Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013 00220
T tG ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/21/2014
Parcel: 2S 109ACO2100
Jurisdiction: Tigard
Site address: 14850 SW 132ND TER
Project: Alberta Rider Elementary School Subdivision: WOODSIDE Lot: PTS 8-9
Project Description: Site utlity alterations for playground improvements,approximately 175'of storm sewer.
Contractor: LAUZON CONTRACTING LLC Owner: TIGARD-TUALATIN SCHOOL DIST 23J
13577 SE WILLINGHAM CT ATTN: BUSINESS MANAGER
CLACKAMAS,OR 97015 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-431-4017
HONE: 503-482-5445
FAX: 503-482-5446
FEES
Quantity Description Date Amount
175 If Storm and Rain Drain 04/21/2014 $100.06
Specifics: 1 12%State Surcharge- 04/21/2014 $12.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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 ' • k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. 'cation Ce -r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir: t questions to OU llin• 503.232.1987 or 1.800.332.2344.
Iss ed By: / /�� Permitter Sign ture: �� ,
'�'� - _ gild l d 4-C r c-P
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.
Pldmbin2 Permit Application
Site Utilities RECEIVED FOR OFFICE USE ONLY
City of Tigard Received Q�� 2�^
ty g Date/By: 7 ! 1 3 1 Pe mil v Y( �D(7 O'OL
y 13125 SW Hall Blvd.,Tigard,OR 97223 J IJ Q I 2013 Plan Review
MI
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Date/By: 1 7-dU l 3-eCYJ(]
TIGARD Inspection Line: 503.639.4175 Date Read /B ( 1 Jens:
CITY OFTIGARD Ready/By: c:::)21), Bl See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 7 it'll/ 3 Suppleme all forma'on
TYPE OF Wt I,rn rc -ISION l//'1 ay /4 ?FEE* SCHEDULE V 7I/y
r
❑New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. ( Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El I-and 2-family dwelling ®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: 14850 SW 132nd Ter Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,Oregon 97224
-
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: l Project name:Alberta Rider Playground Manufactured home utilities 50.03
Cross street/directions to job site:SW Bull Mountain Rd Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:____) Page 2
43 Storm sewer(no.linear ft.:L253- Page 2 Woo 06
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.:2100 Fixture or item:
Tax map/parcel no.:02SO1 WO9AC Backflow preventer _ 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Playground improvements including:Addition of drainage rock below playground Dishwasher 25.02
area,replacement of existing wood chips,and installation of a concrete ADA Drinking fountain 25.02
playground access ramp. Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Titgard Tualatin School District Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:6960 SW Sandburg St
Garbage disposal 25.02
City/State/ZIP:Tigard,Oregon 97223 Hose bib 25.02
Phone:(503)431-4017 Fax:( ) Ice maker 12.51
O ❑ APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Cardno Medical gas(value:$ ) Page 2
Primer 12.51
%• Contact name:Matt Lewis Roof drain(commercial) 12.51
Address:5415 SW Westgate Dr.Suite 100 Sink/basin/lavatory 25.02
4 City/State/ZIP:Portland,Oregon 97221 Solar units(potable water) 62.54
Phone:(503)419-2500 Fax::(503)419-2600 Tub/shower/shower pan 12.51
E-mail: matt.Iewis(/dcardno.com Urinal 25.02
CONTRACTOR _Water closet 25.02
, '! Water heater 37.52
Business name: .� hLL) •• Water piping/DWV 56.29
lA Address: /M.-7 7 6, ' S � Other: 25.02
City/State/ZIP:CA to_e__61._„,,`e.-4... U2 9101 Subtotal NO o ,
Phone:(56 ) U q a 5&/%1& Fax:( ) Minimum permit fee: $72.50
2 t Plan review (25%of permit fee)
CCB Lic.: ( , ��J State surcharge(12%of permit fee) Z U
Authorized signature: ��sy_ TOTAL PERMIT FEE /1 r 07
l nt name: {f Print / /r k" -i fZ �j Date' G i This permit application expires if a permit is not obtained within 180 days
/j J// after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
::dBuilding\PcrmassPLMU-PcrnitApp.doc 10/01/09 440-4616T(10/02.1COM/WEB)
l
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- I"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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: 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
Jacuzzi/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 ❑ Isometric or riser s
diagram is required for new buildings
Garbage -Domestic-non-food g q g
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
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
W:\21303370\Permit\Alberta Rider-PLMU-PermitApp.doc 2
Debbie Adamski
From: Debbie Adamski
Sent: Monday, April 21, 2014 2:01 PM
To: 'Wentz, Philip'
Subject: RE: Alberta Rider Playground, 14850 SW 132nd Ter, PLM2013-00220
I did receive the faxed payment form. I will pay, issue and mail the permit to you.
