Permit (31) 11114CITY OF TIGARD PLUMBING PERMIT
gi . `' COMMUNITY DEVELOPMENT Permit#: PLM2017 00234
13125 SW Hall Blvd.,Ti Date Issued: 06/15/2017
T[ xft. and OR 97223 503.718.2439 9
Parcel: 2S 103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: Fowler Middle School Subdivision: None Lot: None
Project Description: Interior plumbing for science lab. Adding(1)drinking fountain,(1)2"floor drain,(1)Ice Machine,(6)sinks,and(1)
water closet;Relocating(1)eye wash,(1)2"floor drain,and(40)sinks;Installing(2)primers.
Contractor: ADVANCED TECHNOLOGY GROUP Owner: TIGARD-TUALATIN SCHOOL DISTRICT
455 SE 2ND AVE BY MAPLETHORPE, BONITA
HILLSBORO, OR 97123 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-693-9202 PHONE:
FAX: 503-640-4333
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 06/15/2017 $25.02
Specifics: 2 ea Floor Drain/Floor Sink/Hub 06/15/2017 $50.04
1 ea Ice Maker 06/15/2017 $12.51
Type of Use: COM 2 ea Primer 06/15/2017 $25.02
Class of Work: ALT 46 ea Sink 06/14/2017 $1,150.92
Type of Const: 1 ea Water Closet 06/15/2017 $25.02
Occupancy Grp: 25 Misc Other Fee 06/15/2017 $25.02
Stories:
1 12%State Surcharge- 06/15/2017 $157.63
Plumbing
Total $1,471.18
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 9 :Ott 1390 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: Gr f Permittee Signat re: , --'' ,-- /'
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
,� IIi 0 I I L' J",.--01 1),_g11.-,'
Building Fixtures � � I't1u (Il I II I. I ,4 I. ()yIrl
City of Tigard Received Permit No.:
1„ Dme/By:
il Ill13125 SW Hall Blvd.,Tigard,OR 97223 i. �Q PI evie t 7 ff`'I�20/ 1 '��
Phone: 503.718.2439 Fax: 503.598.1960 ,\� Other Permit No.: 1 7_ 0 i 61,
Inspection Line: 503.639.4175 , < W 1
I I(;:1 1?I> p /By: oris ®SEs Page 2 for
Internet www.tigard-or.gov 0 �It d ied/Metbod. j Supplemental Information
TYPE OF WORK 0V1t1lk. v'' FEE* SCHEDULE
0 New construction 0 Demon,i ? For special information use checklist
Description I Qty. 1 Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 R.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El1-and 2-family dwelling Q 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 0 Other:
Fire sprinkler( sq.It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:10065 SW Walnut St Catch basin or area drain 18;76
City/State/ZIP:Tigard,OR 97223
Drywell,leach line,or trench drain 18.76
I� Footing drain(no.linear ft.: ) Page 2
L
Suite/b)dgiapt.no.: Project name:Fowler Middle School Reno Manufactured home utilities 50.03
Cross street/directions to job site:SW Walnut St and SW Tiedeman Ave Manholes 18.76
Rain drain connector18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:,_) Page 2
Water service(no.linear ft.: ,) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.:28103AA00101 Backflow presenter � 31.27
DESCRIPTION OF WORK
Backwater valve ,�t1 % 12.51
Clothes washer 0 11v 25.02
Renovation of Main Entry,Science Wing and Woodsbop as well as other minor (p\'. (d` 25.02
renovations,and a aiesmic upgrade of the building Dishwasher
Drinking fountain p‘43' ' 1 25.02 25.02
Ejectors/sump VA 25.02
0 PROPERTY OWNER ( 0 TENANT Expansion tank 12.51
Name:Tigard-Tualatin'School District Fixtu>e%wer 25.02
--Floor drain/floor sink/hub ✓ -25;02
Address:6960 SW Sandburg St .,--11,' - ',:.;•(
Garbage disposal 25;02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(5a3 ) 44,I ,-4-0,043 Fax:(s9o3) i . s(-0¢1 Ice maker I 12.51 i 1.5-1
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer " 12.51 I ,s-.0sp S
Roof drain(commercial) 12.51
Address: (gal b 0 54J SAv t)sve to 41 Sink/basin/lavatory f _4 25.02 /%5J 4.
City/State/ZIP: 11 i Deg.rl 0 1,2 41 "121-3 Solar units(potable water) 62.54
Phone:(lo; } oil y. Aft,1 Fax::( ) Tub/shower/shower pan 12.51
E-mail: (pr,. j-t p JA Y t m . L i t�'1 H'' 25,112
CONTRACTOR Water closet of1 25.02 ,2.5 v L.
nigo
m �e Water heater 37.52
Business name: nA. t e L/ /�c tl frl o/v9 (j m ti Water piping/DWV
Address: ti g. Z A.../ d4'4t`I Other: j 25.024
City/state9ZIP: MAI-c Loco t D Ire�j o�t ! !23 Subtotal /13#3,55
Phone:(5 13) 6p (3• 1 ?.t,R Fax'(5-03) (,t(0.4f 33 3 Minimum permit fee: $72.50
of permit fee)Plan review (2596
CCD Lie.: 13 O3(p� Plumbing Lie.no.: 3y-31/P8
Statesurcharge�i29�ofpemlit fee) /����,�
Authorized S .� •'a TOTAL PERMIT FE:I/�4;,r 11t
Print name: Date: 1 Is permit application expires if a permitIs net obtained w bier 811 days
after ht bas been accepted as complete
"J methodology set by Tri-ComNY building Industry Service Board.
1:inuiMi PormitApp.doe 10/01)09 446461ft i0/02/00M/W$B)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
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 to 7,200 $23320
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-i st 100' 62.54
Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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
Other Inspections or;Fees Oil' Fee(ea) Total 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 chargee-1/2 hour) and including$25,000.00.
Inspections outside of normal business 91).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 90.00Av 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:
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`Plumbng Installations
FiWork Plan review isrequired for any of the following.
Performed; Capped Added RelePo�iwt'r1e
13fistry/Foat Please check all that apply.
Bath -Tub/Shower 0 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 Tt ru -❑ New exterior plumbing site utilities for any-complex structure
Cuspidor/Water Aspirator as defined in OAR9I 8-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 .Any multipurpose fire sprinkler system.
Drinking Fountain l ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" j 1 Submit sets of plans with any of the above.
-3"
-4" Isometric or Riser Diagram
Car Wash Dram ❑ Isometric or riser diagramrequired for new buildings
-Domestic-non-food �is
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refng.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle
hicle�Dump Station Gt 11 t�1.'rL( late* k_' r�tk.L ,vt) S u,e414.,
-StallShng j li n/a lei 1 k"# 1/? r9
Sink/Lav -Non-food d related C'' .1-Brady 4 A 11. e-4 6kh'l ✓ .ef T t 5: t-
-Commercial-fool.related ..
Service
Swimming Pool Filter
Washer *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet 1fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10865 SW WALNUT ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00234
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor