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Permit CITY OF TIGARD PLUMBING PERMIT .7COMMUNITY DEVELOPMENT Permit#: PLM2016-00008 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/17/2016 [[ f1 fk_>3 9 Parcel: 1S126CD00100 Jurisdiction: Tigard Site address: 9925 SW GREENBURG RD Project: Crescent Grove Cemetery Expansion Subdivision: FAIRVIEW PLACE CONDO Lot: 20 Project Description: Site utilities for a new drive aisle:(9)catch basins,8,443'of footing drain, (5)manholes, 1,187'of storm sewer, 2,030'of water service,(1)backflow preventer&(7)hose bibs. Contractor: BRIAN CLOPTON EXCAVATION INC Owner: CRESCENT GROVE CEMETERY ASS P 0 BOX 509 CRESCENT GROVE CEMETERY WILSONVILLE, OR 97070 9925 SW GREENBURG ROAD TIGARD, OR 97223 PHONE: 503-682-0420 PHONE: FAX: FEES Quantity Description Date Amount g ea Catch Basin or Area Drain 02/25/2016 $168.84 Specifics: 8443 If Footing Drain 02/25/2016 $3,201.71 5 ea Manholes 02/25/2016 $93.80 Type of Use: COM 1187 If Storm Sewer 02/25/2016 $475.26 Class of Work: ALT 2030 If Water Service 02/25/2016 $812.94 Type of Const: 1 ea Backflow Preventer 02/25/2016 $31.27 Occupancy Grp: 7 ea Hose Bib 02/25/2016 $175.14 Stories: 1 Plan Review 02/25/2016 $1,239.74 24 ea Info Process/Archiving-Lg 02/25/2016 $48.00 $2.00(over 11x17) 1 12%State Surcharge- 02/25/2016 $595.08 Plumbing Total $6,841.78 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: n Call 503.639.4175 by 7:00 a.m.for the next available inspection date. Aleelon.) 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 Site Utilities '�� 1.0k(i (11 l lc t l s1: 0\1.1 City of Tigard �i ��Date/By: I Permit No.: f� )` 13125 SW Hall Blvd.,Tigard,OR 97223 l% Received i/� �`r "��' �' '� Phone: 503.718.2439 Fax: 503.598.1960 P �N ailfie/L6, ► Other Permit No.: -7;;2v1 ,� n 1 ! \i'.1,-.to Inspection Line: 503.639.4175 -�J -`By: o � 00�, curia: ® See Page 2 for GGx tt�r Internet: www.tigard-or.gov . My s d/Method: pZ /?y •,-(Ze-J a - Supplemental Information ®New construction 0 Demolition ���N F% special information use checklist 7.,)). Description I Qty. I Ea. I Total O Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) xe,ra . t • �= SFR(1)bath 312.70 ❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ®Other: Fire sprinkler( sq.ft.) Page 2 441"W''''''';'-'4 ''ON AN1D LOCATION Site utilities: Job site address:9925 SW Greenburg Road Catch basin or area drain 9 18.76 93.80 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.:6s7 ggq$ Page 2 2481r.g Suite/bldg./apt.no.: Project name:Crescent Grove Cemetery Manufactured home utilities 50.03 Cross street/directions to j site:(9 u--e-- Manholes 5 18.76 168.84 C +^ � r� Rain drain connector 18.76 npn� k � 1 Sanitary sewer(no.linear ft.: ) Page 2 f" ` 4'24'PD• & r(• t.f I itif x"`�-tet- 4f Storm sewer(no.linear ft.:1,1,30)./181 Page 2 47-572& r�� //J {7 r Water service(no.linear ft.:2030) Page 2 812.94 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.:1S1W26CD tax lot 100 Backflow preventer / 31.27 r , . ,s ,\, , n , Backwater valve 12.51 ,L, Clothes washer 25.02 new drive aisle,drainage improvements and water service improvements. Dishwasher 25.02 Drinking fountain 25.02 , Ejectors/sump 25.02 �\ ii l �}-.sweat Aver Expansion tank 12.51 Name:Crescent Grove