Permit (35) CITY OF TIGARD PLUMBING PERMIT
,111‘ la • •
°' COMMUNITY DEVELOPMENT ' 0 r Permit#: PLM2016 00246
lioDate Issued: 05/09/2016
TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S135CC03300
Jurisdiction: Tigard
Site address: 10050 SW TIGARD ST
Project: Grow Construction-Sewer Reversal Subdivision: GREENBURG HEIGHTS ADDITION Lot: 11
Project Description: Sewer Reversal(50'of sanitary sewer). 5/9/2016: REPRINT permit to add 80'of water service.8/8/16 REPRINT
to add dry well.
Contractor: MIKE PATTERSON PLUMBING Owner: CSC CAP HOLDING LLC
15028 S MITCHELL LN BY GRAY,TIMOTHY
OREGON CITY, OR 97045 22846 SW LODGEPOLE AVE
TUALATIN, OR 97062
PHONE: 503-632-7374 PHONE:
FAX: 503-632-5647
FEES
Quantity Description Date Amount
50 If Sanitary Sewer 05/09/2016 $62.54
Specifics: 80 If Water Service 05/09/2016 $62.54
1 12%State Surcharge- 05/09/2016 $15.01
Type of Use: SF Plumbing
Class of Work: ALT 1 ea Drywell,Leach Line or Trench 08/08/2016 $18.76
Type of Const: Drain
45 Misc Administration Fee 08/08/2016 $45.00
Occupancy Grp:
Stories: 0 12%State Surcharge- 08/08/2016 $2.25
Plumbing
Total $206.10
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•.- .• a 0UNC by calling 503.232.1987 or 1.800.332.2344. /
Issue, BVIy: Permittee Signature:
1
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.
FOR OFFICE USE ONLY–SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it .rovides hel is the review .rocess and res.onse to our .ro'ect.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
11,1 Transmittal Letter
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •
www_tigard-or.eov
DEPT: '
DATE ' i
BUILDING DIVISION
FROM: J U L 27 2016
li
COMPANY:
PHONE: 573 g62 -- �i 8 3
By:, I
RE: o 0 S-D c L/
ite • e e ress � �`-e S
Cs ermit um er
C,.'v hi 'N- 1-HavIt - cOag40
'roject name or su..iision name an. . um.er
ATTACHED ARE THE FOLLOWING ITEMS:
__________ Additional set(s)of plans.
___ Cross sections)and details. Revisions:
___ Floor/roof framing, Wall bracing and/or lateral analysis.
Beam calculations. Basement and retaining walls.
—�_ Engineer's calculations.
Other(explain):
REMARKS: ( / r
Routed to Permit Technician: Date: i _ _ ) �
Due: ; Yes -
No Fee Descri.tion: i
- _ .t__
Amount Due:
Special ���
$ ,
Instructions: - a ',o
Re.rint Permit IIIIIIIIIIIIIIIIIIIIIIIIIIIm.er PE : ���A.
A. .licant Notified: NO anriminDo'ne
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
CITY OF TIGARD t PLUMBING PERMIT
��
: _ COMMUNITY DEVELOPMENT Permit#: PLM2016-00246
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/09/2016
TIGARD 13125
1 S135CC03300
Jurisdiction: Tigard
Site address: 10050 SW TIGARD ST
Project: Grow Construction-Sewer Reversal Subdivision: GREENBURG HEIGHTS ADDITION Lot: 11
Project Description: Sewer Reversal(50'of sanitary sewer). 5/9/2016: REPRINT permit to add 80'of water service.
Contractor: MIKE PATTERSON PLUMBING Owner: CSC CAP HOLDING LLC
15028 S MITCHELL LN BY GRAY, TIMOTHY
OREGON CITY, OR 97045 22846 SW LODGEPOLE AVE
TUALATIN, OR 97062
PHONE: 503-632-7374 PHONE:
FAX: 503-632-5647
FEES
Quantity Description Date Amount
50 If Sanitary Sewer 05/09/2016 $62.54
Specifics: 80 If Water Service 05/09/2016 $62.54
1 12%State Surcharge- 05/09/2016 $15.01
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $140.09
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 0 C by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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.
