Permit (27) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00381
T f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/18/2016
Parcel: 25101 BD00100
Jurisdiction: Tigard
Site address: 7650 SW BEVELAND RD 200
Project: Womens Healthcare Associates Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Adding(3)hand washing sinks and(1)breakroom sink.
Contractor: COLUMBIA CONSTRUCTION INC Owner: PNWP LLC#2
28170 BOBERG RD PO BOX 2206
WILSONVILLE, OR 97070 BEAVERTON, OR 97075
PHONE: 503-427-0304 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 ea Sink 07/14/2016 $100.08
Specifics: 1 12%State Surcharge- 07/14/2016 $12.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 952-001-00x0. You may obtain a copy of the rules
or dire uestions to NC b calling 503.232.1987 or 1.800.332.2344.
Is ed By: J V �/�%�—�1"`) Permittee Signature:
}Cw
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 o _r . oject.
Approved plans are required on the job site at the time of each inspection.
02.5
Plumbing Permit Application QEF �, 1� .bo ,DS al
i `� 'S
•47 /01;
Building Fixtures FOR OFFICE USE ONLY
Cityof Tigard )c..--'`X Received �r r /�> �y-� ICJ y
g Date/By: !�t/�//tom 077--
Plan ,;: 0 C: a)
s' ' 13125 SW Hall Blvd.,Tigard,OR 97223 ..,i , ((
Plan Review
. Phone: 503.718.2439 Fax: 503.Wk, Other Permit
/0�th/t,'i9�1 '
Date/By:
T I G n K[) Inspection Lane: 503.639.4175 ' 1,S)�1 Date Ready/By: furs: H See Page 2 for
Internet www.tigard-or.gov \ v L Notified/Method: 7Z,Z.fy Supplemental Information
TYPE=OF,�WORKl' 4 4
- . ?, 4 c. N }� '; FEE*;SCHEDULE
R .,„ 4 mss u - . ,,
®New construction ❑ it(9 For special information use checklist.
"._tt ' Descristion I Ea. Total
❑Addition/alteration/replacement Q;�rt New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF;CONSTRUCTION __ . ,,, SFR(1)bath 312.70
1:11-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building 111Multi-family
SFR(3)bath 500.32
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:7650 SW Beveland Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:WHA Lab
``1,il /1,, .A/C g
/A1/0j4i. anufactured home utilities 50.03
Cross street/directions to job site: 6.(..;,(j r i3 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 31.27
'* ,_ DESCRIPTION OF WORK
Backwater valve 12.51
k. Clothes washer 25.02
Plumb for 4 sinks w/faucet
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY b'WNER �' ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
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
0 APPLICANT 0 CONTACT PERSON { Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 4 25.02 100.08
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Columbia Const.Inc. Water piping/DWV 56.29
Address:28170 SW Boberg Rd. Other: 25.02
City/State/ZIP:Wilsonville,OR,97070 Subtotal 100.08
Phone:(503)427-0304 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:199903 Plumbing Lic.no.:PB1400
State surcharge(12%of permit fee) 12.04
Authorized signature: g�'vint�� i f,)g, ,t,t i
'''���//// di�G+i.1/�l TOTAL PERMIT FEE 112.0
Print name:Darren Placek Date:07-14-16 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 Board.
1:1Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
*Fee Schedule: Residential Fire Su 'ression S stems:
Orfipil e'er 'Ems `k4
Footing drain-1"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
Sewer-1st 100' 62.54 and d,g a $233.20
7,201 greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52W J-4740,Viele`yJ
Storm&Rain Drain-1st 100' 62.54 $1.00 to$H 55,000.00 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
1` a •. ref or each additional$100.00 or fraction thereof,to
,, ..y �. 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 ch. :e-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 ch. -2 hours each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/th 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 c . e-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*.
''=4W ' ` - ; "" o- Plan review is required for any of the following.
Please check all that apply.
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whiripool New r.
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Taro
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic 0 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"
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
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: -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-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:
I:\Building\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
7650 SW BEVELAND RD 200, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00381
Chip Barnett
Violation Summary:
Inspector Contractor