Permit (141) CITY OF TIGARD PLUMBING PERMIT
■ COMMUNITY DEVELOPMENT Permit#: PLM2018-00252
13125 SW Hall Blvd.,Ti Date Issued: 06/26/2018
Tl( .L R.C) and OR 97223 503.718.2439 9
Parcel: 2S113AB00700
Jurisdiction: Tigard
Site address: 16255 SW UPPER BOONES FERRY RD
Project: The Circuit Bouldering Gym Subdivision: CIRCUIT PARTITION Lot: 2
Project Description: 200 ft.of storm sewer.
Contractor: FLYING H CONSTRUCTION CO Owner: COLEMAN BOULDERING LLC
PO BOX 2533 ATTN:ANDY COLEMAN
WILSONVILLE, OR 97070 16255 SW UPPER BOONES FERRY RD
TIGARD, OR 97224
PHONE: 503-925-1280 PHONE:
FAX: 503-678-4221
FEES
Quantity Description Date Amount
200 If Storm Sewer 06/07/2018 $100.06
Specifics: 1 12%State Surcharge- 06/07/2018 $12.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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 95 -I I -i i•1. You may obtain a copy of the rules
or direct questions to OU by calling 50,E 32.1987 1.800.332.2344.
Issued By: A Permittee Signature:
ir ,
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
Building Fixtures FOR OFFICE USE ONLY
Q��=�X �j
City g of Tigard Received
- `J Permit No.: "fin13125 SW Hall Blvd.,Tigard,OR 97RECEIVED Date/By: 5 '- /i )
, �
•
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960r�"Date/By. �-^ �,+/G 04 Other Permit No.:
Inspection Line: 503.639.4175
TI G A R D Date Ready/By: urns: ® See Pa e 2 for
Internet: www.tigard-or.gov MAY 2 4 2 018 / /t' g
Date : fl O a� / Supplemental Information
y ' TYft, OF Wf3 "'E* SCHEDI33.E
TTY OF TI ARD
❑New construction • 1 .1' ' For special information use checklist
DIVISION Description Qty. Ea. Total
ffie4ddition/alteration/replacement iii er: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CA!I3ORY"OFM'CONSTRUCTION ,,. ' '' SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
ElAccessory building ElMulti-family
SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder g Other:rj 4-ellri+ ON/Rif f c pyo
y Fire sprinkler sq. Page ft.) g 2
:'w JOB
, 1TE„1[VFRMr*fi01T. 1b LOCATIOfyit cs;; Site utilities:
Job site address: 1 ((i S 5 U(r-Qir' rvy Catch basin or area drain 18.76
- Drywell,leach line,or trench drain 18.76
�(
City/State/ZIP: t l/G rd
OR. 17 -zit
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project" na e: (rc,,vt 13`!d.e/ctth G Manufactured home utilities 50.03
N 1
Cross street/directions to job site: Ni (,6 J ave OF Po r('H a>r) + a✓ Manholes 18.76
a1 50 U 1 F e.S FT {v1 RagcJ Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2 /a) Ll Ga
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: 7(TO Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
1 ; '4'. t ;ti"„, "'OF WORK �� tiBackwater valve
12.51
140�Q Clothes washer 25.02
LF 0C- 5 w' d t' f p 112-e' 1 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
• , O OWNER wt :; .=f n Expansion tank 12.51
Name: Mr, I}+r1 G`1 c Q 1 e yy, G nFixture/sewer cap 25.02
Address: L 050c, suj tli GCt cla Floor drain/floor sink/hub 25.02
rn
Garbage disposal 25.02
City/State/ZIP: P ex.1\a -4 c - 9 -72-3 9 Hose bib 25.02
Phone:(503) g4,&., (QO20 Fax:( ) Ice maker 12.51
P A Co =CT P ON � Interceptor/grease trap
25.02
Medical gas(value:$ ) Page 2
Business name: C.G5/v� _�
tie J ter f.6. PLS. Primer 12.51
Contact name: R.,n�Cm 1('Ui +�'
Address: j l C�(� � �(a 1 Roof drain(commercial) 12.51
i Ste. J O Sink/basin/lavatory 25.02
City/State/ZIP: "1-1 1 6 r-c,c Solar units(potable water) 62.54
Phone:(c03) CI (p kig (D Fax::( ) Tub/shower/shower pan 12.51
E-mail: t U,,)!2`l e„ c Urinal 25.02
n` Water closet 25.02
ONTRACTO1 5>°.: t. .
Water heater 37.52
Business name: tty 1 vN } (A1;„&.5:}rv�,4-;t. Waterpiping/DWV 56.29
Address: a 3 Q A, c,/,� 'Re(- N. /A Other: 25.02
City/State/ZIP: 4vv-L,r,l 0 f 1.)
oc �- ! ' Subtotal idCf.CL,
Phone:(5-6 3) 6 ) if -�'( Fax:( ) Minimum permit fee: $72.50
CCB Lic.: /624/&, ,t Aiii._-._ Plumbing Lic no.:3 d y(O� ` o
6'!! State surcharge(12%of permit fee) if,/,0 I
Authorized signature: I'y►/. 7// L,.
TOTAL PERMIT FEE 1i ,LI7
Print name: '' This permit application expires if a permit is not obtained within 180 days
h O�i y e�lQ,,,�` Date: Jr�G¢l� 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:
bite Utilities
Qty.. Fe,),' Total ghtiare FQ,c tage P,e it Fee: x Aa
Footing drain-1't 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
`�'aluaRion: PeiAlt r
: = lt Fee
Storm&Rain Drain-1st 100' j 62.54 74,- $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' l/ 37.52 y 7, ), $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
a) Total each additional$100.00 or fraction thereof,to
dit r Ins i ections': r Fees Qty fQ
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: rl 1`id.
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*. Platt Review for, lamb ,..1 a +tts,
Quantic-by Fixture Type ry Plan review is required for any of the following.
Fixture Type for 4eplaee7 Please check all that apply.
Work performed: tapped Added 7.440eate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
!. �
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2