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Permit n CITY OF TIGARD PLUMBING PERMIT 111111 t; COMMUNITY DEVELOPMENT Permit#: PLM2014-00303 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/07/2015 Parcel: 1 S133DA07200 Jurisdiction: Tigard Site address: 11470 SW 130TH AVE Project: Summer Lake Park Restroom Subdivision: AMART SUMMER LAKE Lot: A Project Description: Site utilities for new restroom: (1)manhole,58'of sanitary sewer line,24'of storm sewer, 105'of water service,(1) backflow preventer&(1)backwater valve. Contractor: DA NEAL CONSTRUCTION INC Owner: TIGARD, CITY OF 36296 NE WILSONVILLE RD 13125 SW HALL NEWBERG, OR 97132 TIGARD, OR 97223 PHONE: 503-625-6802 PHONE: 503-639-4171 FAX: FEES Quantity Description Date Amount 1 ea Manholes 04/01/2015 $18.76 Specifics: 58 If Sewer Service 04/01/2015 $62.54 24 If Storm and Rain Drain 04/01/2015 $62.54 Type of Use: COM 105 If Water Service 04/01/2015 $100.06 Class of Work: NEW 1 ea Backflow Preventer 04/01/2015 $31.27 Type of Const: 1 ea Backwater Valve 04/01/2015 $12.51 Occupancy Grp: 1 12%State Surcharge- 04/01/2015 $34.52 Stories: Plumbing Total $322.20 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 questi o by calling 503.232.1987 or 1.800.332.2344. Issued By: ' / Permittee Signaturee ��Jt�7 rc�� 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 FOR OFFICE USE ONLY City of Tigard Received 9 9 /1 c,..__ Permit ho.: 1pZ.lfiz f -etel,36 3 •• • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: /%�OIY/.aX)/ Inspection Line: 503.639.4175 TIGARD 0 Date Rea /B R Juris. 65 See Page 2 for Internet: www.ti aid-or ov Notified/M ethod: / 7 r Supplemental Information ormation TYPE OF WO' % 1 % , 4.,./ U.% FEE* SCHEDULE ®New construction ❑Dem it. •A For special information use checklist. a ription Qty. Ea. Total ❑Addition/alteration/replacement ❑Oth ��`�;, New 1-2-family dwellings(includes 100 ft.for each utility connection) ATEGORY OF CONSTRU s '�.t u� SFR(1)bath 312.70 12 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 1 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder A. ❑Other: Fire sprinkler( sq.ft.) Page 2 J / /c' i'° JOB SITE INFORMATION AND LOCATION 11111111111 Site utilities: Job site address: Lakeview Ter City/State/ZIP:Tigard,OR 97223 Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name:Summer Lk Park Restroom Manufactured home utilities 50.03 ICross street/directions to job site:Head westbound on Walnut St from Hwy 99W Manholes 1 18.76 18.76 Head northbound(rt)on 128th Avenue to intersection of Winterlake Dr.Head east Rain drain connector 18.76 (rt)on Winterlake Dr.take left on Lakeview Terrace. Site located at end of Sanitary sewer(no.linear ft.:58) 1 Page 2 62.54 `S Storm sewer(no.linear ft.:24) 1 Page 2 62.54 ' . road. Water service(no.linear ft.:ED 1 Page 2 100.06 Subdivision:N/A I Lot no.:N/A Fixture or item: Tax map/parcel no.: 1S133DA07200 Backllow preventer 1 31.27 31.27 DESCRIPTION OF WORK Backwater valve 1 12.51 12.51 Clothes washer 25.02 Installation of 4"PVC Sanitary Sewer Pipe from 10"mainline to restroom Dishwasher 25.02 Installation of 1-1/2"PVC waterline from existing meter to restroom Drinking fountain 25.02 Installation of 4"PVC storm drainage pipe from rain garden to daylight Ejectors/sump 25.02 1 ® 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 ne:(503)718-2466 Fax:(503)624-0752 Ice maker 12.51 ® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name:City of Tigard Medical gas(value:$ ) Page 2 Contact name:Jeff Peck Primer 12.51 Roof drain(commercial) 12.51 Address:13125 SW Hall Blvd Sink/basin/lavatory 25.02 City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54 Phone:(503)718-2466 Fax::(503)624-0752 Tub/shower/shower pan 12.51 A., E-mail:jeffp@tigard-or.gov Urinal 25.02 CONTRACTOR Water closet 25.02 q Water heater 37.52 Q, Business name��+ 1 gel _ ` ., Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal 287.68 Phone:( ) Fax:( ) Minimum permit fee: $72.50 e ,N 117 6l,2 g 3•,. (l� Plan review (25%of permit fee) ,-------CCB Lic.: J Plumbin Lic.no.: / State surcharge(12%of permit fee) 311, Authorized sign TOTAL PERMIT FEE 312_..1Q Print name: �- Date: q This permit application expires if a permit is not obtained within 180 days SeF s �(�� 1 -C/ 14 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\BuildinglPermits\PLMU-PermitApp.doc 10/01/09 440.4616x(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qt . Fee(ca) 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' I 62.54 62 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 1 62.54 62.54 Medical Gas Systems: Water Service-each additional 100' 1 37.52 37.52 �alLahtiL_ Permit Fee: Storm&Rain Drain-1st 100' I 62.54 62.54 $1.00 to$5,000.00 Minimum fee S72.5U Stone&Rain Drain-each additional 10U' 37.52 $5,001.00 to$10,000.00 $72.50 for the fast$5,000.00 and$1.52 for Other Inspections or Fees Qt . ie e' a 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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for an of the following. Work Performed: Capped Added Relocate q y g Baptistry/Font Please check all that apply. Bath Tub/Shower ❑ Any new commercial building with water service 2-and lacuzxi/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 El 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 Garbage Domestic-non-food CI Isometric or riser diagram is required for new buildings 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 Water Closet-Toilet - fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: I:\ENG11 -Active Projects\92048 Summerlake Restroom\PERMITS\COTS°t.PPL1CATIONS\PLMU-PermitApp.doc 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 11470 SW 130TH AVE, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2014-00303 George Heimos 1. Remove pressure reducing valve at meter location. There is one located in the building. You can't have two on same service 314.4 2. Lower water shutoff valve at meter location to a minimum of 24" below grade. 313.5 3. Uncover water service from meter location back 5' to verify depth of water service. 103.5.1.3/103.5.1.4 4. Back ﬂow device requires a minimum 12” clear space with box (prevents inﬁll) to ground below device. 603.3.3 5. Back ﬂow device: provide lawn irrigation device backﬂow test results. 310.3/407.2 6. Back ﬂow device requires a minimum depth of 24” from backﬂow device to grade. 609.1 7. Provide listing and manufacturers installation instructions for soap dispenser in utility room. 301.1.1 thru 301.1.3 and Chapt.14 Referenced Stds (City of Tigard responsibility) 8. Provide 1/4" caps for backﬂow device test ports.103.2.3.1/301.1.3 310.3 9. Recall inspection when corrections have been completed. Re-inspection required. 103.5.6.1 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 11470 SW 130TH AVE, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2014-00303 George Heimos 1. Corrections number 5 and 7, previous inspection not completed. (Test report and listing of soap dispenser not completed, also could not access mechanical room, door locked. 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 11470 SW 130TH AVE, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2014-00303 George Heimos 1. Correction number 5, previous inspection not completed. (Backﬂow Test report) all else ok. Recall inspection when completed. 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 11470 SW 130TH AVE, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2014-00303 George Heimos Violation Summary: Inspector Contractor