Permit (2) CITY OF TIGARD PLUMBING PERMIT
! COMMUNITY DEVELOPMENT Permit#: PLM2019-00245
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2019
Parcel: 1S136DD02300
Jurisdiction: TIG
Site address: 11799 SW 69TH AVE
Project: HAMPTON INN&SUITES Subdivision: Lot:
Project Description: Interior plumbing for a new 87,872 sq.ft.five-story, 152 room hotel. 4/6/2020: REPRINT permit to change
contractor. 8/15/2020: REPRINT permit to change contractor.
Contractor: SOUTH CLACKAMAS PLUMBING Owner: DVKOCR TIGARD, LLC
13355 S MOLALLA FOREST RD 1419 W MAIN STREET, SUITE 110
MOLALLA, OR 97038 BATTLEGROUND,WA 98604
PHONE: 503-480-9630 PHONE: 360-723-0024
FAX:
FEES
Quantity Description Date Amount
t ea Drywell, Leach Line or Trench 10/08/2019 $18.76
Specifics: Drain
2 ea Backflow Preventer 10/08/2019 $62.54
Type of Use: COM 1 ea Backwater Valve 10/08/2019 $12.51
Class of Work: ALT 2 ea Clothes Washer 10/08/2019 $50.04
Type of Const: 1 ea Dishwasher 10/08/2019 $25.02
Occupancy Grp: 2 ea Drinking Fountain 10/08/2019 $50.04
Stories: 3 ea Ejectors/Sump 10/08/2019 $75.06
ea Expansion Tank 10/08/2019 $12.51
39 ea Floor Drain/Floor Sink/Hub 10/08/2019 $975.78
10 ea Hose Bib 10/08/2019 $250.20
5 ea Ice Maker 10/08/2019 $62.55
2 ea Interceptor/Grease Trap 10/08/2019 $50.04
16 ea Primer 10/08/2019 $200.16
37 ea Roof Drain(Commercial) 10/08/2019 $462.87
202 ea Sink 10/08/2019 $5,054.04
152 ea Tub/Shower/Shower Pan 10/08/2019 $1,901.52
Total $18,865.33
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 UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,/ /1 .11x, P—/ ermittee Signature: �1// ejt7"/o
��/ 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 RECEIVED , t,k tri I Ic l 1 ,4 (t.I 1
City ofa rd AUG 06 2020 ee 6'/i5 20 42a Permit .`.L/t�.20/9'DQ.2yS'
1111 13125 SWW Hall Blvd.,Tigard,OR 97223 Plea Review
■ Phone: 503.718.2439 Fax: 503.598490 ';F TIGARD mt./Br Other Permit No.:
Inspection Line: 503.639.4175
a u D - Date Reedy/By: h
'... .i, Internet www.tigard-or.gov am: See Page 2 for
Notified/Method: Supplemental Information
_ TYPE OF WORK - L FEE* SCHEDULE
g New construction ❑Demolition Far special information use checklist
Description I Qty_ I Ea. I 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 II Conurnxcial/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:
--- .-.,-.--.-.. .. Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1!701 61, , ,*e. I Catch basin or area drain 18.76
City/State/ZIP: TI 0 Drywall,leach line,or trench drain 18.76
/ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: i i n kIn Cif i/fCd 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1... 31.27
DESCRIPTION OF WORK Backwater valve ( 12.51 DESCRIPTION
/ ``, s , - Clothes
25.02
13 !d,t ern f�[(LGIfL•Wna P1uaiibMMt.8&i 81ti .kJftaet Dishwasher 1 25.02
,.,,t,,�� r� PllwI'rbtr+c L1.[., Drinking fountain 25.02
jVh(i) piimio*+'firois'ti✓t PI. I G0M-00 L45 Ejectors/sump 25.02
(PROPERTY OWNER 0 TENANT Expansion tank 12.51
u~ .. Fixture/sewer cap 25.02
Name: /��VK OCR + t 1 ��'` Floor drain/floor sink/hub 25.02
Address: I 4141 J. Maio 6r. 5'TE.I l a
Garbage disposal 25.02
City/State/ZIP: $G tle(iW fh'teL v\IA- `Y 09- Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 5 12.51
r:^ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory jai.
25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) y� / Fax::( ) Tub/shower/shower pan 152, 12.51
E-mail 5-f-c,c l e, (�Cc° t h,('14-C k-t','''� / i Urinal 25.02
� l Lk Yw q,Y�, f JI aler closet !3g 25.02
CONTRACTOR
Business name: �/ ' s,�,.`";.i-��-ma4 Water heater ' 37.52
�lGl, 81ufaINGr� C!utnbi�AU.t� p{( YN1?ins Water piping/DWV 56.29
Address: I3355 5. MaIiU& rn- Other: 25.02
City/State/ZIP:61 bl a G1Q.. 4703 O i Subtotal //t%Qq.4,9
Phone:(503) ilk 2-- $a82 Fax:( )•• Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: 2ik)2 bing Lic.no.: FAB!9`5 I State surcharge(12%of permit fee) /3(A,py
Authorized signature: •„._ TOTAL PERMIT FEE /2 i 774 1 Z.
A p�, ........ if Ttds p"unitt appiiw rn
doe e�ires a permit Is not obtained within I )days
I Print name1•/ / AC( Date:, 5/Z®ZQ after It has been accepted as mptete.
"Fee methodology set by Tn-County Building Industry Service Board.
l:16aildinglPemrits1PLMr1-PeaorApp.doc 10/O1/09 440.4616T(10/02/COM/WEB) A/n7•t7"7V -
Dianna Ornelas
From: #Building Permit Technicians
Sent: Friday, August 7, 2020 12:00 PM
To: 'Stacie Cotnam'
Subject: RE: Plumbing permit application
Hello Stacie, �r�� p "e' I
�`
Thank you for the application submittal. le0
I have confirmed with the original plumbing contractor that they approve of this contractor change and there will be a
charge of$45.00 to change the contractor and reprint the revised permit.
The application has been placed in the que for processing. Due to the current working conditions, we are experiencing
significant delays in processing permits. Please allow 1-3 weeks for processing and the permit technicians will contact
you when the permit is ready and with instructions to pay permit fees online.
Thank you for your patience during this time.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From:Stacie Cotnam <stacie@southclackamasplumbing.com>
Sent: Wednesday, August 5, 2020 10:57 AM
To: #Building Permit Technicians <TigardBuildingPermits@tigard-or.gov>
Subject: Plumbing permit application
Warning!This message was sent from outside your organization and we are unable to verify the sender.
Please see attached application. We are South Clackamas Plumbing (Nick Blackman Plumbing, LLC) CCB 216021. We
have currently taken over the work at this location. We need to be added to the existing permit PLM2019-00245
Stacie Cotnam
Office Manager
South Clackamas Plumbing
stacie@southclackamasplumbing.com
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