Cemetery Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:9925 SW Greenburg Road Garbage disposal 25.02 City/State/ZIP:Tigard,Oregon 97223 . Hose bib '7 25.02 Phone:(503)639-5347 Fax:(503)620-1264 Ice maker 12.51 r ��� �o� ������ �\ �, � ►It � 0 �� � `�m: Interceptor/grease trap 25.02 a. Business name:Crescent Grove Cemetery Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Nancy Felton Roof drain(commercial) 12.51 Address:9925 SW Greenburg Road Sink/basin/lavatory 25.02 City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54 Phone:(503-)639-5347 Fax::(503)620-1264 Tub/shower/shower pan 12.51 E-mail:nancy@crescentgrovecemetery.com Urinal 25.02 Pl `� % Water closet 25.02 ..' - w CONTRACTOR 4 , Water heater 37.52 Business name: -6E4 pr 11/4.) OL p P.1..6_0 Al4.77 - Water piping/DWV 56.29 Address: p(, P,pk 607 Other: 25.02 City/State/ZIP: LD, Lye, 1 Ll... 0 C (1 767C) Subtotal 4039.67 Phone: Fax: Minimum permit fee: $72.50 (�� to��- ���(ao ( ) L CCB Lic.: 5 03 37 Plumbing Lic.no.: 3-Sri P6 Plan review (25%of permit fee) 1009.92 State surcharge(12%of permit fee) 484.76 Authorized signature: TOTAL PERMIT FEE 5534.35 WO) ✓f I. I This permit application expires if a permit is not obtained within 180 days Print name: , �_ Date: f[ 1 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. :\Building\Permus\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WE13) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Qty T %lure Fuge: 1'.er Fee: Footing drain 1'100' 1 ry 50.03 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 65 37.52 2438.8 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 1 62.54 62.54 Medical Gas Systems: Water Service-each additional 100' 20 37.52 750.40VthIISt10*N Permit Fe, Storm&Rain Drain-1st 100' 1 62.54 62.54 ' " '°' • "' �'t," $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 11 37.52 412.72 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Totaleach 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: 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*. (Xitudy by Fixture Type *tare Type for RePheel CaAdded PIO B lew:for Plum i ;; to fou wak performs: Plan review is required for any of the following. Baptistry/Font 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. Cuspidor/Water Aspirator 0 New exterior plumbing site utilities for any complex structure Dishwasher -Commercial as defined in OAR918-780-0040. -Domestic 0 Medical gas and vacuum systems for health care facilities. Drinking Fountain 0 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 , , Garbage -Domestic-non-food 0 Isometric or riser diagram is required new Disposal -Domestic-food related f� d forbuildings q -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/Lav -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 C:\Users\Crescent Grove\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CQTV J E0O\CGC03_PLMU_PermitApp.doc e Plumbiner Permit Application ', . Site Utilities 1- FOR OFFICI: IS1•. ON I.v illLit (+f Tigard and $ '' V g s Received �P-r Permit No.: �y�, „ ,,`!\ '. Dar/Dy I �' 1 7• )— r4 `.. I..12j S W Hall Blvd.,Tigard,()R 97223r P P t view �� ` y �' `t 'hone: 503.718.24:I9 Fax: 503.598.1960 tw a//(p�/��6—Other Permit No -� - ,:1,-:, , y t L_ t' nspeeti)n Line 503.639.4175 +`� a �y/E3y: Jo,is ® See Page 2 for L'- ❑ICmCI WNW.tl ala-Of. Oy .