Permit CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit#: PLM2015-00203
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/30/2015
TIGARD Parcel: 25101 AD02400
Jurisdiction: TIGARD
Site address: 12753 SW 68TH AVE
Project: George Fox University Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Installation of(1)lay&(1)water closet for new ADA restroom adjacent to the library.
Contractor: OWNER Owner: GEORGE FOX UNIVERSITY
GEORGE FOX UNIVERSITY ATTN: FINANCIAL AFFAIRS
414 N MERIDIAN 414 N MERIDIAN
NEWBERG, OR 97132 NEWBERG, OR 97132
PHONE: 503-554-2010 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 06/30/2015 $25.02
Specifics: 1 ea Water Closet 06/30/2015 $25.02
1 12%State Surcharge- 06/30/2015 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 06/30/2015 $22.46
Type of Const: Plumbing
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 que •OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: Permittee Signature: A. i
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
Building Fixtures " ' k £ ,a .' ,i FOR OFFICE USE ONI.I
City of Tigard Received 3
' 13125 SW Hall Blvd.,Tigard,OR 97223 DateB : 6 Permit No.: �L�apJ� �
°� I Phone: 503.718.2439 Fax: 503.598.1960 Plan "�" Other Permit No.:,c4 5 t,9
Inspection Line: 503.639.4175 y tL �/ �AGy
I I G A R p P ! + +_ a, a ,. Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov ? Notified/Method: Supplemental Information
a
TYPE' a,E , t.•❑New construction ❑Demolition For special information use checklist.
Description [ Qty. 1 Ea. I Total C"j
❑Addition/alteration/replarrmrnt ❑Other. New 1-2-family dwellings(includes 100 ft.for each utility comection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ti
di
El 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 v?
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 12, S J10,1 ` t It kg; Catch Catch basin or area drain 18.76 .
V Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1\6105,C.0 I).N7 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: ; 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
b ,tATE r-C%v%. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER , I ik ❑ TENANT Expansion tank 12.51
Name: Cal E.Fb�U14% Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: i\0\ 1,..\ \I 1`
Garbage disposal 25.02
City/State/ZIP: I CfL Hose bib 25.02
Phone:(5(j ) SSA .� tq Fax:(50;) SSA.2,44)(f\ Ice maker 12.51
1:1 APPLICA .Q CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory / 25.02
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
CONTRACTOR i
Water heater 37.52
Business name: D(,v/ )E'
Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7a.st)
g 1 T� Plan review (25%of permit fee)
CCB Lic.: - Plumbing Lic.no.: 6/4 .]
. State surcharge(12%of permit fee) 7.70
Authorized signature ' t�,� TOTAL PERMIT FEE I 2
Print name: v9� t Date: (� ' \i This permit application expires if a permit is not obtained within Igo days
"�t�t_� �� W� OV JV after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46I6T(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-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' 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 `l uatiojj Permit F_ee'_
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
OI19 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*. . . )� i2 t a, ± t,�!,I i i i
maw 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
CI Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
CI CCar wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial CI 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"
3" Isometric or Riser Dia ram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the •ualifications 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: -Lav/Bar non-food related j
-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 7 plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 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
12753 SW 68TH AVE, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
FAIL
PLM2015-00203
George Heimos
1. Hot required on left side. 415.0
2. 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
12753 SW 68TH AVE, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00203
George Heimos
Violation Summary:
Inspector Contractor