Permit CITY OF TIGARD PLUMBING PERMIT
II V
COMMUNITY DEVELOPMENT Permit#: PLM2015-00192
Date Issued: 06/16/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Scholls Clinic Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Add(1)new sink and replace(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
2 ea Sink 06/16/2015 $50.04
Specifics: 1 12%State Surcharge- 06/16/2015 $8.70
Plumbing
Type of Use: COM 22 ea Minimum Fee Adjustment- 06/16/2015 $22.46
Plumbing
Class of Work: ALT
Type of Const:
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 qu- ens to ••• C by calli•• 503.232.1987 or 1.800.332.2344.
Issued : • . 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.
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 100, TIGARD,
OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00192
George Heimos
Service@americanheating.com
Violation Summary:
Inspector Contractor
Plumbing Permit Applic4EIV I P
Building Fixtures
City of Tigard JUN 16 2015 Dae/B . 6 /11) )� Permit No.: 9a
• 13125 SW Hall Blvd.,Tigard,OR 97223 y pa 5_�O -
= Plan Review
Phone: 503.718.2439 Fax:15tj9�8tI�OI] AKD Date/By: Other Permit No.:t�,,.0/5-.000(pf
73' ri ■ V Da[e/B
T 1 G A R D Inspection Line: 503.639.41 i i n1� Date Ready/By. runs: la Sc "e age 2 for
Internet: www.tigard-or.g4 J JJ,fl'N( I IVJSI 1% Notified/Method: 1 Supplemental Information
TYPE OF WORK 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
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
Accessory building SFR(3)bath 500.32
El Accessory ❑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: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
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:100 I Project name:Prov Scholls Clinic 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.: / 5 1 3 si6e CO 4/G/ Backflow preventer 31.27
: DESCRIPTION OF WORK
Backwater valve 12.51
Clothes washer 25.02
adding 1 new sink,remove and replace 1 sink
Dishwasher 25.02
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:American Heating Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Brandon Hutchinson
Roof drain(commercial) 12.51
Address:5035 SE 24th Ave. Sink/basin/lavatory 2 25.02
City/State/ZIP:Portland,OR.,97202 Solar units(potable water) 62.54
Phone:(503)239-4600 Fax::(503)239-7038 Tub/shower/shower pan 12.51
E-mail:b.hutchinson @americanheating.net Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:American Heating Inc. Water piping/DWV 56.29
Address:5035 SE 24th Ave. Other: 25.02
City/State/ZIP:Portland,OR,97202 Subtotal
Phone:(503)239-4600 Fax:(503)239-7038 Minimum permit fee: $72.50 '7a 50
CCB Lic.:33135 Plumbing Lic.no.:PB982 Plan review (25%of permit fee)
State surcharge(12%of permit fee) O.70
Authorized signature: TOTAL PERMIT FEE /.ae,
Print name:Brandon Hutchinson Date•!!...g-1 J 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:\Building\Permits\PLMU-PermitApp.doe 1 0/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain- I"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 $I.00 to$5,000.00 Minimum fcc$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
P 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 ❑ 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 ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food q
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 I I
-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:
H:\_Hutch\Permits\City of Tigard Tigard Plumbing Application(Buildingixtures).doc