`'— I, "j I , ! Information r--.-„„,____________ K g [Fkled Merhod. Supplemental Vf+QTtK �`l t FEE!' SCTii ''- ,, n?at� s New construeiion ❑Demolition �, ' For special information use checklist --- - -,: t. Description Qty. Ea. Total ❑Additien'altc ntion/replace.tten. ❑Other: New 1-2-family dwellings(includes 100 ft. for each utility connection) - ;_____'v w-v, it,:,, t «N, r t( • sFR(1)bath - -- - I I 3}2.70 I-and_2-Cantil dwelling SFR(2)bath 437.78 I ❑ > g ❑Commercial/industrial --- - - SFR(3)bath ;00.32 1 E o eessory building E.]Multi-family ------- --- - ------- - -- Each additional bath kitchen - 25A2 ❑ Mester blilder ®Other: --- - -I- Fire sprinkler ( so. ft) I ± Page 2 I i J@#i•'8 rf fNb'Ql2.�lilA•I oN AND LOCATION Site utilities: _ _ Job sire address:9925 J W Greent urg Road Catch basin or area drain 1 9 18.76 -9-3780 i °�` ---------- Drywell.leach line,or trench drain -T 18.76 -- I X it '�tateiL.P "1 gard.. OR 97223 - ---- -�-”-, 1- _ O"}.'1-(- -- Footing drain(no.linear ftr7Tr 8 3 Page 2 ' .,i 1 Soite/aldg. apt.no.: - Project name:Crescent Grove Cemetery--_ T 50.03 - 1 L _ --_ -_- -- Manufactured home utilities I Cross streeddirections t)job site: Manholes 5 i 8 76 1 168 84 i(✓ J Rain drain connector 1 18.76 -- - -- o' t) I Sanitary sewer(no.linear 6.: ) Pati -- - -- - - / t`�� _•yA:��>P ,) r� y Storm sewer(no.linear ti -Jfl f� 7 1',n, )- 475.26_j I' �o� �' -d , f-l- --- Water service(no.linear ft 2100) 1- P,t , ) 8I 94 >--- I Subdi vision: I - -- ==- 1 -. ,_.. . . . Lot- : Fixture or item: > BackClow rovem ( 7 .l fax n ap�parccl t).: 1$ �V_6('D (ax lot 100 I } ---i 2 • '- Backwater valve 1I I TtILSCRIVFTUN OF WORK --- I ___ �.—,.. 1 --'-'----IL-CClothes washer I _ 2 nctr t rive a.'k urian;gr improvements and twain sen ice im trovemcots. -- - - - r__._ ----- --- Dishwasher i Drinking fountain I 21..!2 , Ejectors/sump i L ,2 — P6.011ER FY OWNER ❑ TENANT' Expansion tank { 1 I' I Name Crescent t;rove Cemetery Fixture/sewer cap i - - .a - ---_---"- - Floor drain/floor sink/huh ~ 12 .\tion„•y(tr,Si', Gre:nbu g Road _- ------ �__--7 � Garbage disposal t ' r' i'i s'`t teii IP rgard,Oregon 97223 —I— _ -- - - --- Hose bib -' Ll�75 Phone'(503)639-5347 i-ax:(503)620-1264 Ice maker - --t--- .] -- -___ J 1 APPLICANT cci© coc-r PERSON Interceptor/grease trap I .= J> 1- Burin:ss nr.nte: 'rescen[Grove CemeteryMedical gas(value:$ ) age 2 H---------------- - - Primer �- r 12.51 , Contact name: :Sauey Felton -- . J ;---- ---- — Roof drain(commercial) r- t - yddress:99:5 Sly'Greenburg Road Sink/basin/lavatory -- - 2,.02 X ity'State/LIP:Tigard,OR 97223 Solar units(potable water) I 62. 4 it_ 1 1 Phone (503-)639-5341- --- Fax: :(503)620-1264 Tub/shower/shower pan -- i - I_i ;1 i-mai . nauct a cresceutgruvecenieteiy•com Urinal � _ 21 02 ---_ H------------------ - Water closet i 7S.02 ---- -_-C:O A T©R'. , t Water heater 3-'.;2 Busiiu•ss name: -- -- -- Water piping DWV + �6 '� ycf5�;tib Address: -- - r--------------- --- -- - Other: 02 I-'ity/Sate/%1P. Subtotal -44+35767 Phuce -- - — -- -flax:( )------ ----H - Minimum pe reit fee: S72.50 • 3• -- ------ -- ------ Plan review (25%of tennis tee) -4E>9 " CIS I.ic.: Pluiiihuig Lie.no.. - I- - ---__-. -. -_.l c — -- - - -- ---- I Stati :rch.ugc(l2°'u' i penrit torr id 5`(s 9So \utico iced s au trite 1------ i - -- -- -- _ _ _ f 01 y- FCRM:T FFE I ._.5534.4fs-j Ill 13x11 �# _ t .. - -- )etc 1-7-7-7 ., I-�j j� 1'h is permit app!iea[ion expo es if a pernut n not obtained t�itaia 180 days — - .