Permit , „ CITY OF TIGARD PLUMBING PERMIT
It COMMUNITY DEVELOPMENT Permit#: PLM2015-00322
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2015
Parcel: 2S 102AD03000
Jurisdiction: Tigard
Site address: 12850 SW ASH AVE
Project: The Ash Apartments Subdivision: BURNHAM TRACT Lot: 5
Project Description: Site utilities for 2 apartment buildings and joint parking lot:(18)catch basins/area drains,(2)manholes,(61)rain
drain connectors,271'of sanitary sewer lines,2,879'of storm sewer lines&373'of water service lines.
Contractor: WESTECH CONSTRUCTION INC Owner: TIGARD, CITY OF
2204 NE 194TH AVE 13125 SW HALL
PORTLAND, OR 97230 TIGARD, OR 97223
PHONE: 503-777-7000 PHONE:
FAX:
FEES
Quantity Description Date Amount
18 ea Catch Basin or Area Drain 11/12/2015 $337.68
Specifics: 2050 If Footing Drain 11/12/2015 $800.43
2 ea Manholes 11/12/2015 $37.52
Type of Use: MF 271 If Sanitary Sewer 11/12/2015 $137.58
Class of Work: NEW 2879 If Storm Sewer 11/12/2015 $1,113.10
Type of Const: 373 If Water Service 11/12/2015 $175.10
Occupancy Grp: 1 Plan Review 11/12/2015 $936.44
Stories: 6 ea Info Process/Archiving-Lg 11/12/2015 $12.00
$2.00(over 11x17)
1 12%State Surcharge- 11/12/2015 $449.49
Plumbing
61 ea Rain Drain Connector 11/12/2015 $1,144.36
Total $5,143.70
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 1.800.332.2344.
Issued By: J/ Permittee Signature: At
Call 503.639.4175 by 7:00 a.m.for the next available inspection te.
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.
v
Plumbing Permit Application
Site Utilities r�j FOR OFFICE USE ONLY
Iii E {�IVE� Received
City of Tigard w/1LJ PcrmitNo.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : ��� o�(S UU i:
I Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.: oci A20 C
Inspection Line: 503.639.4175 S E P 2 2 2015 Date Ready Juris: ® See Page 2 for
I IGARD Internet: www.ti ard-or. ov y H
g g Notified/Method: !C)-�/. 2C.'5 Supplemental Information
TYPE OF WORK.:ff 9ian!:, FEE* SCHEDULE
®New construction nt�r For special information use checklist
* fEF7 TU''"'°`'.. Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement ❑Other: 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
SFR(3)bath 500.32
❑Accessory building ® 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: 12850 SW Ash Avenue Catch basin or area drain 18 18.76 337.68
Drywell,leach line,or trench drain 0 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear IL:2050) Page 2 800.43
Suite/bldg./apt.no.: I Project name:Burnham&Ash Apartments Manufactured home utilities 0 50.03
Cross street/directions to job site:SE corner of Burnham Street&Ash Avenue Manholes 2 18.76 37.52
Rain drain connector 61 18.76 1144.36
64
Sanitary sewer(no.linear ft.: 7/ Page 2 JA0:0.613'1'
ID
Storm sewer(no.linear ft. 3-01-A 9 Page 2 94 1v115'
Water service(no. ?7?j Page 2 175.10
Subdivision: Lot no.: Fixture or item:( _�-4��io+•-
Tax map/parcel no.:2S102AD 02800,02900,03000 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Site Utilities to support plumbing and storm sewer for both Buildings 1 &2. Dishwasher 25.02
Plumbing Permit will be applied for by Tradesperson as Deferred Submittal. Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank _ 12.51
Name:Premium Property-Tigard LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1015 NW 111h Ave.
Garbage disposal 25.02
City/State/ZIP: Portland,OR 97209 Hose bib 25.02
Phone:(503)226-1972 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:SERA Design and Architecture,Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Josh Cabot
Roof drain(commercial) 12.51
Address:338 NW 5th Avenue Sink/basin/lavatory 25.02
City/State/ZIP: Portland,OR 97209 Solar units(potable water) 62.54
Phone:(503)445-7898 Fax::( ) Tub/shower/shower pan 12.51
E-mail:joshc @serapdx.com Urinal 25.02
t Water closet 25.02
CONTRACTOR
�, / / �<< Water heater 37.52
Business name: Vv•eSt'eLv, L i 0 ,, 1'(,((A--) (V -0 'lL , Water piping/DWV 56.29
Address: Qu Js E (G1({#( /'y( Other: 25.02 3 _is,7 7
City/State/ZIP: f pi-�akid 6Q q 7 a 30 Subtotal t l: _
3 /77- o-�
Minimum permit fee: $72.50 k If
Phone:( ) 7 Fax:( ) W Plan review (25%of permit fee) 884-6
a 61 t' '� �/�3/1� --sg ,00,n � �
CCB Lic.: Plumbin
�'� State surcharge(12%of permit fee) Iitick +�
Authorized signatur�- 7//`77 TOTAL PERMIT FEE 452339
Print name:Josh Cabot Date:9/22/2015 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.
L\Building\Perm its\PLMU-PennitApp.doc 10/01/09 440-4616T(I0/02/COM/WEB) t[//!✓ 1i 3, To
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- P 100' 1 , 50.03 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 20 37.52 750.40 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer- 1st 100' 1 62.54 62.54 7,201 and greater $327.54
Sewer-each additional 100' 1 37.52 37.52
Water Service- 1st 100' 1 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' 3 37.52 1 12.56
Valuation: Permit Fee: •
Storm&Rain Drain- 1st 100' 1 62.54 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 23 . 37.52 862.96 $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) 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: 2001.1
Other Fixtures:
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
Fixture Type for Replace/ Plan Review for Plumbing Installations
Work Performed: Capped Added Relocate
Baptistry/Font Plan review is required for any of the following.
Bath Tub/Shower Please check all that apply.
-Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and
Car Wash -Each Stall greater,except systems designed and stamped by licensed
-Drive Thru engineer.
Cuspidoi-/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure
Dishwasher -Commercial as defined in OAR918-780-0040.
-Domestic ❑ Medical gas and vacuum systems for health care facilities.
Drinking Fountain ❑ Any multipurpose fire sprinkler system.
Eye Wash ❑ Any complex structure as defined in OAR918-780-0040.
Floor Drain/sink -2"
3" Submit 2 sets of plans with any of the above.
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage -Domestic-non-food - _-
Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings
-Commercial-food related that meet the qualifications above.
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station Comments regarding fixture work:
Shower -Gang
-Stall
Sink/kav -Non-food related
-Bradley
-Commercial-food related
-Service •
Swimming Pool Filter
Washer-Clothes
Water Extractor *Note: If the fixture work under this permit results in an
Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
P:\Architecture\1503004\C-Design Coordination\Deliverables\2015-09.22ite Utilities Permit Set\2015-09.1 1 Site
Utilities_Plumbing_PermitApp.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12850 SW ASH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2015-00322
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Corrections for site utilities are complete - plumbing final approved.
Violation Summary:
Inspector Contractor