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Permit Support Document (2)0 A/"9- z--- ''' ...T/71"6' 0 Plumbing Permit Application UI %1'0 ret ' -Building Fixtures �'�'` j\i3O %y7* •,• REUI-T, ., FOR OFFICE USE ONLY City of Tigard Received 3�� j / � III r� 9 Permit Na v 13125 SW Hall Blvd.,Tigard,OR 97 R 2017 y' r "6/1( 7d17-ow FO _ Phone: 503 718.2439 Fax: 503.598,1960 Plan Review n � p- DateBy: Q,� /_,2PJ 401/ Other Permit No.: U7OI 5, i Inspection Line: 503.639,4175 ±E:; ) r 1 R"t"1! - /for TIGARD CIS ' NoDatified/Method: �,�,,�/ luris G3 See age2 for Internet. www.tigazd or gov NoufiedlMethod �/ N1r"r JJ /�//! i7-�V Suppicmentallnrotmahon TYPE O `i2It /114/E, 'FEE* SCHEDULE ; New construction [II Demolition i /4,E/1/ For special information use checklist. . Description I Qty. f Ea. , Total -V ' Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) lllV///���' ❑ CATEGORY OF CONSITIUCTlori SFR(1)bath 312.70 0 1-and 2-family dwelling Inc ommercial/industrial SFR(2)bath 437.78 ' ❑Accessory building ❑Multi-family SFR(3)bath 500.32 ❑Master builder • Each additional bath/kitchen 25.02 ❑Other: Fire sprinkler( sq.ft.) Page 2 ,J JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ' , a Spa Catch basin or area drain 18.76 + � � t 4 ` Drywell,leach line,or trench drain 18.76 City/State/ZIP: L7f + Q't �> tall , "' Q �'� Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: k' O_� � " rt t 4.�,.Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 ",tt, 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 A 31.27 1 a, DESCRIPTION OF WORK Backwater valve 12.51 6 Clothes washer Lucat1 I' 1 ' rlPit._ROM Fitt C t-. '�,,,-r �/rj •' Dishwasher 25.02 25.02 p�5-�, , ,'. f Drinking fountain ,e/ 25.02 ,a ,. og Ejectors/sump 25.02 r PROPERTY OWNER 0 TENANT Expansion tank I 12,51 /a,. 5/ Name: w tvv�01 Floor drain/floor sink/hub Fixture/sewer cap / 25,02 r� 6, 4 2/ 25.02 /C)O,U i A0" Address: n a„. � tt" Garbage disposal 25.02 City/State/ZIP: �T` }~` B �° Y �. i1 Lit,,,► k -p '".1 hose bib 25.02 Phone: Fax: a 12.51 „s,oa ( ) ( ) Ice maker AJPLICANg' C:CONTACT PERSON Interceptor/grease trap 25.02 Business name: M c `rs {"'tl /I PrimerMedics gas(value:$��) Paget 1 I 12.51 ;3'r e Contact name: MA 1...¢t ,8i.- Roof drain(commercial)/0ver a, 4 12.51 Address: 5.03 6- , , Lt ! 4. Sink/basin/lavato rS' '3c90 r 24 go 25.02 puoJ,•40 .' I 1 City/State/ZIP: il°l" .,ky rite. j� Solar units(potable water) 62.54 Phone:(Vila)9-sal--i Fax: :( ' )rseirl-----741:5 Tub/shower/shower pan { 12,51 /6j� Urinal 25.02 E-mail: ��-y �� .}, ) ,_ j.,x,c1nV �`--^V� ( t Water closet rgi 25.02 ro-"r2�r�/, : -'- y Water heater 1 37.52 a/ 5 ol. CONTRACTOR Business name: irAa � v(l,I" i L0 Water piping/DWV l ,.^dam^ P p g/DWV / 56.29 ."�.•nl ,Y„r, i .. Address: 3 'tw";»i: `t�i". ) 4-� Other:C0r-I :31 (.c16-14 1.5 25.02 315/So •.t+/"'. I Ciry/State/Z1P: x"g y tO 1702, GRiD4 (!- ,1 .2. 'S P?Y-l- )I Subtota Phone:( a3 Fax:( e.. , r- ( ,; ; -/= 1, �.R.�=AMinimum permit Fee: $72.50 CCB Lic.: 5 1 air Plumbing Lie.no Plan review (25%o of permit fee)... �j?y?,3 'a � State surcharge(12%of permit fee) j Authorized signature: P .