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Permit CITY OF TIGARD PLUMBING PERMIT 11111 I COMMUNITY DEVELOPMENT Permit#: PLM2014-00406 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/30/2014 Parcel: 2S 101 AA08700 Jurisdiction: Tigard Site address: 12511 SW 68TH AVE Project: Kassay Clinic Subdivision: WEST PORTLAND HEIGHTS Lot: 34 Project Description: Interior plumbing: Adding(4)sinks,relocating(2)sinks,and installing(1)water heater. Contractor: COLUMBIA CONSTRUCTION INC Owner: BEVELAND BUILDING LLC 28170 BOBERG RD 12511 SW 68TH AVE WILSONVILLE, OR 97070 PORTLAND, OR 97223 PHONE: 503-427-0304 PHONE: FAX: FEES Quantity Description Date Amount 6 ea Sink 12/29/2014 $150.12 Specifics: 1 ea Water Heater 12/29/2014 $37.52 1 12%State Surcharge- 12/29/2014 $22.52 Type of Use: COM Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $210.16 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. :.in:y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.:•' 32.2344. i Issued By: / ` Permittee Signature: ✓ ZIptir 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 �� , . Sdp 1414-01 700 5(4,,� - .1 a • Building Fixtures SCE FOR OFFICE USE ONLY City of Tigard Date/By: Permit No.: nLm O Ike 12„ Date/By: � ptq ��( ;� • 13125 SW Hall Blvd.,Tigard,OR 9722 C 9 2u14 Plan Review ■ Phone: 503.718.2439 Fax: 503.598.10%1d Date/By: Other Permit No.: ecipiv h--t z)a-S't Inspection Line: 503.639.4175 Date Read 'B kris: HI See Page 2 for 1It� 11:1) T1G Ready/By: Internet: www.tigard-or.gov CITY OF Notified/Method: 'MG Supplemental Information TYPE OF W !1a•IS FEE* SCHEDULE ❑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(I)bath 312.70 ❑ I-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: 12511 SW b8t Ave. Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR,97223 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project namel-Ik.Kassay CItrvl'[ 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 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Relocate and provide K 2 new sinks.Relocate water heater. & Dishwasher 25.02 adAl+tlyiLal q Sinks, Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 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: Medical gas(value:5 ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 6 P 25.02 OA= 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 Water heater 1 37.52 37.52 Business name:Columbia Const.Inc. Water piping/DWV 56.29 Address:28170 SW Boberg Rd Other: 25.02 City/State/ZIP:Wilsonville,OR,97070 Subtotal itillaat Phone:(503)427-0304 Fax:( ) Minimum permit fee: $72.50 CCB Lie.: 199903 Plumbing Lic.no.:PB-1400 7/111 Plan review (25%of permit fee) State surcharge(12%of permit fee) !CI Authorized signature: TOTAL PERMIT FEE P 1 a/ i This permit application expires If a permit is not obtained within 180 days Print name:Darren Placek Date: 11/14/14 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:,Building Permits'PLMU•PernutApp.doc 10 0109 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-1s'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 war 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 ec Ins tions or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Inspections 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/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath -Tub/Shower El 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. Isometric or Riser Diagram Car Wash Drain O 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 �1 Sink/Lav -Non-food related T 2 -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\Darren\AppData\Local\Temp\PLMF-PermitApp.doc 2 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 12511 SW 68TH AVE, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL March 3, 2015 at 10:47:53 AM PLM2014-00406 George Heimos 1. Hot water heater. Provide hot water at ﬁxtures. 502.5 2. Recall inspection when correction has been completed. All else ok Violation Summary: Inspector Contractor 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 12511 SW 68TH AVE, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL March 3, 2015 at 10:47:53 AM PLM2014-00406 George Heimos 1. Hot water heater. Provide hot water at ﬁxtures. 502.5 2. Recall inspection when correction has been completed. All else ok Violation Summary: Inspector Contractor 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 12511 SW 68TH AVE, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2014-00406 George Heimos Violation Summary: Inspector Contractor