Permit •
CITY OF TIGARD • PLUMBING PERMIT
• °.E COMMUNITY DEVELOPMENT Permit#: PLM2013 00082
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
® Date Issued: 03/26/2013
Parcel: 1 S 134AA02100
Jurisdiction: Tigard
Site address: 10300 SW NIMBUS AVE P-A
Project: FMC • Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: 3
Project Description: CAP(1)Tub/shower,ADD(1)drinking fntn,(3)3"sink,(4)4"sink,(13)lays,(1)water closet, (2)water heaters,(1)
expansion tank,(3)primers and(2)backflow preventers REPLACE(1)domestic dishwasher,(1)2"sink,(3)lays,
(1)service sink and(2)water closets. 7/18/13,additional plumbing fixtures added to scope of work.
Contractor: D P PLUMBING Owner: FRESENIUS MEDICAL CARE, NA
15825 NE SPRINGBROOK 5251 DTC PARKWAY
NEWBERG,OR 97132 GREENWOD VILLAGE,CO 80111
PHONE: 503-537-9492 PHONE: 303 712-1814
FAX: 503-538-4306
FEES•
Quantity Description Date Amount
2 ea Backflow Preventer 03/26/2013 $62.54
Specifics:, 1 ea Dishwasher 03/26/2013 $25.02
1 ea Drinking Fountain 03/26/2013 $25.02
Type of Use: COM 2 ea Expansion Tank 08/27/2013 $25.02
Class of Work: ALT 1 ea Fixture/Sewer Cap 03/26/2013 $25.02
Type of Const: 12 ea Floor Drain/Floor Sink/Hub 08/27/2013 $300.24
Occupancy Grp: 5 ea Primer 08/27/2013 $62.55
Stories: 18 ea Sink 08/27/2013 $450.36
3 ea Water Closet 03/26/2013 $75.06
2 ea Water Heater 03/26/2013 $75.04
1 12%State Surcharge- 08/27/2013 $135.10
Plumbing
Total $1,260.97
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 • o OUNC by calling 503.232.1987 or 1.800.332.2344.
/Issue. By: (9a Permittee Signature: -Kc
U`7 L�
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.
CITY OF TIGARD PLUMBING PERMIT
a;" COMMUNITY DEVELOPMENT Permit #: PLM2013 -00082
T 1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/26/2013
Parcel: 1S134AA02100
Jurisdiction: Tigard
Site address: 10300 SW NIMBUS AVE P -A
Project: FMC Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 3
Project Description: CAP (1) Tub /shower, ADD (1) drinking fntn, (3) 3" sink, (4) 4" sink, (13) lays, (1) water closet, (2) water heaters, (1)
expansion tank, (3) primers and (2) backflow preventers REPLACE (1) domestic dishwasher, (1) 2" sink, (3) lays,
(1) service sink and (2) water closets
Contractor: D P PLUMBING Owner: FRESENIUS MEDICAL CARE, NA
15825 NE SPRINGBROOK 5251 DTC PARKWAY
NEWBERG, OR 97132 GREENWOD VILLAGE, CO 80111
•
PHONE: 503 - 537 -9492 PHONE: 303 712 -1814
FAX: 503 - 538 -4306
FEES
Quantity Description Date Amount
2 ea Backflow Preventer 03/26/2013 $62.54
Specifics: 1 ea Dishwasher 03/26/2013 $25.02
1 ea Drinking Fountain 03/26/2013 $25.02
Type of Use: COM 1 ea Expansion Tank 03/26/2013 $12.51
Class of Work: ALT 1 ea Fixture /Sewer Cap 03/26/2013 $25.02
Type of Const: 8 ea Floor Drain/Floor Sink/Hub 03/26/2013 $200.16
Occupancy Grp: 3 ea Primer 03/26/2013 $37.53
Stories: 17 ea Sink 03/26/2013 $425.34
3 ea Water Closet 03/26/2013 $75.06
2 ea Water Heater 03/26/2013 $75.04
1 12% State Surcharge - 03/26/2013 $115.59
Plumbing
Total $1,078.83
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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
diAdAhA At Permittee Signature: OM APPti C. -/ (] 1,1_
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.
s
Wa3 /3 .
