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Permit
CITY OF TIGARD PLUMBING PERMIT I • COMMUNITY DEVELOPMENT Permit#: PLM2015-00158 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/18/2015 Parcel: 1 S126BC01506 Jurisdiction: Tigard Site address: 9020 SW WASHINGTON SQUARE RD 500 Project: Aspen for Health Subdivision: 2005-035 PARTITION PLAT Lot: 3 Project Description: Interior plumbing:Adding(1)2"hub drain and(1)break room sink,and installing(1)water heater and(1)primer. Contractor: GRIDLINE PLUMBING Owner: WISCO REAL ESTATE EQUITY FUND I 14844 SW 109TH AVE 1501 SW TAYLOR ST STE 100 TIGARD, OR 97224 PORTLAND, OR 97205 PHONE: 971-275-6167 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Floor Drain/Floor Sink/Hub 05/18/2015 $25.02 Specifics: 1 ea Primer 05/18/2015 $12.51 1 ea Sink 05/18/2015 $25.02 Type of Use: COM 1 ea Water Heater 05/18/2015 $37.52 Class of Work: ALT 1 12%State Surcharge- 05/18/2015 $12.01 Type of Const: Plumbing Occupancy Grp: Stories: Total $112.08 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 foll. . - . - •dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00' . You may obtai a copy of the rules or direct questions to OUNC by calling 503.232.19 . . .2344. Issued By: Perm ittee Signature: ��.pp � Call 503.639.4175 by 7:00 a.m.for the next available i e. This permit card shall be kept in a conspicuous place on the job site •ntil completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application • (S/ 6 . ( 6(57) SKRh(S Occci Building Fixtures FOR OFFICE USE ONLY . Ci}�,of Tigard P Received `, g ♦ '{�� DateBy: 5 1111,5- 4-77--- Permit No.: "i fr I tJ�1,-7, '1 13125 SW Hall Blvd.,Tigard,OR 97Z3�+ v 11ii Plan Review Phone: 503.718.2439 Fax: 50 �`Y/ Date/By: Other Permit No.: 49,,, ,, co i r/j T 1 G A R D Inspection Line: 503.639.4175 Q 7-0C3 Date Ready/By: kris: ® See Page 2 for 7 Internet: www.tigard-or.gov Mn�l 1 D Notified/Method: Supplemental Information TYPE OF WORK ''``11(��-"G v S ON FEE* SCHEDULE ❑New construction [161 t �tTrrrt For special information use checklist �`,t-v lyU Description I Qty. I Ea. I Total Addition/alteration/replacement eAWer: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling ommercial/industrial SFR(2)bath 437.78 - building SFR(3)bath 500.32 ❑Accesso ry g ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOC TION Site utilities: Job site address: i�� /w �!'j �id Catch basin or area drain 18.76 '`� ‘2.-11r-lid 6©/t r� Drywell,leach line,or trench drain 18.76 City/State/ZIP: / Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: 500 Project name: /' Manufactured home utilities 50.03 Cross street/directions to job site: A 17�_/j'� f - ,/ � Manholes 18.76 Vim" / �, 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 4/)T / _ !� Clothes washer 25.02 '✓ l Dishwasher 25.02 _ 1/ �1'at" Drinking fountain 25.02 /---- Gr /Z---7 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 ‘,2 6.-e,1. 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 Medical gas(value:$ ) Page 2 Business name: � ti G f Primer )( / 12.51 j, . 5 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory ( 25.02 ,1- '02-- City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet 25.02 r CONTRACTOR Water heater J /' 37.52 5 7,�Z Business name: ` �Y'� 1)� ,/ L 17/19 Waterpiping/DWV 56.29 Address:/10f. //9 atte ,, Other: 25.02 City/State/ZIP: / j / iVi--- L 722,¢ Subtotal I do, 07 771 j / `/-� Minimum permit fee: $72.50 Phone: , / �'!! 77 r(p((� Fax:( ) Plan review (25%of permit fee) CCB Lic.: 71(17 ' umbing Lic.no.: a91-01t-47/4g I_ State surcharge(12%of permit fee) A.. Authorized signature: 1 ``' / TOTAL PERMIT FE J/),i 67e. Print name: v j J� Date: -/ - This permit application expires if a permit is not obtained wi in Mu nays after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\PLM1.1-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) 4 i i 3-7.or 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-15'100' 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$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 Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to I� 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*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure Each Stall as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher -Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 1 3" Isometric or Riser Diagram 4„ ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -LavBar non-food related / -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor WaterCloset-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Buil ding\Permits\PLMF_PermitApp.doc 08/04/2011 2 111 41- Accumulative Sewer Tally 4 Tenant Name: ASPEN FOR HEALTH SWR# 2015-00053 TIC (:n Site Address: 9020 SW WASHINGTON SQUARE RD 500 PLM# 2015-00158 Parcel#: 1S 126BC01506 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values Baptisery/Font 4 0 0 0 0 0 Bath: -Tub/Shower 4 0 0 0 0 0 -Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash: -Each Stall 6 0 0 0 0 0 -Drive through 16 0 _ 0 0 0 0 Cuspidor/Water Aspirator 1 0 0 0 0 0 Dishwasher: -Commercial 4 0 0 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 1 2 1 2 -3 inch 5 0 0 0 0 0 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 _ 0 0 0 Garbage Disposal: -Domestic(to 3/4 HP) 16 0 0 0 0 0 -Commercial(to 5 HP) 32 0 0 0 0 0 -Industrial(over 5 HP) 42 0 0 0 0 0 Ice Machine/Refrigerator Drain 1 0 0 0 0 0 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Station) 6 0 0 0 0 0 Rec.Vehicle Dump station 16 0 0 0 0 0 Shower: -Gang(per head) 1 0 (1 0 0 0 -Stall 2 0 0 0 _ 0 0 Sink: -Iav/Bar-Non-Food Related 2 0 0 1 2 1 2 -Bradley 5 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 0 0 0 O Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 0 2 4 2 4 Current Fixture Value 4 divided by 16= 0250 Current EDU 1 EDU= $4,900.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 4 divided by 16= 0.250 over (under) $ 1,225.00 Enter EDU Change Here 0.250 Notes: Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 5/18/2015 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges. I:\Building\Sewer Tally\SewerTa llySheet_4900._070114.xlsx 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 9020 SW WASHINGTON SQUARE RD 500, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing final PASS - No C of O PLM2015-00158 George Heimos Also inspected above grid plumbing. Violation Summary: Inspector Contractor