�" y /' ; TOTAL PERMIT FEE I Date rim This permit application expires if a permit is not obtained within 180 days Print name: pC.,, $, ` 8, after it has been accepted as complete E 'Fee methodology set by Tri-County Building Industry Service Board, T:\Building\Pormits\PLMU-PermitApp.doc 10/01/09 440-461GT(10/02/C w7M/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site i Ttilties Q . Fee(ea) 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' 62.54 3,601 to 7,200 $233.20 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Water Service-each additional 100' 37.52 Medical Gas Systems: Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee; Storm&Rain Drain-each additional 100' $1.00 to$5,000.00 Minimum fee$72.50 37.52 $5,001,00 to$10,000.00 $72.50 for the first$5,000.00 and$1,52 for each additional$100 00 or fraction thereof,to Other Inspections or Fees Qty. Fee(ea) Total Inspection of existing plumbing or for and including$10,000.00. which no fee is specifically indicated $10,001.00 to$25,000.00 $148,50 for the first$10,000.00 and$1.54 for P Y90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-I/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: '; 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 Platt Review for Plumbing Installations ' Fixture ixture Type for Re lace/ V rformed; Capped Added Relocate Plan review is required for any of the following. Baptistry/Font - Please check all that apply. Bath Tub/Shower ❑ Any new commercial building with water service 2"and Jaeuzai/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic / ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040. Eye Wash - Floor Drain/sink -2" '- Submit 2 sets of plans with any of the above. 3,, / Isometric or Riser Diagram Car Wash Drain Garbage Domestic-non-food - El Isometric or riser diagram is required for new buildings Disposal -Domestic-food related - that meet the qualifications above, -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall l Sink/Lav -Non-food related ?I. 2 i 1 -Bradley -Commercial-food related -Service Swimming Pool Filter Washer-Clothes tN *Note: If the fixture work under this permit results in an Washer-Extractor f ilo t7 increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet _ 6•/ 8T fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: http://www.tigard-or.gov/document_centerBuilding/PLMF PermitApp.dg 0 Plumbing Permit Applicati . C IV D A iS�:1) / /3L'!£1-77ON SW Site Utilities �± 7 AUG 1 4 201( Received Er11 of Tigard Permit No. Yg Date/By: cf/.f /7 �LMo'tOl7 t�t'1�D SW Hall Blvd.,Tigard,OR 7OF TIC>tA D plan Review Other PetN4`i 0/7 ooe�9y Phone: 503.718.2439 Fax: 503. 6D 1 DatelBy: T I GARD Inspection Line: 503.639.4175 [ DING ni�3 /�lJ Date Ready/B1311Iy: wds: See[age 2 for Internet: www tgard or gov A !1� i 1 DIVISION Notdied/Method: Supplemental Information .., .i :,-A E* ``� T V.•? -,f '17•Mrt ,. •r, F.E SCIiEUYJI:$ 1 W ®New construction El Demolition For special information use checklist Z Description I Qty. I Ea. I Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) 93 SFR(1)bath 312.70 - CATEGORYUF CONSTRiICTIONr Ax';--•,. SFR(2)bath 437.78 El 1-and 2-family dwelling (Commercial/industrial NJ SFR(3)bath 500.32 ❑Accessory building ❑Multi-family t Each additional bath/kitchen 25.02 ❑Master builder 0 Other Fire sprinkler( sq.ft.) Pg JOB S1tIt INFORMATION AND tOC& Ql+1 n Site utilities: Catch basin or area drain 18.76 Job site address:Undeveloped lot -- - Drywell,leach line,or trench drain - 18.76 City/State/ZIP:Tigard/Oregon/97223 7'4/41A/-6--y6"- Footing drain(no,linear ft.: ) Page 2 Suite/bldg./apt.no.:- Project name:72nd MOB ma/at omeg- Manufactured home utilities 50.03 Cross street/directions to job site:SW of the intersection of SW 72nd Avenue Manholes 18.76 and SW Dartmouth Street 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.:2S101BA/300 Backflow preventer 2 31.27 6 2.Ste[ DESCRIPTION OF WORK : Backwater valve 12.51 ;., Clothes washer 1 25.02 Z5.OLl. . Construction of 36,000 if medical office building and accompanying lynch style Dishwasher { 25.02 $, Ye catch basins,stormwater detention,water quality treatment,sanitary Drinking fountain • 25.02 op,t'i3 