Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit#: PLM2015-00179
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/11/2015
T[<'t\.}iD 9 Parcel: 25102AD01700
Jurisdiction: Tigard
Site address: 9025 SW BURNHAM ST
Project: Zuber House-Ash Avenue Dog Park Subdivision: TIGARD HIGHWAY TRACTS Lot: 21
Project Description: Installation of 80'of water service line,(1)backflow preventer&(1)drinking fountain.
Contractor: 1ST CALL PLUMBING& DRAIN CLEANING LLC Owner: TIGARD, CITY OF
6615 SE 42ND AVE 13125 SW HALL BLVD
PORTLAND, OR 97206 TIGARD, OR 97223
PHONE: 971-409-7463 PHONE:
FAX: 503-961-7108
FEES
Quantity Description Date Amount
80 If Water Service 06/11/2015 $62.54
Specifics: 1 ea Backflow Preventer 06/11/2015 $31.27
1 ea Drinking Fountain 06/11/2015 $25.02
Type of Use: COM 1 12%State Surcharge- 06/11/2015 $14.26
Class of Work: NEW Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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.; 2.2344.
Issued By: Permittee Signature:
Vi" ar
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.
0 Plumbing Permit Application
Site Utilities 0I IVEI P FOR OFFICE USE ONLY
City of Tigard �1 Received �
`� g Date/B : /i_ Permit No.: `� • c
.1111 i • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 50}� 191503 2015 Date/By: Other Permit No r _. lifer }
Inspection Line: 503.639.4175 r+ �.
TIGARD Date Ready/By: / / �ifi,, Ions: ® See Page 2 for I
Internet: www.tigard-or.gov ;•,,: r,i .• ' 'i \ Notified/Method:10 c /s Supplemental Information
TYPE OF WTOW T F b iti/L FEE-* SCHEDULE
❑New construction ❑ Demolition For special information use checklist. bt
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ®Other: Dog Park New 1-2-family dwellings(includes 100 ft.for each utility connection)
l
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 O
❑ 1-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 Q
JOB SITE INFORMATION AND LOCATION Site utilities: ON
Job site address:9025 SW Burnham St Catch basin or area drain 18.76 ,,�
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 ;1
Footing drain(no.linear ft.: ) Page 2 O
Suite/bldg./apt.no.: I Project name:Zuber Property Dog Park Manufactured home utilities 50.03 O
Cross street/directions to job site:Located at northeast corner of Manholes 18.76 1
O
intersection of Burnham Street and Ash Avenue Rain drain connector 18.76 (A
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2 (�
Water service(no.linear ft.:80) 1 Page 2 62.54 (1
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.:2S102AD01700 Backflow preventer 1 31.27 31.27 RI
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Installation of a 1"backflow device,and installation of 1"water service line -
Dishwasher 25.02
Drinking fountain 1 25.02 25.02 ,t
Ejectors/sump 25.02
® PROPERTY OWNER ® TENANT Expansion tank 12.51
Name:City of Tigard Fixture/sewercap 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
Phone:(503)718-2466 Fax:( ) Ice maker 12.51
W ® 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)7185-2466 Fax::( ) Tub/shower/shower pan 12.51
E-mail:jeffp @tigard-or.gov Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: 10 CALL PLUMBING
Water piping/DWV 56.29
Address:6615 SE 42nd Ave Other: 25.02
City/State/ZIP:Portland,OR 97206 Subtotal 118.83
Phone:(971)409-7463 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:195480 Plumbing Lic.ne 126 -7////) Plan review (25%of permit fee)
State surcharge(12%of permit fee) ill,kp
Authorized signatur cy„. �
, TOTAL PERMIT FEE rk,�"j 07
Print name:Jeff Peck Date:6/3/15 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.
I:\Buildiug\Permits■PLMU-PermitApp.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 Qt%. Fee(ea) Total Squal otage: Permit Fee:
Footing drain- I'' 100' 5o.0; 0 to 2,000 5121.90
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' 1 62.54 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
_ 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) i 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 any 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
-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.
-3,'
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ 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
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:
I:\ENG\1 -Active Projects\97025 Zuber House_Ash Ave Dog Park\PER v TS\Site Plumbing Water Permit-Ash Ave Dog Park.doc
L
p.
pri Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional,drawn
to scale)labeled with:
A. ❑ map& tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS-Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size,type of material,slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
1:\Building\Permits\PLMF-PermitApp.doc 12/30/05
IIII4 i Accumulative Sewer Tally Tenant Name: City of Tigard SWR# N/A
Site Address: 9025 SW Bumham St. PLM# 2015-00179
TIGARD
Parcel#: 2S102AD01700
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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Hoot Drain/Sink: -2 inch 2 0 0 0 0 0
-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 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lay/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 0 0 0 0 0
-Com/Serv/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 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 1 16
TOTALS 0 0 0 0 1 1 1 -15
Current Fixture Value -15 divided by 16= -0.938 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -15 divided by 16= -0.938 over (under) $ (4,606.00)
Enter EDU Change Here -0.940
Notes: Demolition of single-family dwelling resulted in credits.
Authorized Name/Signature: Dianna Howse Date: 6/10/2015
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\SewerTallySheet_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
9025 SW BURNHAM ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00179
George Heimos
Violation Summary:
Inspector Contractor