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Permit IN U CITY OF TIGARD PLUMBING PERMIT 1 COMMUNITY DEVELOPMENT Permit#: PLM2013-00392 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/31/2013 Parcel: 2S102AA00905 Jurisdiction: Tigard Site address: 12000 SW MAIN ST Project: Sierk Orthodontics Subdivision: PAYLESS SHOPPING CENTER Lot: 5 Project Description: Plumbing for orthodontics office,adding(1)backflow preventer,(1)2"floor drain,(3)sinks and(1)water heater. Relocating(2)lays and(1)water closet. Medical gas under separate permit. Contractor: VENNE PLUMBING LLC Owner: HAAGEN,GARY L&CANDACE C TRS 15145 SW DIVISION ST 2514 SE 112TH AVE SHERWOOD,OR 97140 VANCOUVER,WA 98664 PHONE: 503-624-9309 PHONE: FAX: 503-684-0940 FEES Quantity Description Date Amount 1 ea Backflow Preventer 10/31/2013 $31.27 Specifics: 1 ea Floor Drain/Floor Sink/Hub 10/31/2013 $25.02 3 ea Sink 10/31/2013 $75.06 Type of Use: COM 2 ea Lavatories 10/31/2013 $50.04 Class of Work: ALT 1 ea Water Closet 10/31/2013 $25.02 Type of Const: 1 ea Water Heater 10/31/2013 $37.52 Occupancy Grp: 1 12%State Surcharge- 10/31/2013 .$29.27 Stories: Plumbing Total $273.20 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- 90. You may obtai , opy of the rules or direct que ' UNC by calling 503.232.1987 or 1.800.332.2344. Issued By )1.,... )060,12.,,e4.6.44.; Permittee Signature: 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 Building Fixtures FOR OFFICE USE ONLY City of Tigard Received 1� 2 �� )/�, Permit No.: /f ��3 ''1 v 13125 SW Hall Blvd.,Tigard, 97223 Date/By: /d G / �'.�/ L!�( '� 1- 74 C ' Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No.: �,�/��,�, Date/By: C�0E..""/3-LIU 19 Inspection Line: 503.639.4175 Date Ready/By:B orris: ® See Page e 2 for K -NGARD Y y g Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK . •• FEE* SCHEDULE ❑New construction ❑Demolition For special information use check list: Description I Qty. I Ea. I Total V Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)_ CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 ❑ 1-and 2-family dwelling R 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 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 1'L 00 O $w M A t IJ s 7' Catch basin or area drain 18.76 City/State/ZIP: Drywell,leach line,or trench drain 18.76 ty t ( C A rt t� D et ot.Z L.4'G Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Stan..(![ 02;n40 4Q 00„mos Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: +! Backflow preventer I. 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 PL I'■(31")C f-c.) rt Ea t..) O 4.1I S d n V p171(S Dishwasher 25.02 O rrl ``r t p.t ft 4 JAL r d 7 G,,p7.4 L Drinking fountain 25.02 137rQ t- `A Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 - Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub ' I 25.02 Address: Garbage disposal \ 25.02 City/State/ZIP: Hose bib ' 25.02 Phone:( ) Fax:( ) Ice maker v1/4))\:6,'!‘ " !t%' 12.51 14 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap, . 25.02 /► �� gC L Medical gas(value:$I. Page 2 Business name: N� P�-C!L Ist.t� 7 I Primer 12.51 Contact name: Atit 0 3a0 S leA Roof drain(commercial) 12.51 Address: 2.2_415 S s J Pt J I>j.i✓ 7 G-t Sink/basin/lavatory 5-.A7 25.02 City/State/ZIP: 5 N ta�oro o 0 I Q•.� l �,o Solar units(potable water) 62.54 Phone:(Yo;) G 8 ci - (D.4 4 4 Fax: :( _t ) Tub/shower/shower pan 12.51 E-mail: DAMa .` 1j LJ - PM.c.t_gf-, I . (a Urinal 25.02 Water closet 1 25.02 CONTRACTOR Water heater 1 37.52 Business name: I,V fr eti t cD l J at p..) G Water piping/DWV 56.29 Address: i 5 I. 4 S s 14 1✓, S,,, tJ i.7 Other: 25.02 City/State/ZIP: 5 Oa 4,,.4,,...� i> 8 tilt V Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: t O+Z c, tubing Lic.no.:5 et G P Plan review (25%of permit fee) State surcharge(12%of permit fee) IAuthorized signature: TOTAL PERMIT FEE I Print name: -��`� 3 s J�4 Date: 113 This permit application eapires if a permit is not obtained within 180 days l r, 3 r after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\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(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 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: $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• Quantiy 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 greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive tall 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 ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram ❑ 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 -Bradley -Com/Serv/Util food related -Service *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 ' plumbing permit can be issued. Urinal Other Fixtures: 1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 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 12000 SW MAIN ST, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal 2014-01-03 00:00:00 PLM2013-00392 PASS - No C of O 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 12000 SW MAIN ST, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal 2013-12-31 00:00:00 PLM2013-00392 FAIL 1. Provide water for inspection. 2. Not ready for inspection. No inspection made OPSC 103.5.1 Recall 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 12000 SW MAIN ST, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal 2014-01-02 00:00:00 PLM2013-00392 FAIL 1. Caulk both tooth brushing sinks. 310.4/407.2 Recall when complete, all else ok Violation Summary: Inspector Contractor