Permit (70) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00378
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/02/2016
g Parcel: 25101AB03100
Jurisdiction: Tigard
Site address: 12115 SW 70TH AVE
Project: Red Rock Center Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: Building C-Site utilities for a new medical office building:(3)catch basins,486 ft.of footing drain,(1)rain drain
connector,5 ft.of sanitary sewer, 118 ft.of storm sewer,5 ft.of water service,(1)backflow preventer,and(1)PRU.
Contractor: BRIAN CLOPTON EXCAVATION INC Owner: TIGARD TRIANGLE PARTNERS LLC
P O BOX 509 18187 SIERA DR
WILSONVILLE, OR 97070 LAKE OSWEGO, OR 97034
PHONE: 503-682-0420 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Catch Basin or Area Drain 11/02/2016 $56.28
Specifics: 486 If Footing Drain 11/02/2016 $200.11
1 ea Rain Drain Connector 11/02/2016 $18.76
Type of Use: COM 5 If Sanitary Sewer 11/02/2016 $62.54
Class of Work: NEW 118 If Storm Sewer 11/02/2016 $100.06
Type of Const: 5 If Water Service 11/02/2016 $62.54
Occupancy Grp: 1 ea Backflow Preventer 11/02/2016 $31.27
Stories: 25 Misc Other Fee 11/02/2016 $25.02
1 Plan Review 11/02/2016 $139.15
1 12%State Surcharge- 11/02/2016 $66.79
Plumbing
Total $762.52
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 qu ions to Ob C by calling 503.232.1987 or 1.800.332.2344.
Issued y: / // / 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.
Plumbing Permit Application
Site Utilities .
Received L 1,/'^ ^0 g
City of Tigard y: 7 �7 /�O ( PermitNo.: I I P���'W
,�
Date/By:
a 13125 SW Hall Blvd.,Tigard,OR 9722 1 oo 20 i Plan Review
a Phone: 503.718.2439 Fax: 503.598.1960 J�) Other Permit No.
Inspection Line: 503.639.4175 �` +114
Date/By: 7-217-/G ( r .r&e,to Cp
T I C A R D C I 1 r ± ., Date Ready/By: / Juris: ® See Page 2 for
Internet: www.tigard-or.gov UIr EP i'!°f Notified/Method:7 /hf�/(fry it>r ✓ y Supplemental Information
t o r r,. I ' 1''7•t 4- ; { , FEE* SCHEDULE
TYPE OF WORK
A New construction ❑Demolition al �jUN, For special information use checklist
41 '
Description Qty. Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family.dwklhugs(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUL&FION SFR(1)bath 312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /ail 5 rte) 7O' 4,) e> Catch basin or area drain 18.76 54..2.t
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7 q )j
y / 4�C a Footing drain(no.linear ft.:4136 Page 2 aoo.it ✓
Suite/bldg./apt.no.: 1 Project name: Red- floc/C 1 - Manufactured home utilities 50.03
Cross street/directions
to job site: ell
Manholes 18.76
Sid 7�11. 4 v e +" Seel DG it --#410 C/ell 5t Rain drain connector , 18.76 j g 7 6 i/
Sanitary sewer(no.linear ft.:.-..J ) Page 2 6,s,5 f ,/
N
Storm sewer(no.linear ft.:166r it Page 2 /00. 06
(� Water service(no.linear ft.: $Z) I Page 2 L A•S¢ %/
Subdivision: , Lot no.: Fixture or item:
Tax map/parcel no.: j 5/(,f /41_8 3426 3/CO
Backflow preventer ' 31.27 31•.1 R •••••'
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
04 5I --e' l'' 4/47l ';15 Dishwasher 25.02
1.2)o 6e-v, 5 l.d✓ 4.1 ' Cc,'4 F e-,.?✓ f) Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Oda cej F;:j Floor drain/floor sink/hub 25.02
Address: /13/8 7 1e i'l 2. 177r
Garbage disposal 25.02
City/State/ZIP: 4,0 ke d 5 td elv $R 9,153(7 Hose bib 25.02
Phone:(1.03) 53 3 1380 Fax:( ) Ice maker 12.51
Af APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: (fed /76 cic /3c,sine5.5 .4556C.r41-e ac...
Primer 12.51
Contact name:
0G>N ✓� Roof drain(commercial) 12.51
Address: /8 f'7 5/e 0 2. (7,", Sink/basin/lavatory 25.02
City/State/ZIP: 40( cs 0 S W ey€ o le 9703 if Solar units(potable water) 62.54
Phone:( ) Fax::( ) J Tub/shower/shower pan 12.51
E-mail: ((cz. . C.P @I roh t I e_„... , Co, , Urinal 25.02
Water closet 25.02
CONTRACTOR
_ Water heater 37.52
Business name: 73 1,1-^J CLTD
DAA)
n �CCf}/4-Tti� /,Jatc• Water piping/DWV 56.29
Address: dtz. PO lox_ 509 - Other: R.U.P, _ I 25.02 25.0 a-
City/State/ZIP: l LSO/J U l�C_ "`O . c)' 767O Subtotal S 5..Se
Phone:(503 (p u_ UC/2...,e) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: *p.3 -7- Plumbin Lic.no.: '3--5 i 1°6 Plan review (25%of permit fee) f 3q•f�
State surcharge(12%of permit fee) C`•9 I
Authorized signature: ��/� TOTAL PERMIT FEE ?6,2,,SA
Print name: Date: 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.
I:\Building\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 Suppression Systems:
Site Utilities Qty Fee(ea) Total SquaresFootage: Permit Fee:
Footing drain-151 100' 50.03 so.b5 0 to 2,000 $121.90
Footing drain-each additional 100' 4. 37.52 /so 08 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54
� 6%�•S 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' I 62.54 4 .sci Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 1 62.54 L 2 S¢ Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' ' 37.52 34162- $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
h 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: 425.25
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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic El Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagrambuildings
is required for new
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
'Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
WaterExtractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU_PermitApp.doc 2
F
IN _ p Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map&tax lot# ❑ project name ❑ site address ❑ suite number
0 zoning 0 applicant name 0 phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS -Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping,manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Permits\PLMF-PermitApp.doc 12/30/05
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12115 SW 70TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2016-00378
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Correction's are complete, plumbing final approved.
2. Note: remove filter bags from catch basin's
Violation Summary:
Inspector Contractor