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Permit ,w n CITY OF TIGARD PLUMBING PERMIT 1111 3 COMMUNITY DEVELOPMENT Permit PLM2015-00121 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/07/2015 Parcel: 1 S134BC00300 Jurisdiction: Tigard Site address: 12266 SW SCHOLLS FERRY RD Project: Pacific Dental Services,LLC Subdivision: GREENWOOD TERRACE CONDO Lot: 17 Project Description: Plumbing for TI:Installing(1)backflow preventer,(1)backwater valve,(1)expansion tank,(1)water heater,(1) plaster trap,and(1)water piping;Capping(2)sinks and(2)water closets;Adding(1)2"floor drain,(6)sinks,(1) clothes washer,and(2)water closets. Medical gas also included in scope of work. Contractor: CASCADE PLUMBING CO Owner: FW OR-GREENWAY TOWN CENTER LLC 2416 N HAYDEN ISLAND DR ONE INDEPENDENT DRIVE, SUITE 114 PORTLAND, OR 97217 JACKSONVILLE, FL 32202 PHONE: 503-603-4709 HONE: 503-289-7095 FAX: 503-283-9514 FEES Quantity Description Date Amount 1 ea Backflow Preventer 07/06/2015 $31.27 Specifics: 1 ea Backwater Valve 07/06/2015 $12.51 1 ea Clothes Washer 07/06/2015 $25.02 Type of Use: COM 1 ea Expansion Tank 07/06/2015 $12.51 Class of Work: ALT 3 ea Fixture/Sewer Cap 07/06/2015 $75.06 Type of Const: 1 ea Floor Drain/Floor Sink/Hub 07/06/2015 $25.02 Occupancy Grp: 1 ea Medical Gas 07/06/2015 $284.02 Stories: 6 ea Sink 07/06/2015 $150.12 1 ea Water Piping/DWV 07/06/2015 $56.29 2 ea Water Closet 07/06/2015 $50.04 1 ea Water Heater 07/06/2015 $37.52 25 Misc Other Fee 07/06/2015 $25.02 1 Plan Review 07/06/2015 $196.10 1 12%State Surcharge- 07/06/2015 $94.13 Plumbing Total $1,074.63 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•• . .. C by calling 503.232.1987 or 1.800.332.2344. Issued By: I /) 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. t. Plumbing Permit Applicatio Building Fixturesit i l `t ! FOR OFFICE USE ONLY City of Tigard Received �/ i r"-1i Permit No � Gv/ : • 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: � CJ � `(/� a 11 III Plan Review ��s Phone: 503.718.2439 Fax: 503.598.1960 Date/B 4/'Y//.s G/. Other Permy�'L3.%�,;?1/..�'1i 006 Inspection Line: 503.639.4175 ( .7 ', " 1 Date Rea B > ^,�,1!')luris: ® See Page 2 for I I C;A R D Internet: www.ti ardor. ov t ,v, a Notified/Method: It„. `�' pp 8 g g )s n� Notified/Method: Supplemental Information ❑New construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total z\ ❑Addition/alteration/replacement ®Other:TI New 1-2-family dwellings(includes 100 ft.for each utility connection) SFR(1)bath 312.70 (1 • ❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 Accessory SFR(3)bath 500.32 ❑ ry buildin g ❑Multi-family l/, Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler L_sq.ft.) Page 2 1ka 1 Site utilities: Job site address: 12266 SW SCHOLLS FERRY RD Catch basin or area drain 18.76 \ J. ell,leach line,or trench drain 18.76 City/State/ZIP:TIGARD,OR 97223 v �('� ` Footi,g drain(no.linear ft.:h Page 2 Suite/bldg./apt.no.:180 I Project name:TBD(DENTAL OFFICE) KL(/r U O J Man actured home utilities 50.03 Cross street/directions to job site: �� Man oles 18.76 t-U Rd drain connector 18.76 i tt/ M 1 itary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) I Page 2 Subdivision: OLot no.: Fixture or item: Tax map/parcel no.: /S 43yQGeo.59O Backflow preventer 1 _ 31.27 DESCRIPTION OF WO' Backwater valve 1 12.51 Clothes washer 1 25.02 VACCUM/AIR/WATER TO DENTAL CHAIRS,PLUMBING DISTRIBUITON, Dishwasher 25.02 TWO TOILETS,SINKS,WASHER/DRYER, Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENANT Expansion tank 1 12.51 Name:REGENCY CENTERS Fixture/sewer cap 25.02 Floor drain/floor sink/hub 