Permit 14 q CITY OF TIGARD PLUMBING PERMIT
i COMMUNITY DEVELOPMENT Permit#: PLM2014-00323
T IGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/01/2014
Parcel: 1S 134BC00401
Jurisdiction:
Site address: 12442 SW SCHOLLS FERRY RD 206
Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Interior plumbing:Capping(1)sink and relocating(1)sink.
Contractor: AMERICAN HEATING INC Owner: PROVIDENCE HEALTH SYSTEM-OREGO
5035 SE 24TH AVE ATTN: REAL ESTATE&CONSTRUCTION
PORTLAND, OR 97202-4765 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 10/01/2014 $25.02
Specifics: 1 ea Sink 10/01/2014 $25.02
1 12%State Surcharge- 10/01/2014 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 10/01/2014 $22.46
Type of Const: Plumbing
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 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 or 1.800.332.2344.
Issued By: 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
Building Fixtures FOR OFFICE USE ONLY
Received
City of Tigard G z P�rnit No.: _ t
III Date/BY f / r (y);2)ly op i I 13125 SW Hall Blvd.,Tigard, /a�/ I r Plan Review Atha Permit No.:
s Phone: 503.718.2439 Fax: Sq` 1%1� DateBy:i l A r L Inspection Line: 503.639.4175 GQ p J Date Ready/By: Juris: la See}'age 2 for
Internet: www.tigard-or.gov Cj` ) O Notified/Method Supplemental information •
I''FI O1 WQt FEE* `5 4
❑New construction ®Demolition',.7 For special information use checklist.
- Description _I Qty. I EL I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY- OF CONS(RUCTION - SFR(1)bath 312.70 _
1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
El
❑Accessory building y SFR(3)bath 500.32
❑Multi-fermi!
Each additional bath/kitchen 25.02
❑Master builder 0 Other Fire sprinkler( sq.ft.) Page 2 •
T.T.JQJ3 SITE INFO1tMAT10N�111in'1Q2A'tIOI( : Site utilities:
Job site address:12442 SW Scholls Ferry Rd. Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR.,97223 Drywell,leach line,or trench drain 18.76
Pr7V,clen/Ce Nieel ",( LVeroting drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 0 Project name 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 R.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: ! Lot no.: Fixture or Item:
Tax map/parcel no.: Backflow preventer 31.27
__= ' - s ; Backwater valve 12.51
_ _ .mss,
Clothes washer 25.02
Demo&Cap (1)Existing Countertop Sink /i.tzttoit.--
J Dishwasher 25.02
Install(1)New Countertop Sink Drinking fountain 25.02
sec t
o swnp
25.02
_ . ___� �_ t'"2 Expansion tan k 1
2 51
Fixture/sewer cap t 25.02
;-5-i 0J.Name:
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/21P: IIose bib 25.02 I.
Phone:( ) Fax:( ) Ice maker 12.51
- • jai:ig 'Vii-_ Interceptor/grease trap 25.02
Business name:American Heating Inc.
- - Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Scan Dyer Roof drain(commercial) 12.51
Address:5035 SE 24th Ave. Sink/basin/lavatory - / 25.02 t_s t}A. .
City/State/ZIP:Portland,OR,97202 Solar units(potable water) 62.54
Phone:(503)239-4600 I Fax::(503)239-7038 Tub/shower/shower pan 12.51
E-mail:sears @americanheating.net Urinal 25.02
- - atWer closet 25.02
▪ CONRCTQR tit ` ":M4'2.ti rii� - s-�._ __. TA -_- .. ..._.-=- _ . Water heater 37.52
Business name:American Heating Inc. Water piping/DWV 56.29
Address:5035 SE 24th Ave. Other. 25.02 I.
City/State/ZIP:Portland,OR.,97202 Subtotal 5'0.Oq !!
Phone:(503)239-4600 Fax:(503)239-7038 Minimum permit fee: S72.50 2,5-ra. I•
CCB Lie.:33135 Plumbing Lic.no.:PB982 7 1 11 Plan review (25%of permit the)
Authorized signature: _./ State surcharge(12%of permit fee) 70
i s „� �� TOTAL.PERMIT FEE �I,
Print name:Sean Dyer Date:9/18/14 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.
L1DuildieglPermits`PI,MU-PermitApp.dx 10!01 69 44OA6161'(I0/07J12OM/WL13)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12442 SW SCHOLLS FERRY RD 206, TIGARD,
OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00323
George Heimos
Violation Summary:
Inspector Contractor