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Permit (234) CITY OF TIGARD PLUMBING PERMIT I: COMMUNITY DEVELOPMENT Permit #: PLM2012 -00319 T t G ARE) . 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/13/2012 Parcel: 2S115BA02500 Jurisdiction: Tigard Site address: 16200 SW PACIFIC HWY S Project: Gentle Dental Subdivision: 2004 -015 PARTITION PLAT Lot: 1 _ Project Description: Vacuum air system. • Contractor: PMSI LLC Owner: SN PROPERTIES PARTNERSHIP 21195 NW EVERGREEN PKWY #204 1121 SW SALMON ST HILLSBORO, OR 97124 PORTLAND, OR 97205 PHONE: 503 -466 -2222 PHONE: FAX: 503- 466 -2211 FEES Quantity Description . • Date Amount • 1 ea Medical Gas 11/13/2012 $288.64 Specifics: 1 Plan Review 11/13/2012 $72.16 1 12% State Surcharge - 11/13/2012 $34.64 Type of Use: COM Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $395.44 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 i is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility otification Cen :. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or d' ect questions to OUN - ailing 503.232.1987 or 1.800.332.2344. Iss ed 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. Nov. 9. 2012 2:46PM / - lo. • : ! P. 1 Plumbing Permit Application � c-�`� 1s(-- Building Fixtures r , � ` - FOR O1 Fi ON! City of Tigard LI 1 ii,i.. ii -��� // /j it (Z t l No.: ' �1a.3/7 a 13125 SW Rail Blvd., Tigard, OR 97223 Plan Review o phone: 503.718.2439 Pax: 503.598.1960s in DalenlY / /_j ? -/ . °therPermitNo.: Inspection Line: 503.639.4175 "UV 1 3 ? 012 nataReady/By toll! see Page z ror GA n Internal: www.ti or. ov 8 g C NoliflodtMethod: Supplementaltntbmtstlon TYPE OF W j . , ,n T1G " A� FEE' SCHEDULE o New construct ion 0 Gfbt WfVJSION For special information use checklist D escription 1 Qty. Ea. Total ® Addilion/alteration/replacement ❑ Other: New 1- 2- ramlly dwellings (includes 1001L for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 El 1- and 2 - family dwelling ® Commercial/industrial SFR (2) bath 437.78 SPR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional batMatchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site Utilities: Job site address: 16200 SW Pacific Hwy Suite S Catch basin or area drain 18.76 City /StaleJZWP: Tigard, OR 97224 Drywoll, loath line, or trench drain 18.76 .- Footing drain (no. linter ft.; ) Page 2 Slide/bldg./apt. no.: l Project name: Gentle Dental Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear 1L: ) Page 2 _ Starm sewer (no. linear IL: ) Page 2 Water service (no. linear ft.: ) _ Page 2 Subdivision: I Lot no.: Fissure or item: Tax map /parcel no.: 13aakftow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 dal air and vacuum lines - - - Dishwasher 25.02 Drinking fountain 25.02 Ref permit BIIP2012.00071 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Namo: Fixiure/aewer cap 25.02 Floor drain/11oor aink/hub 25.02 Address: Garbage disposal �/ 25.02 City/Stale/ZIP: Hose bib v 00 25.02 IN Phone: ( ) Fax ( ) Ice maker /1( r) 12.51 ❑ APPLICANT ❑ CONTACT PERSON Infer eplor/grease trap X \ � � 25.02 4,4 Business name: Medical gas (value: S 5000) ` Page 2 Contact name: Primer r 2 ";( 1 .r i'1,6)-f-r 12.51 Roof drain (commercial) 12.51 Address: Sinkr/basinfavatory 25.02 City/State/ZIP: Solar units (potable water) 62.54 Phone: ( ) I Fax : ( ) Tub/showerlehower pan 12.51 E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 3732 _ Business name: PMSI LLC • Water piping/DWV 36.29 Address: 21193 NW Evergreen Pkwy Suite 204 Other: 25.02 City /Slate/ZIP: Hillsboro, OR 97124 Subtotal , aW Phone: (503) 466 -2222 Pax: (503) 466 -2211 Minimum permit fee: 572.50 r � - Lie.: 158286 PlunLbing Lic. no.: 34-434PB Plan review (25% of permit fee) V ' 7A.,, L� ()� - Stateanre �'4,rl°• 3y. Authorized signature: V v "v " `. " TOTAL PERMIT FEE 11 Print name: Lanell Robinson Date' 1118/12 This permit application expires IF a permit Is not obtained within 160 daps 77 alter It has been accepted as complete. 