Permit CITY OF TIGARD Permit
PLUMBING
PLM2017-00462 PERMIT
Fri 111.`.' #:
COMMUNITY DEVELOPMENT Date Issued: 11/16/2017
T[G R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 200
Project: Liberty Mutual Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Interior plumbing for TI:Capping(1)sink and adding(1)sink.
Contractor: MIKE PATTERSON PLUMBING Owner: G&S FC LLC
15028 S MITCHELL LN 16083 SW UPPER BOONES FERRY RD,
OREGON CITY, OR 97045 STE
TIGARD, OR 97224
PHONE:
PHONE: 503-632-7374
FAX: 503-632-5647
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 11/13/2017 $25.02
Specifics: 1 ea Sink 11/13/2017 $25.02
22 Minimum Fee Adjustment- 11/13/2017 $22.46
Type of Use: COM Plumbing
Class of Work: ALT
9 12%State Surcharge- 11/13/2017 $8.70
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 1.800332.2344.
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.
fPlumbing Permit Application
Building Fixturesi_ ,1 ,i''1i ;'
City of Tigard , Received
''li V` � Date/By: 1I /3 /y 7 Permit No.: /j 7M�
13125 SW Hall Blvd.,Tigard,OR 97223 l / ' ��
w
j Plan Review
Phone: 503.718.2439 Fax: 503.598 1960 Date/By: Other Permit No.: 34` !7,0 t i93
Inspection Line: 503 639.4175 e,al 1 ', ' t ,J"� Z
n' T I G A h D Date Ready/By: J IN See Page t for
Internet
www.tigard-or.gov 6 I1! '' 91 ' 1 Notified/Method:
4"r' v,. s .� . Supplemental Information
'< = :TYPE OF WORK ==;:-.,,,- - ti E* CHIEDULE
0 New construction21 0 DemolitipgrivrivilmFor special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
,'"r., ,: ,CATE RY OfCONSTR ;Q` tfivFDSFR(1)bath 312.70
01-and 2-family dwelling ®Commerci '1N 'alp SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
0Master builder ��1 Each additional bath/kitchen 25.02
�. 0 Other: O 1 3 7 017
�. Fire sprinkler( sq.ft.) Page 2
'�. JOB n' INFORMATION ND LOCATIOyu' 17', r 0` Site utilities:
Job site address:16083 SW Upper Boones Ferry Rd
r 17l,� :J Catch basin or area drain 18.76
� tx
City/State/ZIP:Tigard,OR 97224 y 4 c ,t ( D ,R- ' I .rywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:200 Project name:Liberty Mutual Tigard
i Manufactured home utilities 50.03
Cross street/directions to job site:Located Across from where SW 72nd Ave Qj/ 11641 Manholes 18.76
dead-ends into SW Upper Boones Ferry Rd O� t Rain drain connector 18.76
0 l��' Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
.' I Water service(no.linear ft.: ) Page 2
_2 Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.:2S113AB00500 Backflow preventer 31.27
` Backwater valve 12.51
A ' , , a., t Yx� Ii' �-. 6 ' rt i ,I Y , ,
Clothes washer 25.02
This Tenant Improvement project involves the conversion of a single tenant,full
Dishwasher 25.02
floor suite to a small suite and multi-tenant floor. _ Drinking fountain 25.02
'j /f/i,/i 7 ue (ir.A (I) s �, Ejectors/sump 25.02
P . OP R 1,` E > 'N ' Expansion tank 12.51
Name:Liberty Mutual Insurance Company Fixture/sewer cap 25.02
Floor drain/floor sink/hub ' 25.02 v
Address:175 Berkley Street-Mailstop
Garbage disposal 25.02
City/State/ZIP:Boston,MA 02116 Hose bib 25.02
Phone:(857)224-6117 Fax ( ) Ice maker 12.51
4,... x14
-, .,','LI, r 4. N RS( ,1 Interceptor/grease trap 25.02
Business name:Brereton Architects Medical gas(value:$ ) Page 2
Contact name:Kim Ramos
Primer 12.51
Roof drain(commercial) 12.51
Address:909 Montgomery Stret,Suite 260 _ Sink/basin/lavatory r 25.02
City/State/ZIP:San Francisco,CA 94133 Solar units(potable water) 1 62.54
Phone:(415)963-4620 Fax::( ) Tub/shower/shower pan 12.51
qE-mail kramos@brereton.com Urinal 25.02
� 's Water closet 25.02
�", , "`TRACTO R y,, : Water heater 37.52
Business name:Mike Patterson Plumbing Water piping/DWV 56.29
Address:17845 SE 82nd Dr": Other: 25.02
City/State/ZIP:Gladstone,OR 97027 Subtotal go. ei
Phone:(503)655-4306 Fax:( ) Minimum permit fee: $72.50 ).5V
Plan review (25%of permit fee)
CCB Lic.:81746 Plumbing Lic.no.:3-359PB
7 h-
State surcharge(12%of permit fee) 7Li
Authorized signature: / TOTAL PERMIT FE ti rril)
Print name: �� Date: 11/14/2017 This permit application expires if a permit is not obtained wi in 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pennits\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:
SiWUtitities ' r Y =µ y, 4ee ) total 1 ,,Square ootag ,, `e�:`n t
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 ` �
ti00; Pe` t#'4 : . ,r
Storm&Rain Drain-1st 100' 62.54
mal$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
y _n, each additional$100.00 or fraction thereof,to
Other`- io r.Fees ;. Qt'. Fee :, otal: 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Other Fixtures: I I I I
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 ape
Fixture Type forB*plate :,�,It,,'II'tam t , °l i , , '
i1 :04 a-
Work Performed: ,
" Capped Added Relocate
Baptistry/Font Plan review is required for any of the following.
Please check all that apply.
Bath -Tub/Shower
Jacuzzi/Whirlpool D 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 0 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 • ' ''
Garbage Domestic-non-foodm ` .0 ,Or. 1m
Disposal -Domestic-food related U Isometric or riser diagram is required for new buildings
-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 REMOVING ONE SINK,ADDING A SINK AT
-Stall DIFFERENT LOCATION.
Sink/Lay -Non-food related 1 1
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor
-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
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2017-1031.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16083 SW UPPER BOONES FERRY RD 200,
TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2017-00462
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor