Permit CITY OF TIGARD PLUMBING PERMIT
,� Permit#: PLM2016-00079
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/16/2016
TIGARD Parcel: 2S110AC01300
Jurisdiction: TIGARD
Site address: 11430 SW BULL MOUNTAIN RD
Project: Bull Mountain Heights Apartments Subdivision: 2003-083 PARTITION PLAT Lot: 2
Project Description: Adding(2)catch basins and 300 ft.of storm sewer.
Contractor: KODIAK PLUMBING Owner: ANDREWS MANAGEMENT LTD
12030 SE MT SCOTT BLVD 5845 JEAN RD
PORTLAND, OR 97266 LAKE OSWEGO, OR 97035
PHONE: 503-756-4696 PHONE.
FAX:
FEES
Quantity Description Date Amount
2 ea Catch Basin or Area Drain 02/16/2016 $37.52
Specifics: 300 If Storm Sewer 02/16/2016 $137.58
1 12%State Surcharge- 02/16/2016 $21.01
Type of Use: MF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $196.11
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:• �_ Permittee Signature:
e"..1").7.0C;
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
Cityof Tigard Received ii/ �/y� e
�r�`� Date/By: o i6 ill �_ Pennit No.: /N't�of/_ -tri
,71 111 13125 SW Hall Blvd.,Tigard,OR 97223 Vv I� Plan Review 1� (�(�t1
Phone: 503.718.2439 Fax: 503.598.19x0` Q 1 f� �0`� Date/By: Other Permit No.: ( �G/s``_-Q0jq3
Inspection Line: 503.639.4175 P 1 r to Ready/By: sur s: I ® See PageeNN2 for
1 Ili.\1:1> Internet: Line: gard-or..41 �� / ; , g
�{ P�,� i d/Method: Supplementallnformation
l
-, .1'1' ; 4 :; ' T'IYPE OF WORD '.``�i 1 .. FEE*$C#IE LE
❑New construction 0 Dettlgr" For special information use checklist.
Description I Qty. I Ea. Total
'Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
.. _ CATEGORY OF-coN twci'ioN SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building [p7Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: l LI-5b S (G1 o l), l 4Duir pn LV Catch basin or area drain 1 18.76 37,5
Drywell,leach line,or trench drain 18.76
City/State/ZIP:' P- T79c).112� Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:v",li/� xJ . 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.:3.a)) 3 Page 2 3CO
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OP'
-WORK Backwater valve 12.51
.� Clothes washer 25.02
p
f QL .) 1 U LJ'` t v/4A- &er5 i t ) tot-(E7 Dishwasher 25.02
30x` OE- -1-00,- sA ¶jteas&e.42 Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: 1\31-‘1
Floor drain/floor sink/hub 25.02
Address: I'J O'T +,
C Hp In Garbage disposal 25.02
City/State/ZIP: y4�p /.f1 C I' -1 '_U-2___ Hose bib 25.02
Phone:(61,? 2 0001 / +� Fax:( ) Ice maker
/ 12.51
'U APPLICANT ' CONTACT PERSON Interceptor/grease trap 25.02
Business name:C,/J_��y.r�v� CD- rig/�-,-,�(
Medical gas(value:$ ) Page 2
Contact name: ` ���V`` ter`` '' �' 2. l Primer 12.51
`A�� y I . \ t`N Roof drain(commercial) 12.51
Address: 252'1 2�"1 Sink/basin/lavatory 25.02
City/State/ZIP:acre4 n \(-1 0-1/._ C 009 Solar units(potable water) 62.54
Phone:( -14:5S) (i-IZ Ica `�Il 9 Fax::( )I Tub/shower/shower pan 12.51
E mall 0m , Urinal 25.02
Water closet 25.02
" ;' '": "'� .WNT C�i#1.7,1-tw Water heater 37.52
Business name: y_..cb' � QbAk.,11\2,E) Water piping/DWV 56.29
Address: 1311 LA-)110-r-02._ EFT- NI-E--- Other: 25.02
City/State/ZIP: Gj �� ,/� (512-� C/ 7 l Subtotal''(7.5.10
Phone: 3 3 4 ,-W5� Minimum permit fee: $72.50
(�j ) Fax:( )
CCB Lie.: TL22:2), Plumbing Lic.no.: - CFI Plan review (25%of permit fee)
State surcharge(12%of permit fee) /
Authorized signatuTOTAL PERMIT FEE /94,„//
Print name:( NOSH Z'a.i f>��� Date: 24 (6/ '5- This permit application expires if a permit is not obtained within 180 days
�„i`� t V tV tl after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:Building Permits PLMU-PermitApp.doe 10 01 09 440-46161(1002 COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site;Utilities Qtr. Fee(ea) Total S4uare�Pootage. Permit Fee:
Footing drain-I"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 6•7 t f 7,201 and greater $327.54
Sewer-each additional 100' 37.52 7S 0/l
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuaiitm;
$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
D#her Inspections or Fees Qty. Fee(et0 Tom 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: l 37.Sr
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*. Plan Review for Plumbing Installations
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 ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
IDCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR9 I 8-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
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 Diagram
El Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications 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: -fav/Bar non-food related
-Bradley
-Coin/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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:ABuilding\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
11430 SW BULL MOUNTAIN RD, TIGARD, OR,
97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00079
Don Sylvester
Violation Summary:
Inspector Contractor