Permit (70) ,� CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00479
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/22/2017
Parcel: 2S 101 AB03100
Jurisdiction: Tigard
Site address: 12115 SW 70TH AVE 201
Project: Advanced Endodontics Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: Interior plumbing for new tenant:
Contractor: CASCADE PLUMBING CO Owner: TIGARD TRIANGLE PARTNERS LLC
15765 SW 74TH AVE 18187 SIERA DR
TIGARD, OR 97224 LAKE OSWEGO, OR 97034
PHONE: 503-289-7095 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/22/2017 $31.27
Specifics: 1 ea Clothes Washer 11/22/2017 $25.02
4 ea Floor Drain/Floor Sink/Hub 11/22/2017 $100.08
Type of Use: COM 6 ea Sink 11/22/2017 $150.12
Class of Work: ALT 1 ea Lavatories 11/22/2017 $25.02
Type of Const: 3 ea Water Closet 11/22/2017 $75.06
Occupancy Grp: 1 ea Water Heater 11/22/2017 $37.52
Stories:
1 Misc Other Fee 11/22/2017 $1.00
1 12%State Surcharge- 11/22/2017 $53.41
Plumbing
Total $498.50
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:
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 Applicat
Building Fixtures
Cit of Tigard N i)V 15 l Q�E Received J "� ^ �../ /��/
City g Date/By: ll ��p/, ( Permit Ngry..o g0/7"6G'% 75
13125 SW Hall Blvd.,Tigard,011,_974,1 r
Plan Review Other Permi144,_25Z7762,0/7-4,3t.
' � Phone: 503.718.2439 Fax: 505 1 ���' �i(JAW) Date/8y:
tit;n R I> inspection Line: SU3.639.4175 gg gg'yy 1 (� pate Ready'13y: Juris: ® See Page 2 for
Internet: www.tigard-or.gov U LDlrj f ,!�p: Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist.
0 New construction ❑Demolition
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 0.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
ElAccessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.0.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
"G 51,,,..N .1C5t-V� /t_Ne 2J 0' Catch basin or arca drain 18.76
Job site address: P. J j(Ja'-�+1-["L. vv
Drywell,leach line,or trench drain 18.76
City/State/ZIP: �d b4 . g1Z2�
JJ Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: 4-. 41./k/CSD Manufactured home utilities 50.03
Cross street/directions to job site: L o ilN7 e 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer ✓ t 31.27
DESCRIPTION OF.WORK Backwater valve 12.51
t ,�,. -�. Clothes washer V I 25.02
I t ,n sL - Vix`� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER ( 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub e' 44 25.02
Address:
Garbage disposal 25.02 '
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
'APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:l3e',Jlles.x., V.SOSC �‘ ;,ryv Medical gas(value:$ ) Page 2
►/`v "� � Primer 12.51
Contact name:����� ,
Roof drain(commercial) 12.51
Address:6 1 tc, SAS 'el kA itts� *`` pc Sink/basin/lavatory v Cr 25.02
�
City/State/ZIP ((a, 0k. (."L2„2,4 Solar units(potable water) 62.54
Phone:(55) .1qS }I Fax:: ) -C(51 Li Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet z 3 25.02
CONTRACTOR
Business name: Water heater ./ t 37.52
Water pI ing'DWV 56,29
Address: ,.....j).40, a 0.0v.e
Other:Pj.,. ,,Wdsh fr, k 25.02
City/State/ZIP: S v Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: j - Plumbing Lic.no.:TI5 `�j2 _
y State surcharge(12%of permit fee)
Authorized signaturree:�/� �-1 TOTAL PERMIT FEE
Print name���p'x�'-'r" G�ej�" Date: \,\( .t t t This permit application expires if a permit is not obtained within ISO dais
f- after It has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I Building Permits PI.9AC-Perm6App doc to 01 09 440-16101110 02 COM W1,10
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 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
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,(100.00 and$1.52 for
Other Inspections or Fees Qty• 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 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:
✓ 3 La-V i $ v- l 8 r-
Commercial Fixture Work: 3 d ,�{L„n..\ Si",1LS �Q°w`�iN'K"
Are you capping,adding or replacing fixtures? If"yes", 7 i k vi. e- Si r,r„
please indicate work performed by fixture. Failure to i/ l ha.tnd+l,.x;tSki Ile) Sih-k-
accurately report fixtures could result in increased sewer fees*.
Quantly 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 dcfin. sail in OAR9I8-780-0040,_.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities ")
-Domestic Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR9I8-780-0040.
Eye Wash - ..
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
t..
4" Isometric or Riser Diagram
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
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 /1//tp / 6i-' 64517) /56 (4-74)P4,-/g22>
Shower -Gang 1� - ;� - -
-Stall
Sink/Lav -Non-Mod related 9 - e4- 4- . -Al'
for
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes i /
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet '3 , ° fees assessed for the sewer increase must be paid before the
Urinal ,---- plumbing permit can be issued.
Other Fixtures:_y'(}Gl- ,._ l
w Atex( t
C:AUsers\Cascade Ma' ownloads\PLMF_Permi pp(7).doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12115 SW 70TH AVE 201 , TIGARD, OR, 97223 June 19, 2018 at 9:16:00 AM
Record Type: Record ID:
Commercial - Plumbing PLM2017-00479
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Previous corrections completed.
Violation Summary:
Inspector Contractor