Plumbing Permit AnnlicR EIVED
Building Fixtures r•o1z OFFICE USE ONLY
City of Tigard MAR 14 2013 Date/By: 313 /3 Sr Permit Nollig clot3-4:00&c
. a 13125 SW Hall Blvd.,Tigard,O Dn Plan Review
C Phone: 503.718.2439 Fax: 5 j98<Ipb�ETIGAf1LJ Date/By: Other Permit NoDtaX a0l3'i s�l
T 1 G A R D Inspection Line: 503.639.417JILDING DIVISION Date Ready/By: I ® See Page 2 for /
Internet: www.tigardor.gov Notified/Method: 7/ l SupplemeotalInformation
TYPE OF WORK FEE* SCHEDULE
la New construction ❑Demolition For special information use checklist tl
Description I Qty. I Ea. I Total
❑Addition/alteretion/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utilit connection) 1
y
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 O
❑ 1-and 2-family dwelling KCommercialrndustrial SFR(2)bath 437.78 6
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
K ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 0300 � ►(l Catch basin or area drain 18.76
. 'result VC Drywell,leach line,or trench drain 18.76
rQ City/State/ZIP: Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: Project name: rr �II
Q rr�C a�70lit art Manufactured home utilities 50.03
* .ft Cross street/directions to job site: Manholes 18.76
J Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) 18.76
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 0 z 31.27 "' c2
i,`LN ' DESCRIPTION OF WORK Backwater valve A 12.51
- e Clothes washer lv 25.02
Philmill 'at df yin Vfi%ft, Dishwasher 4I II/ 1 25.02 (`/ '
a
Drinking fountain � I - r 25.02 ✓. /
Ejectors/sump % 25.02 /�
Z ❑ PROPERTY OWNER I ❑ TENANT Expansion tank . / I. 12.51 0_
Name: Fixture/sewer cap 25.02 /
Floor drain/floor sink/hub 4/62/t to'.. 25.02 ./ /07-
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
-
) Phone:( ) Fax:( ) Ice maker • 12.51
J ❑ APPLICANT 1 ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer ca. 3. 12.51 S
Contact name:
Roof drain(commercial) 12.51 b
.A= Address: Sink/basin/lavatory•• / 1"7 25.02 it
c'
7City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
I I` 'E-mail: Urinal 25.02
Water closet 5.. 25.02
37.52
�/ Water heater 2
CONTRACTOR
Business name: OP r'l(/IIw�I J I Water piping/DWV . 56.29
Address: (S$ �P( 61rot>F 9 9t yf%.' 25.02
1'0 City/State/ZIP: /t/� OR 007/it-- _ /6a, 63 3 I Subtotal
Phone _ ,` 7±"' Fax:( ) Minimum permit fee: $72.50
CCB Lic.: ( D 61 Z 1(I3 O d Plan review (25%of permit fee)
( 2 I Plumbing Lie.no.: 3�- B
if,5Z State surcharge(12%of permit fee)
O Authorized signature: 0b„� Pe& ?(1/I p TOTAL PERMIT FEE
Print name: 11 GYt I Date: �is permit application a res If a permit is not obtained within 180 days
dPl�tK 3 f j \ r n accepted as complete.
5 3 '...5/9 - 7
Q v •F ee methodology set ti-County Building Industry Service Board..
1:1BuildinglPermi ts1PlMU-PemitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) AL it 1°41.-1 Avt
alarrenGeo/cur) 6/.` .c/ • Co nti "
• DATE DONE
CODE DESCRIPTION DISP . DONE BY NOTES
•
(Descending Order)
399 Plumbing final 07/11/2013 FAIL George Heimos Date:7/11/2013
1. Provide hot water at staff bathroom sink.418.0
2 correct toilet not working,staff bathroom. 310.0
3. Provide strainer for floor drain P-16 chair 12/1/
310.4
4. Correct sink P-3 not working in treatment area
•
310.0
5. Provide hot water at patient bathroom sink.
418.0
6. Expose water hammer arrestor for soiled utility
flush sink. 310.4
7. Install water heater vacuum breakers a min 6"
above top of both tanks. 310.4
8. Install water heater temperature and
temperature relief tubes a minimum of 6 to 12
inches above floor.
9. Locate/uncover floor drain primer assembly for
inspection_203.0/310.4
10.Add 11-ea additional fixtures to permit. See
• me about tot
. rovide 2-ea double check valve test results.
603.3.3
12. Locate backflow device for RO equipment
13.There may be more corrections.