May. 09.2016 09:02 AM Mike Patterson Plumbing 5036554349 PACE. 1/ 2
Plumbing Permit ApplicatiRECEI V ED Pty 2016/ •--00246
Building Fixtures MAY 0 9 2016
ac«ivod
City Of Tigard
lvd PermitNo,:
-M 13125 SW Hall Blvd.,Tigard,OR '4‘ OF TIGARD P)nxcRe 1� ��i' ���. ��'C�O.?y�
-APlan Review
Phone: 503.718.2439 Fax: 513 'l:•� t Otlwr Permit No.:
1.' c nmerBy:
I t a It 1 Inspection Line: 503.639,4175 NG DIVISION DMO Ready/By: Jude: 65 Scc Pogo 2 for
Internet: www.tigard-or,gov NotiOai/Method: Su r tlementat Intormntlon
h', n t it ti w '.I. ,,f g (I• r`1 h t, A6 Y{t,f t y .1.. '1W,4;''',4' .iP A `te 4 t 4�t 7272 r� } �z, ...,;. ! 1 r.
i��l i'� �}� f t tF'1y!"y"i)11�.� �1 a 97 I 4 r ',`7Yv l no(ty':��iQ•1 ?,r t i P i yt� t'!Ik t:. : ➢ �zl 11 s� . yA Qi.1�i�"*r,'{
.� 1P.. ,, •.'e at• i..i• '''t {',d lltE SI A.:ti )r' .l.M f'�1,, �ra �..v 4 t'.{:6'ri•• 1 t.� BYt .+r L •. .. ,A,,at f,1.
El New construction Q Demolition Far special hiformation use checklist.
Dowdy...ion J Qty I Ga. I Total
®Additio /alteration/repincement 0 Other: New 1-2•fawlly dwellings(Includes (0011,Ibr each utility connection)
'Q'A,l•, 7trxr t l NHr I t- F6 > t t >vwa, A. r*rT r r
` r a a is �' ' "; SFR(I)bath 312.70
4*. 'tardi, tq y�1i' y,' a r< t�} t h- i' 1)dat;r �:,lk .,(
n 1-and 24fomily dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
D Accessory building 0 Multi-family Is'atoh additional bath/kitchen 25.02
El Master builder 0 Other:
": i ;�tt rte ,, r n f t ,p e Tire sprinkler( sq,R,) Page 2
`,' l fla*:47ettA •alt § �4 i�L° . •st�c,,ia"y -7a" fi;''',Ili• Site utilities:
Job site address:10060 SW'Fiord St Catch basin or area drain I8.76
Drywall,leach line,or trench drain 18,76
City/State/ZIP:Tigard,OR --
Footing drain(no.linear ft.: ) Page 2
Suite/bldg/apt.no.: I Project name:Grow-Sewer Reversal + 44/a•-Er Manufactured home utilities 50.03
Cross street/directions to•job site: .SerVice Manholes - 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear R.: ,) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear It: go) I Page 2
Subdivision: I Lot no.: Fixture or item: - r
Backflow preventer 31.27'1ax !ap/paCel no.:
rix. ' f(fyltr v, t i w - tt r {.e i ,I� p.i!aBackwater valve 12.51
!ik:N^" t k4rgit7 a :44.1 ,112. lldale �j,.� d
Clothes washer 25.02
/ ^_ 1// c �, nishwasher 25.02
_ml.J so,. of Wafer serkile &j illi ` Drinkingfountain 25.02
P r-- .I- Ejectors/sump 25.02
vt�.'''1%;.:..:',,1.. .11 ;tt3 4 y,c iJ (1-�� `t x,•rie' ,.I, .?r✓c{, !. l',n'l...• ) i rl,.at • ti, rxpanslan tank 12.51
,f. -• w,t�1lAt ...:Atlx� il ..I�IE'lw ii><�.,WF-t.4 . !'.7‘..‘.• .. ��1 �.'�YJ.�1itt3•i 1C.I , ��d. ,^.1;'It
ta��r
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
Phone:( ) Fax:( ) Ice maker 12.51
'a rt Jr4. T gkI= ts4 i4I n
I Interceptor/grease trap 25.02
rru111n1,.t ., , .a 0rs1,nalll-L3kva•
.7 ...7
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: -
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
r.