1 25.02 Address:5335 SW MEADOWS,SUITE 295 Garbage disposal 25.02 City/State/ZIP:LAKE OSWEGO,OR 97035 Hose bib 25.02 Phone:(503)603-4709 Fax:( ) Ice maker 12.51 Ei ® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02 a89,0_r Business name:PACIFIC DENTAL SERVICES Medical gas(value:$1 .) : =� Page 2 i• Primer 12.51 Contact name:BRANDON WEBB Roof drain(commercial) 12.51 Address:2044 CALIFORNIA AVE. Sink/basin/lavatory 6 25.02 City/State/ZIP:CORONA CA 92881 Solar units(potable water; 62.54 Phone:(951)582-5758 Fax: :(714)388-3951 Tub/shower/shower pan 12.51 E-mail:webbB @PACDEN.COM Urinal 25.02 Water closet 2 25.02 CONTRACTOR„! T G I Water heater 1 37.52 Business name: �1� J` Lt,el-t /Ai Water piping/DWV 1 56.29 Address: 9tI/ /J. Arty-) kJ /`a2 f}A.)1) .7 Other:PLASTER TRAP 1 25.02 City/State/ZIP: rch /)2 972/7 Subtotal Phone:6)J;) 01-.S' q_ 7 o 9 Fax:( ) Minimum permit fee: $72.50 CCB Lic.: / 1-g 5 Plumbing Lic.no.:0 V 9./,pi; Plan review (25%of permit fee) t,..._ State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:BRANDON WEBB Date:4-20-15 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. 1:1 BuildingtPermits\PLMU-PermitApp.doc 10/0l/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-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 S stems: Water Service-each additional 100' 37.52 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 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 Y 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 Fixturrz'pe j I (1 Fixture Type for Replace/ Plan review is required for of the following.Performed: Capped Added Relocate Q any ow g' Bapustr},I kont Please check all that apply. Bath Cub/Shower El 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" 3 ✓ 1 f Submit 2 sets of plans with any of the above. -3" Car Wash Drain Isometric or Riser Dia ram Garbage Domestio-non-food ❑ Isometric or riser diagram is required for new buildings Disposal -Domestic-food related that meet the •ualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rcc.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related 4 `� 2 ,// -Bradley -_ -Commercial-food related -Service Swimming Pool Filter - *Note: If the fixture work under this permit results in an Washer-Clothes 1 v/ Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet 2 ✓ fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: C:\Users\Dianna\AppData\Local\Microsoft\Windows\Temporary Internet!iles\Content.Outlook\KCQ39QIQ\PLMF-PermitApp.doc i43. Plumbing Permit Application Building Fixtures RECEIVEP FOR OFFICE. USE ONLY City of Tigard Received`, g DateB 1 Permit No.: sib:• ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 DateBy:Ci6/O?f/,-' �/� �witNo.:0 /5-Mr 7 TIGARD Inspection Line: 503.639.4175 APR 21 2015 Date Ready/By: I , Jude: 110 See Page 2 for Internet: www.ttgard-or.gov Notified/Method: ' , I Supplemental Information TYPE OF W t f i FEE* SCHEDULE ❑New construction 't campla1DIVl I , For special information use checklist Description Qty. Ea. Total ❑Addition/alteration/replacement ®Other:TI 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 ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building SFR(3)bath 500.32 g ❑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: 12266 SW SCHOLLS FERRY RD Catch basin or area drain 18.76 Drywell,leach line,or trenc• drain 18.76 City/State/ZIP:TIGARD,OR 97223 Footing drain(no.line: .: ) Page 2 Suite/bldg./apt.no.:180 I Project name:TBD(DENTAL OFFICE) Manufactured home . ilities 50.03 Cross street/directions to job site: Manholes 1 8.76 Rain drain co.. ector 18.76 Sanitary -•er(no.linear