•
CaseActivityShortForm.rpt Page 2 of 2
•
Plumbing Permit Apr...R D /ED
Building Fixtures
City of Tigard MAR 1 4 2013 Received / Permit No. {''�
1 2 a 13125 SW Hall Blvd., Tigard,0 C Date/By: * j/ / .3 /3 �c..(rc cab /3 ' LzZ &�'
Phone: 503.718.2439 Fax: 5 1 Q TIGA Date/By: Review �� Other Permit No 30/ 3 Q�s
{ ��
T I G n R U Inspection Line: 503.639.417 IL DIIV G Di V IS Date Ready/By: 7u s ®See Page 2 for
Internet: www.tigard- or.gov Notified/Method: rO Supplemental Info
TYPE OF WORK FEE* SCHEDULE
N t New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) i
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 C
❑ 1- and 2- family dwelling IR,Commercial/industrial SFR (2) bath 437.78
CIS
SFR (3) bath 500.32
❑ Accessory building ❑ 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: 1 03 Qp SC(/ 1111,4131/c Catch basin or area drain 18.76
City/State/ZIP: /� Drywell, leach line, or trench drain 18.76
Cit
y ( (fQ4j .. A Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: ph Project name: Fm C S,h0'lt ferr 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: 1 Lot no.: Fixture or item:
Tax map /parcel no.:
Backflow preventer 2 31.27 >!
DESCRIPTION OF WORK Backwater valve 12.51
bays. - . Clothes washer 25.02
Pl 1 4,.. LLrAd y sl. Cl1 &tft Dishwasher ` 25.02
Drinking fountain 1 ,. 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 1 12.51
Name: Fixture /sewer cap j 25.02
Floor drain/floor sink/hub 25.02 • ✓
Address:
Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 3 , 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory • IT 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 3.. 25.02 ✓
Water heater 2. 37.52
Business name: by kuvolto� Water piping/DWV . 56.29
Address: (S O ? F • .J/ ' /y S r f 6 eo k Other: 25.02
City/State /ZIP: ittivill eiR Cr ?L 3 I Subtotal
Phone: (,5 .S37 -g 71 5 / X I Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: ( (D 6 2 `-t./ (13 �� Plumbing Lic. no.: j 76 Plan review (25 %of permit fee
/� I P� State surcharge (12 %ofpermit fee)
Authorized signature: V41.4.4.44, ��� /// 124 ,, / '1(1 I TOTAL PERMIT FEE
d PI�GN P `
Print name: t This permit application expires if a permit is not obtained within 180 days
I D ate: 3131 � after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\Building\Perrnits\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 (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
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
Valuation: Permit Fee:
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
Other ec
Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspections 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:
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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
Bath: -Tub/Shower 0 greater, except systems designed and stamped by licensed
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
- Domestic A ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain 1
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2" �
3" 3 Isometric or Riser Diagram
4 " y ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non -food that meet the qualifications above.
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: -LavBar non -food related 1
- Bradley
- Com/Serv/Util food related
- Service 1 - *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
WaterCloset - Toilet I • plumbing permit can be issued.
Urinal
Other Fixtures:
I:\ Building \Permits\PLMF- PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
. . 'Tenant Namc: FMC SWR # 2013 -00054
TIGARD Site Address: 10300 SW Nimbus, Tigard, OR 97223 PLM # 2013 -00082
Parcel #: 1 S 134AA02100
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptistry /Font 4 0 0 0 0 0
Bath: -'I'ub /Shower 4 0 1 4 0 - -
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash: - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher: - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 3 15 3 15
- 4 inch 6 0 0 4 24 4 24
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 1 - HP) 16 0 0 0 0 0
- Commercial (to 5 1 - IP) 32 0 0 0 0 0
- Industrial (over 5 1 - IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower: - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink:
- Lav /Bar - Non -Food Related 2 0 0 13 26 13 26
- Bradley 5 0 0 0 0 0
- Com /Scrv/Util - Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Watcr Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0.2 3.2
'1'OTAI,S 0 0 1 4 22 72 21 64.8
Current Fixture Value 64.8 divided by 16 = 4.050 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous [DU
Change 64.8 divided by 16 = 4.050 over (under) S 18,893.25
Enter EDU Change Here 4.050
Notes: 3/14/13, CREDITS FROM PLM2011 - 00184 APPLIED '10 TI - IIS PERMIT, NO CREDITS REMAINING. Dra
Authorized Name /Signature: Shirley Treat Date: 3/13/2013
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
l:A Building \ Sewer Tally ASewer'I'allyShect - 4665.x15 07/01/12
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10300 SW NIMBUS AVE P-A, TIGARD, OR,
97223
Commercial - Plumbing
320 Plumbing rough-in
04/12/2013 00:00
PLM2013-00082
FAIL
1. Level trap primer 310.4
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10300 SW NIMBUS AVE P-A, TIGARD, OR,
97223
Commercial - Plumbing
305 Plumbing underslab
03/27/2013 00:00
PLM2013-00082
PART
1. Provide 4" clean out as shown on plans pg P2.2 recall when ready
2. Add to existing permit cap offs for toilet and sink.
Violation Summary:
Inspector Contractor