Permit CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit#: PLM2015-00391
13125 SW Hail Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/26/2016
Parcel: 2S 102AD02900
Jurisdiction: Tigard
Site address: 12790 SW ASH AVE
Project: Burnham&Ash Apartments Subdivision: BURNHAM TRACT Lot: 5
Project Description: Building 2-Interior plumbing for(26)apartment units and(2)retail spaces. (Retail spaces=(2)sinks and(2)water
closets)
Contractor: WOLCOTT PLUMBING Owner: PREMIUM PROPERTY-TIGARD LLC
1075 W HISTORIC COLUMBIA RIVER HWY 1015 NW 11TH AVE, STE 243
TROUTDALE, OR 97060 PORTLAND, OR 97209
PHONE: 503-667-1781
PHONE: 503-226-1972
FAX: 503-667-9891
FEES
Quantity Description Date Amount
2 ea Backflow Preventer 01/26/2016 $62.54
Specifics: 26 ea Clothes Washer 01/26/2016 $650.52
26 ea Dishwasher 01/26/2016 $650.52
Type of Use: MF 1 ea Ejectors/Sump 01/26/2016 $25.02
Class of Work: NEW 1 ea Expansion Tank 01/26/2016 $12.51
Type of Const: 6 ea Floor Drain/Floor Sink/Hub 01/26/2016 $150.12
Occupancy Grp: 5 ea Hose Bib 01/26/2016 $125.10
Stories: 6 ea Primer 01/26/2016 $75.06
2 ea Roof Drain(Commercial) 01/26/2016 $25.02
26 ea Sink 01/26/2016 $650.52
41 ea Lavatories 01/26/2016 $1,025.82
32 ea Tub/Shower/Shower Pan 01/26/2016 $400.32
40 ea Water Closet 01/26/2016 $1,000.80
2 ea Water Heater 01/26/2016 $75.04
1 Plan Review 01/26/2016 $1,232.23
1 12%State Surcharge- 01/26/2016 $591.47
Plumbing
Total $6,752.61
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: rte'/ Permittee Signature:
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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.
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�'lambin2 Permit Applicatw' .. Ki V+'I P t)We a61 �
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Building Fixtures
Cl of Ti ar(� Received permit No.: 34�
13125r SW Hall Blvd.,Tigard, Plan Reviewf `r
Phone: 503.718.2439 Fax: 503V8'' C rf €a Other Permit NotIt .:
Inspection Line: 503.639.41 11F6l1 !� t� E6 Date Read B Juns: ® See Page 2 for
Internet: www.ti ard-or. ov �r 'S t)�!jP 1.r /i Ready
y Supplemental Information
g g �F K Notified/Method: 3 ��(t-v'J
TYPE OF WORK- UPIFSE* SCHEDULE -
New construction ❑Demolition For special in ormadon 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(1)bath 312.70
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
F1Accessory building Multi-family SFR(3)bath 500.32
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:\D,o,o �, Catch basin or area drain 18.76
`\ �` �, 22� Drywell,leach line,or trench drain 18.76
City/State/ZIP: ^�
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
OO r( Rain drain connector 18.76
t
it I Sanitary sewer(no.linear ft.:_) Page 2
RT. Storm sewer(no.linear ft.:_) Page 2
` `J Water service(no.linear Page 2
Subdivision: Vti , E'' t Lot no.: Fixture or item:
Tax map/parcel no.: ';Cf Backflow preventer 31.27 S
DESCRIPTION OF WORK Backwater valve 12.51 --
Clothes washer 25.02 S U,
Dishwasher 25.02
` Drinking fountain "' 25.02 --
Ejectors/sump 25.02 OZ
PROPERTY OWNER ❑ 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 IU
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT CONTACT PERSON Interceptor/grease trap 25.02 -
Business name: Medical gas(value:$ ) Page 2
` Primer 12.51 7S,(A-
Contact name: e_Xss7
` Roof drain(commercial) 2 12.51 ;c-Z
Address:1c'�_ �1, ��S�CdC�L_CC�\l1.W��C\ � j + Sink/basin/lavatory 25.02 Ia7(G ;3c{
City/State/ZIP: . . 0� �� dlC?d Solar units(potable water) 62.54 -
Phone:(Sc3) -(-(� 3pZ Fax::(�3 )4' (o�-C(,8 Ck Tub/shower/shower pan Z 12.51 L/(�c,
E-mail:.-� .C�, --��_�•���� ����� t L� Urinal - 25.02
CONTRACTOR Water closet L1O 25.02
Water heater 37.52
Business name: ( � Water piping/DWV 56.29
Address: ellOther: 25.02
City/State/ZIP: _ Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 -'
IT
CCB Lic.: ,1 � Plumbing Lic.no.: - Z{ \ -_ Plan review (25%of permit fee) ,
State surcharge(12%of permit fee) r
Authorized signature: x,_� TOTAL PERMIT FEE
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This permit application expires if a permit is not obtained within 80 days
Print nameV1\ Date:11-t
after it has been accepted as complete.
*Fee methodology set.4Tri-County Building Industry Service Board.
I\Building\Permits\PLMU-PermitApp doc 10/01/09 440-4616T(10/02/C0M/WEB) it�J ^ 7 h,
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Supp ession Systems:
7$327.54
00
00
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 27,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-I st 100' 62.54 0 1
7,201 and greater
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
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 faction thereof,to
�a4X 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: E)U_I t_71
t,)(ID cp, 40-IJ
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 • e 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 El Any new commercial building with water service 2"and
Bath: -Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
-Drive Thru as defined in 0AR918-780-0040.
Cuspidor/Water Aspirator El Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial El Any multipurpose fire sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Dunkin Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3"
4"
-Car Wash Drain El Isometric or riser diagram is required for new buildings
Garbage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Reffig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-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-Qothes fees assessed for the sewer increase must be paid before the
Water Extractor
lumbin
Water Closet-Toilet pg permit can be issued.
Urinal
Other Fixtures:.
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13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
12790 SW ASH AVE, TIGARD, OR, 97223
Record Type:
Commercial - Plumbing
Inspection Type:
399 Plumbing final
Result:
PASS- NoCofO
Comments:
Tel: 503.718.2439
Inspection Date:
Record ID:
PLM2015-00391
Inspector:
Don Sylvester
1. Corrections are complete for interior plumbing for bldg # 2 - approved
Violation Summary:
Inspector Contractor