ft.:_) Page 2 Storm wer(no.linear ft.: ) Page 2 Wa service(no.linear ft.: ) Page 2 Subdivision: Lot no.: F ture or item: Tax map/parcel no.: :ackflow preventer 1 31.27 DESCRIPTION OF WORK Backwater valve I 12.51 Clothes washer V 1 25.02 VACCUM/AIR/WATER TO DENTAL CHAIRS,PLUMBING DISTRIBUITO Dishwasher 25.02 TWO TOILETS,SINKS,WASHER/DRYER, Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENA Expansion tank 1 12.51 Name:REGENCY CENTERS L p Fixture/sewer cap ' 25.02 Address:5335 SW MEADOWS,SUITE 295 [� �\ Floor drain/floor sink/hub / 1 25.02 U Q( Garbage disposal 25.02 City/State/ZIP:LAKE OSWEGO,OR 97035 V Hose bib 25.02 Phone:(503)603-4709 Fax:( ) t� Ice maker 12.51 ® APPLICANT ® •NTACT PF�k$ON Interceptor/grease trap 25.02 Business name:PACIFIC DENTAL SERVICES K/ \\ Medical gas(value:S Kj ) Page 2 229.51 [, R Primer 12.51 Contact name:BRANDON WEBB L Roof drain(commercial) 12.51 Address:2044 CALIFORNIA AVE. Sink/basin/lavatory 6 25.02 City/State/ZIP:CORONA CA 92881 / Solar units(potable water) 62.54 Phone:(951)582-5758 'Fax::( 14)388-3951 Tub/shower/shower pan 12.51 E-mail:webbB@PACDEN.COM Urinal 25.02 Water closet 2 25.02 CONT' CTOR Water heater 1 37.52 Business name:TO BE DETERMINE% Water piping/DWV 1 56.29 Address: Other:PLASTER TRAP 1 25.02 City/State/ZIP: . Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lie.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:BRANDON WEBB Date:4-20-1S This permit application expires if a permit is not obtained within I80 days after it has been accepted as complete. 'Fee methodology set by Tri-County Building Industry Service Board. 1-\Building\Permits\PLMU-PermitAppdoc 10/01/09 440-4616T(10/02/COM/WEB) 6 George Heimos From: Webb, Brandon <webbb @pacificdentalservices.com> Sent: Friday,June 05, 2015 6:32 AM To: George Heimos Subject: Pacific Dental BUP2015-00117 Follow Up Flag: Follow up Flag Status: Flagged Hi George, below is the cost of equipment and piping: Compressor: $5500 Vacuum pump: $4200 Model Trimmer: $400 Backflow: $300 Piping: $8,328 Total: $18,728.00 /(-74-71 GAS /j 7,2? /Si:AI,or-c) Ale, cc? Thanks, I0 0-71-0 t Brandon et PACIFIC 41 DENTAL SERVICES` Brandon Webb I Project Designer I GC" -- Pacific Dental Services T 951.582.5758 F 714.388.3951 E webbb @pacden.com Autodesk'Revit` Architecture PCS r✓) 0 Certified Professional '� 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 12266 SW SCHOLLS FERRY RD, TIGARD, OR, 97223 Commercial - Plumbing 320 Plumbing rough-in FAIL PLM2015-00121 George Heimos 1. Work not completed, no inspection made. Recall when ready. 103.5.4 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 12266 SW SCHOLLS FERRY RD, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2015-00121 George Heimos 1. Provide hot water at mop sink. 502.5 2. Provide clothes washer trim covers. 310.3 3. Re-caulk mop sink. 408.2 4. Complete air vac labels in mechanical room. 5. Provide identifying permanent labels on back ﬂow devices when more than one is located in the same area. 603.3.1 6. Recall inspection when air and vacuum piping is completed at chairs and equipment. 103.5.4 7. Recall inspection when corrections have been completed. Re-inspection required. 103.5.6.1 Backﬂow test results provided 1/2" Watts model LF009QT serial number 7121/Watts model LF009M2QT serial number 062167 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 12266 SW SCHOLLS FERRY RD, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2015-00121 George Heimos 1. Complete correction number ﬁve from previous inspection, all else ok 2. Recall inspection when completed. Violation Summary: Inspector Contractor