOTAL PERMIT FEE '�C t( This permit application expires if a permit is not obtained within 180 days Print name:Crystal Jones Date: after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Build ng\Pemmits\P1.MU_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) Tom Square Footage: Permit Fee: Footing drain-1'100' 50.03 0 to 2,000 $121.90 2.001 to 3,600 $169.69 Footing drain-each additional 100' 37.52 3,601 to 7.200 $23310 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 Qt}. Fee(ea) Total each additional$100.00 or fraction thereof;to 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 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$120 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 Future Type for Replace/ Plan review is required for any of the following.Performed: Capped Added Relocate Please check all that apply. Y g• Baptistry/Font 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 _ I ❑ 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" 4" 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 increase of sewer EDUs,a sewer permit will be issued and Water Extractor P Water Closet-Toilet / / ,I/ fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: C:\Users\Owner\Downloads\PLMF-PermitApp(1).doc 2 numbing Permit Application Building Fixtures RECE1 VE D q FOR OFFICE: USF. ()NU City of Tigard ' /f��,, I / + 13125 SW HaU Blvd.,Tigard OR,�9�2t�33 � Date/BY /"�/ „ - .�'J I Permit No-: /NA!, -eoo Phone: 503.718 2439 Fax: 503.IS9R.►1?�6d+ 4 2014 rtan Review y3 ,Q6/yr OC>�3 Deter Other Permit NS.: TIGARI) ltrlanett�www.ti ard.orp4175 ,� }}aateRaadY _ •••.. k,rix' Page Line OF t; go I a I ARD r '� ,q 2 for N atlfred�Adethod: tal atba ❑New construction ❑Demolition For special information am ekeek l i5L '" -"D"a"�ai cm --7 Ea. -- ttOddition/aitcxatinl/rcplacemcnt 1 © ltbes: %.n New 1.2 fatally dwellings(includes 100 ft,for each utility cotutcctionl ` .CATEGORY•.OF CONSTRUCTION:':1:: :; .`::::r :•::::�:� :.;:::.. SFR(1)bath 2.7 1 and :family dwelling ominerciai/industrial SFR(«)hark) I 437.78 t 1 r-.m- _ ©Accessory building ( ❑Multifamily SFR(3)bath _.. 508,32 ; 0 Q Master builder - -.'`�" additional bath/kitchen ©O h ddii'onal ..:...., :> .. , . .. . .. .. .. Ftrespfutl3er 2 25. 2 :lit?C .,...::.::,:.... .. .::..JOB.'SE'IE`INFO�MA • .AND A1'lON''•:,!::." >';;. . ;:,.,. Site utilities:( _ �..�..sq.!i. page Job site address: i 5 0 ' 40/ / . . J _ Catch basin c t area drain 1 8,76 W ./�1 ""'""' Drywell,leach line,or trench drain 18.76 City/State/ZIP: 4�J . / ^ Feat Footing drain(tut.linear ft.: ) Page t Suite/bldg./apt.no project nam /I/ J� _. ~Manufactured home utilities .,.,$ ��-.�-.••- $0.43 Cross sweet/directions to job site: ., Manholes .._ ._W I F ""� I 1 8.76 m_.. _-_- _ Rain drain connector 18.76 Sanitary sewer bw.linear ft,.,•`) f Page 2 Storm sewer(no.linear fi.: ) j 1 Page 2 '•__ �--- -- �.,•.,.. Water service(no.linear f.: ) i 1 Page 2 I Subdivision: j Lot no.: Fixture or Item: Tax map/parcel no.: a a 1/07:3&57:530 Backilow preventer j 3127 '`cf.: .DEESCJUPT ON.',OB;,WOI�( Backwaltr valve - I 12.51 !;1 Viet vL,d f • ••.... Ito- S Clothes w711C7. ._ f D1S1waSlei ' •f 23.(Z -"_ T- 5.02 Drinking fountain _ ( / _ 25,02 pL - _ Fjectors/sump I 25.02 ,:.. .PR k.:fRr , WNEI41.,44r:.:.:,:1:: 4 vg nattsion 12.51 Name; Fixture/sewer cap i 25.02 - ... .. __.�...•...., _ _.._.... I n,....tltain/floor sink/bub f 25.02 Address: } J Garbage dispas% 25.02 1 City/State/ZIP: Host bib Phone;( I _I 25,02 Fax:( ) Ice makes_ 12.31 I ' ';0 A'''kiC,1APNT `t'Ctrig4i k its Interceptor/grease trap fir 25.42 IBusiness name:Same as below . ... ""--- Printer Medical gas(value:S ) i _ Page 2 Contact name: 12.5) .._, __-.-_-- Yu Roof drain(commercial)al) ! 12.51 I Address: w 1 Sink/basinrlavatory I a j 25.02 525,SF City/State/ZIP: Solar units(potable wato-) 62.54 Phone:( ) I Tub/slower/shower a t� 12.51 1 E-mail: 1l Hal 25.02 __. P.,) 25,12 V 15i /::•.•au >N tg P o-0-, t> 00 % *i.ilM €.1�: " .,• Water henna 37.52 Business name:Cascade Plumbing Co Waterpipip/DWV 56.29 Address:2416 N.Hayden Island Drive -• .W__ 77,41.: 25.02 IIIIIIIIII City/State/ZIP:Portland,OR 97217 L......._ .- Subtotal 7 .y'A Phone;(503)2894095 Fax:(503)283.9514 { Minimum permit fee; S 12.50 CC13 Lie.:120893 Plumbing Lie.no.:34.412PB 1 Plan review (25%ofpermit fee) State surcharge(12%of permit fee) r ! 