395 'Fee methodology set by T6•County Building Industry Service Board. Oct. 30. 2012 11:26AM . No. 6715 ' " P. 2 , Plumbing Permit Application - • . __1 Building Fixtures RECEIVE City of Tigard er / %4 / . Z Permit No.: 7 3, cl 13125 SW Hall Blvd., Tigard, OR 97x23 OCT 3 0 2012 Plan Review C Phone: 503.718.2439 Fax 503.598.1960 Date/13y: Other Permit No.: 44 ,"s ,'2- o o' 7f Inspection Line: 503.639.4175 CITY OFTIGARD DateReadyBy: seric I RI Seo Page 2for II i; A k O Internet: www -or. v �° B UILDING DNISION"e"M : supplemental inrormatlon TYPE OP WORK FEE* SCHEDULE IN ❑ New construction ❑ Demolition For special information use checklist. Description j Qty. I Pa. t Total ' ® Addition/ alteration/replacennent ❑ Other: New 1- 24fantily dwellings (includes 1 ft. for each utility connection) • CATEGORY OP CONSTRUCTION SFR(1)bath 312.70 r1 El 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 437.78 Q SFR (3)bath 500.32 ❑ Accessory building ❑ Multi - family Each additional ballykitchen 2 .02 ❑ Master builder ❑ Other: Fire sprinkler (__ sq. fl.) `age 2 JOB SITE INFORMATION 1 LOCATION Site utilities: t lob site address: 16200 SW Pacific Hwy Suite S Catch basin or area drain 18.76 ~ Drywell, lead` line, or trench drain 18.76 City /Smte/21P: Tigard, OR 97224 Footing drain (no. linear ft.: ___) Page 2 Suite/bidg /apt. no.: I Project name: Gentle Dental Manufactured home utilities 50.03 1 ? Cross slrect/dircctions to job site: Manholes -M 18.76 Rain drain connector 18.76 Sanitary sower (no. • , ft.: , ) Page 2 Stone sewer (no. I' I. car ft.: ) Page 2 Water service (. ,. linear ft.: ) Page2 kN Subdivision: j Lot no.: Future or1 1: Tax map /parcel no.: t ow • venter 31.27 125.08 llackw valve 12.51 1 � DESCRIPTION OF WORK - Cd.. ea was . 25.02 e 0 ,, hwaslrer 25.02 Re: permit BDP2012-00071 A•C... 0.-LC H A ( R.. t V5T "1 Drinking fountain 25.02 � Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank , 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor aink/hub 23.02 50.04 Address: Garbage disposal ■ 25.02 City /SlaIJZIP: Hose bib 5.02 Phone: ( ) Fax: ( ) Ice maker >IC 2.51 12.51 ❑ APPLICANT ❑ CONTACT ' : .ON Interceptor /grease trap 25.02 Business name: Medical gas (value: 3 L()) . Page 2 Printer 12.51 Contact name: Roof drain (commercial) 12.51 Address: 3U/basin/lavatory 25.02 225.18 City/State/ZIP: Solar units (potable water) 62.54 Phone: ( ) I Fax:: ( Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR 1Veler • closet ' 25.02 50.04 Water healer a 37.52 37.52 Business name: PMSI LL W C Water piping/DV / 56.29 Address: 21195 NW Evergreen Pkwy Suite 204 Other: 25.02 City /State/ZIP: Hillsboro, OR 97124 Subtotal 500.37 Phone: (503) 466 -2222 l( / 2 Y Fax: (503) 466 -2211 Minimum permit fee: $72.50 CCB Lic.: 158286 Plumbing Lic. no.: 34 - 434PYI Plan review (25% of permit fee) 125.09 t State surcharge (12% of permil fee) 60.04 Authorized signatu ifills'c P U `^"dT TOTAL PERMIT PEE 685.50 Print name: Lanell obinson I Date: 10/30/12 I TNs perntll application eapiras ire permit is sot obtained ninon 100 days after K has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. Oct. 30. 