connection,domestic water connection,and fire water connection. Ejectors/sump j 25.02 _ ®`PROPEI'1 k OWNER ❑ fl NA'Nt :. Expansion tank l 12.51 /l. Si( Name:Base Camp 1,LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 41 25.02 /CD, O Address:29080 SW Petes Mountain Road Garbage disposal 25.02 City/State/ZIP:Nest Linn/Oregon/97968 Hose bib 3 25.02 75.is 1j Phone:(5(13)880-5623 Fax:( ) Ice maker 2- 12.51 2' :0•L ® AlPLICANT ❑ 'CONr'ACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name:Base Camp 1,LLC Primer 12.51 26, OZ. Contact name:Brian Bennett Tog drain(co erciai) ?it , 12.51 1c(),i 2. Address:29080 SW Fetes Mountain Road 3i&basin/la\4ry 13Z 25.02 2V.551,t4 City/State/Z1P:West Linn/Oregon/97968 Solar units(potable water) 62.54 Phone:(503)880-5623 Fax::( ) Tub/shower/shower pan 1 12.51 1?.S Urinal 25.02 E-mail:Bennettdevelopment@gmad com a er c oset W t t ;f,� 25.02 5,2.5., ' Wate h t E 37.52 3 75 L Business name:Lease Cruteber Lewis Water piping/DWV I 56.29 51y.2-1 Address:550 SW 12°i Avenue Other: Str Pad 4 //ea) jS 25.02 City/State/ZIP:Portland,Oregon 97205 UAW KS t•i5Z-1"--- SubtotaL 3Z s 5- Phone:(503)233-0500 Fax:(503)223-2874 Minimum permit fee: $72.50 CCB Lie.:92919 Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) - 11,©b • Authorized signature: TOTAL PERMIT FEE-11 ' Pt'ir,t name: Date: This permit application expires if a permit is not obtained within 180 days AV- after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. Ltfluilding\Pennits\PLMU-PennitApp.doc 10/01/09 440-4616TO0/02/COM/WEB) Plumbing Permit Application - City of Tigard . Page 2 -Supplemental Information Fee Schedule: ... ... ... .. . Residential Suppression f It 1t h: Fee .....x to ... tc. C1 < s. . ... :..:; .::.•.... ... . .... .,.., .. .. .. � � • , AT #<;�Q,F� `?. ., „. b Fuotmgdraut-I''100' 50.03 0 to 2,000 $121.90 Err chain-each additional 100' 37.52 2,001 to 3,600 $169.69 Sc cr-1st 100' 62.54 3,601 to 7,200 $233.20 7,201 and greater $327.54 Sewer-each additional 100' 37.52 • • Water Service- lit 100' 62.54 i Wager Service-mil 37.52 additional 100' Medical Gas Systems: Storm k.Rain Drain- i1 nation a:;'i ;? :it:i` 62.54 - a 1st 100' !�'�'��, .[.t`.:£E:.:�pia;'5 '.<:j:i:;; ii:::.`:=�. ii<~:``-:` • $1.00 to$5,000.00 Minimum fee$72.50 SI: k';.Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the fast$5,000.00 and$1.52 for } t rnspectioIlS or;Tees, < Q3 _ .ee.(en '_,•;Total each additional$100.00 or fraction thereof,to Ins loll of existing plumbing or for and including$I0,000,00. ,vn, ;,no fee specifically indicated $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for p Y 90.00/hr each additional$100.00 or fraction thereof,to • (minimum charge-1/2 hour) and including$25,000.00. • • Insl,ections 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 Hour.�inininmm charge-2 hours) each additional$100.00 or fraction thereof,to Rein ;+cction Fees 90.00/hr and including$50,000.00. Ad i nil plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the fist$50,000.00 and$1.20 for (m am charge_l/2 hour) each additional$100.00 or fraction thereof, Subtotal: Cep'-,mercial Fixture Work: Ar capping,adding or replacing fixtures? If"yes", pie, : 'iicate work performed by fixture. Failure to ace'_ ',ly report fixtures could result in increased sewer fees*. `Quantity by Fixture Typc. = _•s_,:::; F-a ; , 'lan .e ae*for.1iunibi ngiTn ta`TIatons::"' �'• `Re orate. Plan review is requiredany g biro r r(tn mcd: "Capped :Added Relocate:: for of the following. Bap? �-/Font Please check all that apply. Batt rub/Shower - - 0 Any new commercial building with water service 2"and -Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed Car' , -Each Stall engineer. -Drive Thru J 0 New exterior plumbing site utilities forany complex structure Cm,` 'tip:,ter A pirator - as defined in OAR91$-780-0040. Dish -r -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic ! - 0 Any multipurpose fire sprinkler system. Drip :'untain 0 Any complex structure as defined in 0AR918-780-0040. Eye Floor lnhink -2" P... _ Submit 2 sets of plans with any of the above. Car Wash Drain _...::.. -:.:... .. -. Q�' $�1"�i. .:Jla�°,r1C11Ii -i�r: l:-;.: .;iy:.'