Permit CITY OF TIGARD PLUMBING PERMIT
1111 COMMUNITY DEVELOPMENT Permit#: PLM2018-00106
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/27/2018
T[Ca tie ft.L g
Parcel: 2S 111 ACO2700
Jurisdiction: Tigard
Site address: 14650 SW 97TH AVE
Project: Twality Middle School Subdivision: None Lot: None
Project Description: Site utilities for(5)new modular restroom buildings:(5)catch basins,(10)rain drain connectors,237 ft.of sanitary
sewer,519 ft.of storm sewer,and 553 ft.of water service.
Contractor: TRIPLETT WELLMAN INC Owner: UNION HIGH SCHOOL DISTRICT
PO BOX 160 NO. 3 JT
WOODBURN, OR 97071 00000
PHONE: 503-982-4188 PHONE:
FAX: 503-982-0390
FEES
Quantity Description Date Amount
5 ea Catch Basin or Area Drain 03/27/2018 $93.80
Specifics: 10 ea Rain Drain Connector 03/27/2018 $187.60
237 If Sanitary Sewer 03/27/2018 $137.58
Type of Use: COM 519 If Storm Sewer 03/27/2018 $250.14
Class of Work: NEW 553 If Water Service 03/27/2018 $250.14
Type of Const: 1 12%State Surcharge- 03/27/2018 $110.31
Occupancy Grp: Plumbing
Stories: 1 Plan Review 03/27/2018 $229.82
Total $1,259.39
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 952-11-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.3 . -44.
Issued By: ,ee Signature: =LI / A
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
Site Utilities
City of Tigard Received -�- Permit No.: pyotit,y�
64,
13125 SW Hall Blvd.,Tigard,OR 97223 plat,RevreDate/By: w/i �` +3T-7-2,„,r ��� `
Phone: 503.718.2439 Fax: 503.598. 960 ?, , + �01 DateBy: 3 f�'�cl r
Other Permit No.: tir ,3
��l� Inspection Line: 503.639.4175 a,,e Ready/By: loci. ® See Page 2 for
Internet: www.tigard-or.gov $'f 01,1 1 �� �!.fied/Method: ,",�d(4j Supplemental Information
1 is n a
TYPE OF WORK :� �DULE
��.�� e �Lll�r � � 1�� tt. FEE*,
®New construction 0 Demolition - d'„ kvfor special inform:lion use checklist
cription 711 I Qty. Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 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 ®Other:Manuf Strucs Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION ANI)LOCATION Site utilities:
Job site address:14650 SW 97th Avenue Catch basin or area drain 5 18.76 qG
Drywell,leach line,or trench drain 0 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.:0) 0 Page 2
Suite/bldg./apt.no.: I Project name:TMP/TMS Modulars Manufactured home utilities 0 50.03
Cross street/directions to job site:965h&Murdock -Modular Units located Manholes 0 18.76
in the center of the Twality Middle School track. Rain drain connector
).-37110 18.76 ' 60
Sanitary sewer(no.linear ft.:,250r 3 Page 2 1311 s8
Storm sewer(no.linear ft..,,.5 1 sic( 6 Page 2 a 5„,1,4..
litat
4-
atat r serviee-(ne cucat fl. 3= -' J I S.40„..i4
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.:2S111ACO2901 Backflow preventer 0 31.27
Backwater valve 0 12.51
D S+ RIPTION OF"WORK.
Clothes washer 0 25.02
All site utility work required to install(5)new modular restroom structures. Dishwasher 0 25.02
All stormwater management necessary to complete site work. Drinking fountain 0 25.02
o
Ejectors/sump 0 25.02
it PR' OWNER T'. ❑ ANT _ Expansion tank 0 12.51
Name:Tigard Tualatin School District Fixture/sewer cap 0 25.02
- Floor drain/floor sink/hub 0 25.02
Address:6960 SW Sandburg Road
I Garbage disposal 0 25.02
City/State/ZIP:Tigard,OR 97224 - _ 4 Hose bib 0 25.02
.-
Phone:(503)523-8103 Fax:( ) Ice maker 0 12.51
814 APPLICANT .❑ CONTACT PERSON Interceptor/grease trap 0 25.02
Business name:Day CPM Medical gas(value:$ ) 0 Page 2
Primer 0 12.51
Contact name:Angela Caffrey
Roof drain(commercial) 0 12.51
Address:6960 SW Sandburg Road Sink/basin/lavatory 0 25.02
City/State/ZIP:Tigard,OR 97224 Solar units(potable water) 0 62.54
Phone:(503)523-8103 Fax::( ) Tub/shower/shower pan 0 12.51
E-mail:acaffrey@daycpm.com Urinal 0 25.02
Water closet 0 25.02
CONTRACTOR
Water heater 0 37.52
n]
Business name:TBD 1? � " Water piping/DWV 0 56.29
Address: 11.1 l i �' v5 `t _, Other: 0 25.02
City/State/ZIP: (N)O t t to ik-V 0. L 1� Subtotal q l - �
c h J
Phone:(�)) Minimum permit fee: $72.50
Fax:( )
- 1 Plan review (25%of permit fee) /a q,9 a
CCB Lic.: /I-31/4o ( P1umbin., i'.no.:
State surcharge(12%of permit fee) f(01, '3 i
Authorized signature: / TOTAL PERMIT FEE l a set ,3
p C This permit application expires if a permit is not obtained within1180 days
Print name: �/l D v(�! C Date: 3 (? I b after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
RBuitding\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:
Site
Utilities Qty. Fee(ca) 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
Sewer-1st 100' 1 62.54 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 2 37.52 15.041
Water Service-1st 100' 1 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' 5 37.52 168.84. 7,bC;
Valuation:
Storm&Rain Drain-1st 100' 1 62.54 62.54 Permit Fee:,
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 5 37.52 187.60 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty.
' F`C(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: 02.8t,
Other Fixtures: 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 Type
Fixture Type for Replace/ o n
Work Performed: Capped Added Relocate Plan Review for Plumbing Installations
Baptistry/Font Plan review is required for any of the following.
Bath Tub/Shower Please check all that apply.
Jacuzzi/Whirlpool ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Dishwasher -Commercial as defined in OAR918-780-0040.
-Domestic ❑ Medical gas and vacuum systems for health care facilities.
Drinking Fountain ❑ 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.
Car Wash Drain Isometric
Garbage -Domestic-non-food or Riser Diagram
Disposal -Domestic-food related 0 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
-Stall
Sink/Lav -Non-food related _
-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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Plumb Site Permit App.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14650 SW 97TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2018-00106
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor