Permit (112) CITY OF TIGARD PLUMBING PERMIT
,1114
. ' COMMUNITY DEVELOPMENT Permit#: PLM2018-00487
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/17/2018
Parcel: 2S103DD01100
Jurisdiction: Tigard
Site address: 13939 SW PACIFIC HWY
Project: Providence Retail Clinic Subdivision: None Lot: None
Project Description: ADD(2)service sinks for new tenant.
Contractor: ADVANCED TECHNOLOGY GROUP Owner: WALGREEN CO#5780
455 SE 2ND AVE PO BOX 901
HILLSBORO, OR 97123 DEERFIELD, IL 60015
PHONE: 503-693-9202 PHONE:
FAX: 503-640-4333
FEES
Quantity Description Date Amount
2 ea Sink 10/17/2018 $50.04
Specifics: 22 Minimum Fee Adjustment- 10/17/2018 $22.46
Plumbing
Type of Use: COM 9 12%State Surcharge- 10/17/2018 $8.70
Plumbing
Class of Work: ALT 1 ea Investigation Fee 10/17/2018 $90.00
Type of Const: 1 ea Investigation 12%State 10/17/2018 $10.80
Occupancy Grp: Surcharge
Stories:
Total $182.00
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. Yo 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: , /
A . L. di
'
Call 503.639.4175 by 7:00 a.m.for the next available insp-ction date.
This permit card shall be kept in a conspicuous place on the job site u it completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building FixturesFOR OFFICE USE ONLY
City of Tigard
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Date y::/'6 ",. ff Permit N9pl.H 7/rf�Qd If7
lig • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ,/_"
Phone: 503.718.2439 Fax: 503.598.1960 p ,,2�I
� (plate/By:
ateBy: Other Permi /� /�e �
Inspection Line: 503.639.4175 I j[ 1, 1 �.U I`Date Ready/By: Duds: Bf See Page 2 for �°
TIGAItHg
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
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❑ ❑ �r�y �r i For special information use checklist.
New construction Der itiD PING DA 1.,,t
h,.'9. ^ Description I Qty. I Ea. I Total
®Addition/alteration/replacementi" III Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
� 11
j( 11W:. O GO1t"Y OF CONSTRUCTION _ jjdli) SFR(1)bath 312.70
❑ 1-and 2-family dwelling Z Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ['Other: Fire sprinkler( sq.ft.) Page 2
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w.E'�-- iii i ,-.�- °� i
)1 1OB',`SITE INFO.IRMA'plON-AND 1.O AtIOI 05:' ' Site utilities:
Job site address: 13939 SW Pacific Highway Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard/Oregon/97223
?1/t tt /41)14 at w. Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name,; ' Manufactured home utilities 50.03
Cross street/directions to job site: 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 31.27
11•1101"--;'''''''''
- p ' DE-'''''''''''''''4"'''''
}iiiTQN OF WOo��
,,,;-,i,11111,9,19$-,',.'- Backwater valve 12.51
tW o „ F. : ii'''
Clothes washer 25.02
Installation of new two new sinks
rZitki Dishwasher 25.02
I I I -.4:0P
f'� ' - 1L_,/ //ii pz r"I Drinking fountain 25.02
/" f Ejectors/sump 25.02
RI Ir :I'ROPERT.' QWNER '�� ?. :. - L ❑ TE° ;NT I1,1II�1N1. Expansion tank 12.51
Name:Providence Health&Services-OR Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25,02
Address:4400 NE Halsey,Building 2,Suite 190
Garbage disposal 25.02
City/State/ZIP:Portland/OR/97213 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
` 2( APPrT ANT` -'W3-,4):4,,,,,..i . - ,�Iti❑. oNTAtT PERS - Interceptor/grease trap 25.02
Business name:Advanced Technology Group,Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Michael Hudson
Roof drain(commercial) 12.51
Address:455 SE 2"d Avenue Sink/basin/lavatory 2 25.02 50.04
City/State/ZIP:Hillsbobo/OR/97123 Solar units(potable water) 62.54
Phone:(503)545-0249 Fax::(503)640-4333 Tub/shower/shower pan 12.51
E-mail: michaelh@atgweb.com Urinal 25.02
P, ' igH 2 1,6ONT1 ACTOReW �rnfN
Water closet 25.02
,ogo,1 . - 991 ! 4Cu�. .,,,,94.,6,-,.- � P-- .., � A
Water heater 37.52
Business name:Advanced Technology Group,Inc. Water piping/DWV 56.29
Address:455 SE 2"d Avenue Other: 25.02
City/State/ZIP:Hillsboro/OR/97123 Subtotal 50.04
Phone:(503)693-9209 Fax:(503)640-4333 Minimum permit fee: $72.50 702,Spry
CCB Lic.:130364 Plumbing Lic.no.:34-399PB /N����6.fini �� 41
State surcharge(12%of permit fee) cp. -70
Authorized signature: TOTAL PERMIT FEE /17¢2,Gre
Print name:Michael Hudson Date:10/11/18 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
C\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:
Site Utilities = Qty. Fee ca) Total Sgjiarc eet ge.R nidi' i''' Permit Fee: R n
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 ' . � � ��y:�� b„��� u�;" •+
Val latlOr : PermitF; i g01�u 6 tii dou
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$5,000.00 and$1.52 for
-77
Other Ins ections'or Fees Qty, Fee(ea) Total each additional$100.00 or fraction thereof,to
h 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:
Other Fixtures:
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!
' Plan Re 0fClP111 IngiIniti d 1UnS
WarkFerformed• Capped AddedRelocate :!
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 ❑ 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 °; d�'i6 v9�� `�i�i�i���� {-r
Garbage -Domestic-non-food I'IC flr RIset 1 1'"d
Disposal Domestic-food related ❑ 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 ATG's scope of work was the installation of two clinic sinks
-Stall
Sink/Lay -Non-food related 2 and faucets.All other plumbing work was performed by
-Bradley by others.
-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
\\atg-nas\FDrive\ATG Job Folder\_MRH Jobs\_In Progress\MRH180070_2Valsh_Providence Express_051118\17-
Permits\PLMFPermit 101118.doc
Dianna Howse
From: Branden Taggart
Sent: Thursday, October 11, 2018 11:34 AM
To: Don Sylvester
Cc: #Building Permit Technicians;Walter Barnett
Subject: Providence Retail Clinic: PLM2018-00301 - 13939 SW Pacific Hwy
Attachments: Branden Taggart.vcf
Hi Don,
I spoke with Michael Hudson from Advanced Technology Group regarding the interior plumbing work at the Providence
Retail Clinic for(2) new sinks that were added, and this work was in fact completed without a permit. I will be adding an
investigative fee of$100.80 to their permit once we process it. The remaining work that you noted at the plumbing final
inspection for PLM2018-00301,for(2)water heaters and (1) hub drain,was completed by Cascade Plumbing. I just
wanted to let you know that a second plumbing contractor was involved.
Thanks,
Branden Taggart
* City of Tigard
Mr Senior Permit Technician
Community Development
tQ
13125 SW mall Blvd
Tigard,OR 97223
(503}718-2449
brandent tigard-or.gov
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
1
Branden Taggart
From: Branden Taggart
Sent: Thursday, October 11, 2018 11:19 AM
To: 'Michael Hudson'
Cc: #Building Permit Technicians
Subject: RE: Building permit application: Providence Retail Clinic - 13939 SW Pacific Hwy.
Attachments: Branden Taggart2.vcf
Thank you, Michael. Please allow 2-3 business days for processing. We will contact you when the fees are ready to be
paid online. The fees will be as follows:
Plumbing permit: $81.20
Sewer permit: $1,412.50
Investigative fee for work without permit: $100.80
Total: $1,594.50
Thank you,
Branden Taggart
q. City of Tigard
II a° Senior Permit Technician
Community Development
MARA
13125 SW Hall Blvd
Tigard„OR 97223
(503}718-2449
brandent@tigard-or.gov
From: Michael Hudson [mailto:michaelh@atgweb.com]
Sent:Thursday, October 11, 2018 10:53 AM
To: Branden Taggart<brandent@tigard-or.gov>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: RE: Building permit application: Providence Retail Clinic- 13939 SW Pacific Hwy.
Branden,
Here is the revised, signed, application, thanks.
Best Regards,
Michael Hudson, PMP Project Manager
455 SE 2nd Avenue, Hillsboro, OR 97123
M. 503.545.0249
michaelh a(�atoweb.com
atgweb.com
1
From: Branden Taggart<brandent@tigard-or.Rov>
Sent:Thursday, October 11, 2018 10:37 AM
To: Michael Hudson <michaelh@atgweb.com>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: RE: Building permit application: Providence Retail Clinic- 13939 SW Pacific Hwy.
Hi Michael,
Thank you for the application. However, per our conversation, (1) hub drain and (2) water heaters will also need to be
added to the scope of work—if your company installed them. If Cascade Plumbing installed these fixtures,then you do
not need to add them to this permit. As previously stated, we need you to complete the Commercial Fixture Work
section on the second page. Lastly,we will need you to sign the permit application before we can proceed. I will be
adding an investigation fee for work without a permit, and this fee will be $100.80. Please let me know if you have
questions.
Thanks,
Branden Taggart
it City of Tigard
lo �" Senior Pernit Technician
Community Development
TIGARD
13125 SW Hall Blvd
Trgard,OR 97223
(5031718-2449
bra ndent r-,tigard-or.gov
From: Michael Hudson [mailto:michaelh@atgweb.com]
Sent:Thursday, October 11, 2018 10:24 AM
To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Building permit application
Brandon,
Attached is the plumbing permit application for the Tigard Express Care Clinic I called you about.ATG's scope included
installation of two each clinic sinks and the faucets, we did not do anything with hub drains.All other plumbing work was
performed by others (see PLM2018-00301). Please let me know if there are other questions,thanks.
Best Regards, ,
Michael Hudson, PMP I Project Manager
455 SE 2nd Avenue, Hillsboro, OR 97123
M: 503.545.0249
michaelh(a,atgweb.com
atgweb.com
/4\`1 1.,
G
,._,
,„, ..
2
.
--
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requemhad, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
3
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13939 SW PACIFIC HWY, TIGARD, OR, 97223 October 18, 2018 at
9:26:11 AM
Record Type: Record ID:
Commercial - Plumbing PLM2018-00487
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor