Permit '..'..4.-.:•:- CITY OF TIGARD PLUMBING PERMIT
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Permit#: PLM2015-00400
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/24/2015
TIGARD 13125 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD
Project: Providence Scholls Medical Center 'Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Installation of backflow on cold water supply to heating water,2nd floor mechanical room behind boiler.
Contractor: EVOLUTION PLUMBING LLC Owner: PROVIDENCE HEALTH SYSTEM-OREGO
7715 NE 33RD DR SUITE D ATTN: REAL ESTATE&CONSTRUCTION
PORTLAND, OR 97211 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-655-3388 PHONE.
FAX: 503-305-8373
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/24/2015 $31.27
Specifics: 1 12%State Surcharge- 11/24/2015 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 11/24/2015 $41.23
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 stions to•► C by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: / / Permittee Sig ature:
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Call 503.639.4175 by 7:00 a.m.for the next available' pection 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.
From: 1/1812015 09:35 #051 P.001/001
Plumbing PermitAp �VE
Building Fixtures ((�, . FOR OFFICE..USE. O L\ ,•
Ci of Tigard N O V 1 O 2015 Received y
g Date/By. // /
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..° Permit No.: 11.1,20/'�6tao ifoD_I
II
• 13125 SW Hall Blvd.,Ti rd OyR%9�722-3y GAR Plan Review CCC
Z Phone: 503.718.2439 �5ty3.eZYzt.f 96Q A.! Other Permit No.:
Date/By:
Inspection Line: 503. 1 5 -
TIGARD Internet www.ti and-or, ov��''`"G olvISI®� DateReady/By: ^ loris SeePage2for
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tion
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:........:...,.,,.:- ... ..... .:...... TYPE F..1V
For special information use checklist.
0 New construction 0 Demolition
Description LQty. [ Ea. I Total
®Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
-
,R ONSTRUGTIONi_;''sv:'�<;:::::;<•::.;;t;=,=s'' rax>'- SFR(I)bath 312.70
0 1-and 2-famil
y dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
0 Master builder
0Other:
Fire sprinkler( sq.ft.) Page 2
"r::..:;.:..':":.: ",,JOB: IEItVFORMATI"ON'ANIACATIOV .%t:.`:�-'=:-`,.i`:=:-',, " ''°.
site utilities:
Job site address:12442 SW Scholls Ferry Rd Catch basin or area drain 18.76 ^�_
Drywell,leach line.or trench drain 18.76
City/State/ZIP: Portland,OR 97223
Footing drain Ino.linear ft.: 1 Page 2
Suite/bldg./apt.no.: 1 Project name:Prov Scholls 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
:;;s; ;.a. ;,::'::..:;_._.,:.:..... .........TI ....,.,. ::>::.: ;,„ Backwater valve 12 51
DESCRIPTION*WORKx;-.2fm ;r:;::i_: ;:;::.
Install new backflow
.:,,._,:..;. .,.....,,..::..:.::...:.:......:::;,.:.....,�,.::...-.....,.,:.:.�,,.:- . :..,., :, ::- Clothes washer 25.02
w on cold water supply to heating water Dishwasher 25.02
2otl floor mechanical room behind boiler Drinking fountain 25.02
Ejectors/sump 25.02
:,.r.:'. .. . ..... ..... , A. ..:�c:e ':;,,-` Expansion tank 12.51
®;::RROPE$TY..O,WNER:^c;"._,....... ........_....,.,. . . . , >,
,, TENANT.":'::... ;.;<::,
Name:Providence Health Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:4400 NE Halsey St,Bldg 2,Suite 190
Garbage disposal 25.02
City/State/ZIP:Portland,OR 97213 Hose bib 25 02
Phone:( 1 Fax:( ) Ice maker 12.51
APPLICANT ','-.: '-'- :.: A... . .-... ........
:.. --•_. ;CONTACT=PERS Interceptor/grease trap 25.02
Business name:Evolution Plumbing Medical gas(value:S ) Page 2
Primer 12.51
Contact name:Suzanne Postula
-
Roofdram(commercial) 12.51
Address:7715 NE 33'Drive, Suite D
Sink/basin/lavatory 25.02
City/State/ZIP:Portland,OR 97211 Solar units(potable water) 62.54
Phone:(503)655-3388 Fax::(503)305-8373 Tub/shower/shower pan 12.51
E-mail:suzanoe.postula@evoplumbing,oet Urinal 25.02
C Watercloset
25.02
-- ` ONTT,OR: ; -
. - Water heater 37.52
Business name:Evolution Plumbing Water piping/DWV 56.29
•
Address: _ Other: 25.02 -
City/State/ZIP: Subtotal 31.27
Phone:( ) Fax ( ) Minimum permit fee: $72.50 72.20
P8$31 Plan review (25%of permit fee)
CCD Lic.: 189876 Plumbing Lic.no.JBtS''�
// n �t State surcharge(12%of pennit fee) 8.67
Authorized signature. !U¢?�/l,, /� TOTAL PERMIT FEE
Print name:Suzanne Postula VVV �Wi Date: 11/18/2015
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 Boir��•/�
l-Buddme Per.ntsPLMC-PermitApp doc 1001'00 440-151(3T(10.02:COM WEB)