�1__�___ —� —_ --�_� after it bas been accepted as eompick, "Fee metirodologyset by ,:i-CouuttBuildingIudt::'rySe,c<cr ,,l.'en i:°I hii-1 ri i,.!,p1, tot Is i t.."1 don-4b:r, I IBIS.'CUhI/`/ER) 177 3r 18 • • r Plumbinv Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Qty, Fee(ea)- .total Squat'e.Footage Perj ft Fee .* Footing drain-1' 100' 1 50.03 50.03 0 to 2,000 $121.90 Footing drain-each add'tional 100' E4 37.52 „..243g-8 3(S(.6b 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer- 1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 00' 37.52 Water Service- 1st 100' l 62.54 62.54 Medical Gas S stems Water Service-e'a::h adc mortal 100' 20 37.52 750.40 �,, +r/f+Wilm E1 .i'.:.+• E- 1� tt v°I ky 6 40$Z4..144;" Storm&Rain Di ain- I s 100' I 62.54 62.54 $1 00 to$5,000.00 Minimum fee$72.50 Storm&Raja Drain-ea:h additional 100' 11 37.52 412.72 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or traction thereof,to ' w� � � "' ;. and including$10,000.00. Inspection of existing plumbing or fir $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicate( 90.00/hr each additional$100.00 or fraction thereof,to (mini,numeharg:_- 1/2 Hour) and including$25,000.00. Inspections cutside of n(rmal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours pninimum charge -2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review lir 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: Other Fixtures: 1 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*. Qaastfty by1CIx*te.Type irgMirepat; rPlan Review for PlumbingInstallations . fwa d: r> > ea 1"-ae� B..ti>try/Font _ Plan review is required for any of the following. Bath lib/Sl ower Please check all that apply. -J acro_iWiiripool ❑ Any new commercial building with water service 2"and Car\'ash -Each Stall greater,except systems designed and stamped by licensed -Drive''hru engineer. Cus•idor/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 .beilities. Drink in�Fountain ❑ Any multipurpose tire sprinkler system. E 'e\/ash ____ El Any complex structure as defined in OAR918-780-0040. Floor Drairu'sink -.' Submit 2 sets of plans with any of the above. t'ar Wash Dain � r ...• • ., Garb.,ge -Domestic-ion-food - _ ' 011f trig or'Riser Dia rat*. Disposal -Domestic-food related ❑ Isometric of riser diagram is required for new buildings -Cotunerci,tl-trod related that meet the qualifications above. - -Industrial-looe related Ice Mach./Ro:frii_Drain: Oil S::parator(Gas Station) Rec. Vehicle Dump Stat on Comments regarding fixture work: Shower -Gail: -Stall Sink/'_av -Noa-food related -Bradley _ -C'o.nmercinl-food rela.ed -Set,/(:c Swimming Fool Filter Washer-Clothe> • Water Extractor *Note: If the fixture work under this permit results in an Water Close:-To let increase of sewer EDUs,a sewer permit will be issued and Urinal ----- fees assessed for the sewer increase must be paid before the C:AUsers\Cresce it GruveiAppD2.ta\Local\Microso(f\Windows\Temporary ktcrnet Files C'ontent.Outlool.\CQTVJEJO\CGC03 PLMtI_PertnitApp.doc