.i. Garb Domestic-nun-food - Cl Isometric or riser diagram is required for new buildings Dispc -Domestic-food related that meet the qualifications above, -Commercial-food related - -lndustrial-food related Ice is /Reri•ig.Drains Oil S, do/(Gas Station) Comments regarding fixture work: Rec. dc Dump Station Show' -Gang -Stall Sinkf -Non-food related i ool -Bradley -Commercial-food related -Service ilo ' Swir>. i'ool Filter yVasl o ncs - *Note: If the fixture work under this permit results in an Ware, actor of sewer EDUs,a sewer permit will be issued and Water set-Toilet AI fees assessed for the sewer increase must be paid before the Urin plumbing permit can be issued. Other ;rsr: http://'. •,v.tigard-or.gov/document center/Building/PLMF_PermitApp,de, - ' Plumbing Permit Application Se E 1PLn1 jam/ G610 /G_S Building Fixtures FOR OFFICE ESE ONE 1 City of Tigard Date/By:Received Permit No.: 1 III13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review n pL Ot d 11 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: ,` /..ej--o2CJI ( Other Permit No.: T 1 G A R[ Inspection Line: 503.639.4175 Date Ready/By: kris: 65 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE New construction ❑Demolition For special information use checklist Description 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 eKi Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 Accessory building 0 Multi-family 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: f Catch basin or area drain 18.76 ���� ' �t'l1�4hYt1(SIL P` .St' Drywell,leach line,or trench drain 18.76 City/State/ZIP: 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 a ✓ 31.27 lo_,5e{ DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1/ I ✓✓ 25.02 ,35:04- 1,,-"-&r:41t •L .u-t"• a i h-1 Dishwasher / j ✓✓✓ 25.02 )5 A a Drinking fountain ,...- 4`'t/ 25.02 1IXU,091 Ejectors/sump 25.02 0 PROPERTY OWNER ❑ TENANT Expansion tank i ✓ 12.51 %a,5 i Name: r f1.t....{,c,,...a�� Floor drain/floor sink/hub ," 4 vi/ 25.02 a OCR dad} Address: Garbage disposal 25.02 City/State/ZIP: Hose bib ✓ 25.02 rj r 66 Phone:( ) Fax:( ) Ice maker 12.51 15,6A 0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 31,5.3 Primer 3 ✓ 12.51 Contact name: o drain(comqmercial)JOC16,+1�� 44 12.51 '30'0, Address: i asin/la�afory 7 if ,/ gj 'V 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/sho(ver/shower pan i../ I r/„, 12.51 /01,5 Urinal 25.02 E-mail: Water closet t,, f t'✓ 25.02 5)5 4/; CONTRACTOR Water heater 1 / 37.52 xi,5 Business name: Water piping/DWV 1 ✓ 56.29 4,ell Address: Other: 15 ✓ 25.02 t 5 1 City/State/ZIP: C.r_f s L5 6.,i g,art r/),.J;3 i Subtotal•31)7A,"-)it Minimum permit fee: $72.50 3FN.�� Phone:( ) Fax:( ) ri��=`��(YI x-/= I / CCB Lic.: Plumbing Lic.no.: p�ta /, p/j.1/=3 Plan review (25%of permit fee)✓ 4 q' State surcharge(12%of permit fee)v 214,4 i Authorized signature: TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained in 80 days` after it has been accepted as complete. dir ✓r.2C.7.d 9 *Fee methodology set by Tri-County Building Industry Service idoard. I:\Building\Permits\PLMU-PermitApp.doc 10/O1/09 440-4616T(10/02/COM/WEB) gge#/�� /� /� �� � eo