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
747,li p.4 w�ro! vp;;;: F � ¢^ 7 4,R� 00Mygtl i - att^,�i ,T W
ater closet 25.02
I .:�," eSle si;;4• an4g1,1� �Me E t�tkk !!i$ tVi\li,,iA Vi�.-1gy ,; Hater
heater 37,52
Business name:Mike Patterson Plumbing Water piping/DWV 56.29
Address;PO Box 850 Other: _ 25.02
City/Statc/ZIP:Gladstone,OR 97027 Subtotal 62.54
Phone:(503)655-4306 Fax:(503)655-4349 .._ Minimum permit fee: $72.50
-
CCB Lie.:81746 Plumbing Lie,no.;3-359P!3 Plan review (25%ofpemtlt tee)
t1 , , Slate surcharge(12%of permit tee) 7.50
Authorized signature: C Y\ - s-r5-'L TOTAL PERMIT FEE 70.04
Print name:Jennifer Bergen VVV Date:t 5/<)9/2016 This permit application expire§lin permit to nut obtained within 180 day§
Atter It hart been accepted a§complete.
"Poo methodology Ret by Tri-County Building Industry Set'viet+Boned.
I lnullding\Por iolHU'LMU-I'°f mitANp.doo 10l/09 410.1616T(I O/02JCOM/W aa)
May. 09.2016 09:03 AM Mike Patterson Plumbing 5036554349 PAGE. 2/ 2
Plumbin Permit Application - City of Tigard
Page 2 Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
ry ° q+ 90
P}`t MG 1IW u. a 1.+''7aPri�`.R�.,
Footing drain-I"100' 50.03 0 to 2,000 $121,90
Pooling drain-each additional 100' 37.52 2,001 to 3,600 $169,69
Sewer-1st 100' 62.54 — 3,601 to 7,200 $233.20
t 7,201 and greeter $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 1 62.54 4.2. S1 Medical Gas Systems:
Water Service-each additional 100' 37.52 i �+ til t5�,,�y� {{ s v' ,; {�` 19 r a
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 ibr
each additional$100.00 or fraction thereof,to
Y KtOltf�t ; c < 4
and includinl$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 includia}L$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 ehurge—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*.
a i i l 1 tt t .F x dr ',IVO
V 'w" 8y i� Yr Y �^' tc,a�
,ti>Kr ,y�,� a Macer
!lire .! 0 phut review is required forarty of the following.
v�ot�llydi'ki�flotc¢: ” !�. ,�lai~d 1X6flt�, Please!cave check all that apply.
Bath -Tub/Shower ❑ Any now commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ Now exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in 0AR918-780.0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain, ❑ Any complex structure as defined in 0AR918-780-0040.
_Eye Wash
Floor Drain/sink -2" w Submit 2 sets of plans with any of the above,
rip".. 4,,,.,,,,g. '}tit.R!7��, 4 i 1• `[` I . 1 f 11,( �,.,64 ,,�,: .4,,a�i`;i
Car Wash Drain_ ID Isometric or riser diagram is requited for new buildings
Garbage -Doutestic-non-rood _
Disposal -Domestic—gmd related that meet the qualifications above.
-Commercial—food related
Industrial-food related
Ice Mach./Rafrig,Drains
Oil Separator(Gas Station). Comments regarding fixture work:
Rec,Vehicle Dump Station _ ..
Shower -Gang -
-Stall
Sink/Lav -Non-toad related
-Bradley
-Commorcial-food related
-Service
Swimming fool fincr_,. . _ .. *Note: if the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be Issued and
Water Closet- oilet -
'tfees assessed for the sewer increase must be paid before the
Urinal _ plumbing permit can be Issued,
Other Fixtures.
C:1Users\Jc;nnifcr\Downloads\PLMF_PermitApp(1),doc 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
10050 SW TIGARD ST, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00246
Don Sylvester
Sanitary sewer has been approved . Plumbing is ok
Violation Summary:
Inspector Contractor