0 . Authorized signature: _ •-- 1 ..,,r . ,_. TOTAL.psFo r FEE "755''x, ..0 Print name:Crystal Jones Dare; Tilts permit eppl cotton yTiros If s permit b mot obtained Nubtm 110 day. 1 after it bas been accepted as complete. 1. , *Fee methodology set by Di-County building Wintry Service board. 4,nwldioyU'amae1 U U.pawaApp.doc =woo 44 OA 01 61X toU:/COMAVEB) TO•d 17TS6C8Z£OS o0 buigmnTd apaose0 Wd6Z:80 t?T/TZ/Z0 'r. Plumbing Permit Api licatio - City of Tigard �L�t�0 -f- OA S� Page 2 - Supplemental Information EYE ff E4LTiy Ai I Sag 8 So) P,Y/ILi- ACy aA o� Fee Schedule: Residential Fire Suppression Systems: Site Utilities': QtY Fee ea) ^; Total; ' [Square Footage- •Pernut Fee Footing draw•1'100' 50.03 �---- .. 10.0- 0 to 2,000 i $121.90 Footing drain-each addition:id 100' 5� 2AOl l0 3,600 q 37..,_ 516. G9 l 3,601 to 7.200 5233,20 Sewer-Ira 7'Ol 100' 62.54 ..._ and greater _ $3_7,54 , Sewer-each additional 100' 37,52 -•---- Water Service-1st 100' 62.54 " Water Service-each additional 100' Medical Gas Systems: 37.5., Valuation. Permit Fee: ' Storm St Rain Drain-1st 100' 62.54 Storm it Rain Drain•each additional 100' , S 1.00 to S5,000,00 Minimum fee$72,50 37.52 $5,001.00 to S10.000.00 $72.50 for the first$5.000.00 and S1.52 for — Other Inspections or Fees , Q '• Fee{raj soul 1 each additional$100.00 or fraction thereof,to Lcupectiau of cxiadng plumbing or for and including 510.000,00, - I which no fee is specifically indi�atrd 90.00/1u- f 510,001,00 to$25,000.00 TS 148.5(1 for the first 510,(K10,00 aid St,54 for ! e,eh ackiiriarcal$100.00 ar fraction thereof,to (miatimua»clurrcr.- 1/2 hour) anti i»cIudina$25()00.00. Inspections outside of normal business 90,Utilhr _.. 1.� °-- - , bout ss(inirtimum Large-2 hours} 51.5,003,00 to 550,000.00 each a 0 for the tarsi 525,000.00 and$1,45 for- -- ° 3 each additional S100.00 or faction thereof,to -Fteinapection Fees 9(,.OU/hr l-._._.. .,_--� and includi,t 550.000,00. _ Additional plan review for revisions - 90.00/hr $50.001.00 arid up $742.00 for the first 550,000.00 and$1 0 fur _(mini mum cl>.xrge.•-1/2 hour) .._ ,-.. L.,,._.. - -_ I each additional$100,(10 or traction thereof Subtotal: - „ Commercial Fix-hire %Vprk: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately re ort fixtures could result in increased sewer fees*. e•antity by Fixture Tv. P1ai Review for Plumbin 'Installations Fixture Type for - Replace/ Work t'cr[ortued Capppt Ref a Plan review is required for any of the following. 13apuStt /Font Please check all that apply. Bath 7'uh/5howor 0 Any new commercial building with water service 2"and -Jacur-WWhirf' .1 11111111111_ greater,except systems designed and stamped by licensed Ciu.Wash -Each Stall engineer. -Drive Thru � ❑ New exterior plumbing site utilities for any complex structure Cu-•'dor/Water As•irator as defined in()AR918.780-0040. Dishwasher -Commercial =1111111111111=111111111= ❑ Medical gas and vacuum systems for health care facilities. -Domestir. ❑ Any multipurpose fire sprinkler system. Drinkin Fountain ==1 ❑ Any complex structure as defined in OAR9 18.780-0040. E,eWash Floor Drain/sink •2" Submit 2 sets of plans with any of the above. Car Wash Drain Isometric or Riser Dia-ram:i` Garbage •Domestic-nan•fond i—= Isometric or riser diagram is required for new buildings Disposal -Domestic-ftx,4 related MI that meet the qualifications above, -Commercial-food related - — - -Industrial-food related = ice _ Oil Sc rotor(Ciao:Station, ME Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang .......� ..- .....-. .._ -Stall Sunk/Lav -Non-food related MIN ---• .-----------' -Bradley •Comana coal-food related •Service IIIIIIIII - ._ - -- Swlmmin:.Pool Filter Washes-t:tothrs ailiiiil Note: If the fixture work under this permit results in an Water Extractor 11111.111 increase of sewer FDUs,a sewer permit will be issued and water Closet-Toilet fir' fees assessed for the sewer increase must be paid before the tlrtnal NEM. plumbing permit can be issued. Other Fixtures: C::\Users\OwnerkDownloads\PLMF-PermitApp(1).doc 2 ZO•d bT56£8Z£OS 03 butgmnTd apsosp3 1HV6Z:90 bT/TZ/ZO 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 15298 SW ROYALTY PKWY, TIGARD, OR, 97224 Commercial - Plumbing 399 Plumbing final 2014-04-17 (null) PLM2014-00050 PASS - No C of O Violation Summary: Inspector Contractor