2012 11:26AM No. 6715 P. 3 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: Fooling drain - 1 " 100' 50.03 010 2,000 $121.90 Fooling drain - each addiliona1100' 37.52 - 2,801 to 3,600 _ _ 8169.68 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater 5327.34 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Wafer Service - each additional 100' 37.52 Valuation: Permit Fee: stoma & Rain Drain - 1st I00' 62.54 $1.00 to $5,000.00 Minintuci fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 forthe first $5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof including $10,000.00. ; to 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 8100.00 or fraction thereof to (minimum charge - 1/2 hour) aid 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 Pees _ 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 fbr the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) t 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 *. ouanuly by Fixture Type Plan Review for Plumbing Installations - Work Fleur. Type Capped Added te Plan review is required for any of the following. Baptistry/Font Please check all that apply. Datb - nib/Shower ❑ Any new commercial building with water service 2" and .Jac uzi /Whirlpool greater, except systems designed and stamped by licensed Car Wash .Bach Stall engineer. - Drive mm ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918- 780.0040. Dishwasher - Commercial N Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose the sprinkler system. Drinking Poimtain ❑ Any complex structure as defined in 0AR918 -780 -0040. Eye Wash Floor Drain/sink - 2" 2 Submit 2 sets of plans with any of the above. Isometric or Riser Diagram Car Wash Drain Garbage - Domealio- nonfood 21 Isometric or riser diagram is required for new buildings Disposal - Domestio -food related that meet the qualifications above. -Commercial-food related - Industrial -food related Ice Mach/Refiig, Drains Oil Separator (Gas Station) Comments regarding fixture work: Rea Vehicle Dump Station _ Shower -Oang -Stall Sink/Lav - Non -food related 6 1 - Bradley -Commercial -food related 1 - Service 1 Swimming Pool Filter *Note: If the fixture work under this ermit results in an Washer - clothes p Water Fa irador increase of sewer glAis, a sewer permit will be issued and wafer closet - 'toilet 1 1 fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Pixtures: (503) 466 -2222 RECEIVED r 1 Fax: (503) 466-2211 km 2 .. . , 2 1 195 NW Evergreen Parkway, Vile 4 L Hillsboro, OR 97124 � OFTIGARD WILDINGDterISi LETTER OF TRANSMITTAL TO: City of Tigard DATE 11/1/2012 IJOB NO. 40399 13125 SW Hall Blvd ATTENTION Debbie Adamski Tigard, OR 97223 RE Gentle Dental Durham WE ARE SENDING YOU , ATTACHED VIA EFAX EUS MAIL CUSTOMER P/U © COURIER COPIESIDATE INO. (DESCRIPTION 2 Vacuum and air drawings THESE ARE TRANSMITTED AS CHECKED BELOW: ® FOR APPROVAL EFOR YOUR USE DAS REQUESTEDE REVIEW &COMMENT REMARKS: COPY TO: SIGNED: amen Rodi.Soi PROPOSAL • * Interdent Install At: Interdent Order #: 20121112092413468 Cust# 503 - 970 -4420 • 1101 SE Tech Center Drive Ste.195 • 1101 SE Tech Center Drive Ste.195 Bid Date: 11/12/2012 Vancouver WA 98687 Vancouver WA 98687 Rev. Date: 11/12/2012 * ** Equipment Expansion * ** Phone: 503 - 970 -4420 Fax: 360-449-5699 Phone: 503-970-4420 Fax: 360 -449 -5699 Rev. Time: 9:27:57 AM Home: Contact: Bid Expires: Contact: Approximate Installation Date: Page 1 of 1 • Retail Cost Doctor Cost Qty Manuf PIN Product Description Each Extended . Each Extended Stock Code 1 AIRTEC AS50 Airstar 50 Compressor -Twin $5,962.00 $5,962.00 $5,962.00 $5,962.00 698-7632 • 1 AIRTEC 2V3 Mojave Dry Vac Dual System $9;706.00 $9,706.00 $9,706.00 $9,706.00 698 -0363 1 PRACTI 10012 Gleco Plaster Trap Complete $87.29 $87.29 $87.29 $87.29 681 -5249 - • 1 BUFF 61790A Model Trimmer 1 /3HP loin. • $458.81 $458.81 $458.81 $458.81 -365 -6944 ' • — Gam= � - d• -.. - v $16,214.10 $16,214.10 '.'\) A 1g ue , 5 - s __ !! HENRY HEIN • SC ® µof 4vc 114c. ( a r ..- DENTAL 6I T gb -- @I1 - chi .,. — • H enry Schein Dental 25589 SW Canyon Creek Road , Suite 600 • • Wilsonville Or 97070 • ( 6 ' -- . • Phone: (503) 682 -2609 Fax: (503) 682 -5730 /.. ` J • •