Anytime you demo a structure you need to get a permit for the demolition. This is how the structure gets removed from
the tax rolls and it also allows system development fee credits for future construction. These credits can be
considerable.
To apply for the permit, you will need to complete a residential application form and attach (3) copies of a site plan
showing the property lines, the footprint of the building(s) being removed, corner lot elevations, whether the property is
connected to sewer service or is on septic,and it also needs to show the erosion control plan. We do not issue these
over the counter, it is usually a 2-3 day turnaround for the processing. The permit fee is based on the valuation of the
work to do the demo. Once the permit is issued,the demolition can begin and a final inspection is required to close the
permit. After that the system development fee credits s will be available for future construction.
Debbie Adamski
Senior Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
From: Wentz, Philip [mailto:pwentzCattsd.k12.or.us]
Sent: Monday, April 21, 2014 1:27 PM
To: Debbie Adamski
Cc: Matt Lewis (Portland)
Subject: RE: Alberta Rider Playground, 14850 SW 132nd Ter, PLM2013-00220
Thanks Debbie that would be great. Form is in the fax.
On another topic—I am working on the demolition of the house and barn on the property the District owns on west Bull
Mountain. Is there a permit required for demolishing a structure?
Philip Wentz,M.Ed.
Facilities Manager
Tigard-Tualatin School District
6960 5w Sandburg St.
Tigard,OR.97223
Office 503.431.4017 Fax 503.431.4020 Cell 971.563.1605
CONFIDENTIALITY NOTICE:
This email may contain confidential and privileged information.The information contained in this transmission
is intended for the addressee ONLY. If you are not the addressee of this email, please do not review,
disclose, copy or distribute any of the information enclosed. If you have received this transmission by
mistake, please telephone us immediately. Thank you!
1
From: Debbie Adamski [mailto:DEBBIE @ tgard-or.gov]
Sent: Monday, April 21, 2014 12:53 PM
To: Wentz, Philip
Cc: Matt Lewis (Portland)
Subject: RE: Alberta Rider Playground, 14850 SW 132nd Ter, PLM2013-00220
Phil,
That would be fine if you want to do that. I will add Lauzon as the contractor. Once I pay the fees do you want me to
issue and mail the permit to you?
Debbie Adamski
Senior Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd., Tigard, OR 97223
503-718-2450
From: Wentz, Philip [mailto:pwentz @ttsd.k12.or.us]
Sent: Monday, April 21, 2014 11:19 AM
To: Debbie Adamski
Cc: Matt Lewis (Portland)
Subject: Alberta Rider Playground, 14850 SW 132nd Ter, PLM2013-00220
Debbie,
Matt forwarded your email:
We are checking on the permits we have in our ready to issue file and the above mentioned permit has been ready to
issue since 7/18/13. The permit fees that are due are$112.07. We will need to have a contractor identified prior
issuance of the permit. The associated site work permit, SIT2013-00017 was issued on 8/13/13 and is still open. Please
let me know if this project has been cancelled or if we need to do a permit extension on it.
The contractor who did the work was Lauzon Contracting. Should I complete a payment authorization form for the
$112.07?
Thank you.
Philip Wentz,M.Ed.
Facilities Manager
Tigard-Tualatin School District
6960 Sw Sandburg St.
Tigard,OR.97223
Office 503.431.4017 Fax 503.431.4020 Cell 971.563.1605
CONFIDENTIALITY NOTICE:
This email may contain confidential and privileged information.The information contained in this transmission
is intended for the addressee ONLY. If you are not the addressee of this email, please do not review,
disclose, copy or distribute any of the information enclosed. If you have received this transmission by
mistake, please telephone us immediately. Thank you!
2
Debbie Adamski
From: Debbie Adamski
Sent: Monday, April 21, 2014 5:05 PM
To: Phil Wentz (pwentz @ttsd.k12.or.us)
Subject: Alberta Rider Site Utility Permit for Playground
Attachments: CounterCopier@ tigard-or.gov_20140421_160047.pdf
Phil,
Attached is a copy of the receipt and the issued permit. I faxed and mailed a copy to the contractor. If the work has
been completed,just have the contractor call in a final inspection. Thanks for following up on this!
Debbie Adamski
Senior Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd., Tigard, OR 97223
503-718-2450
1
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
14850 SW 132ND TER, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
2014-04-23 00:00:00
PLM2013-00220
FAIL
1. Provide documentation and photo's showing installation of sub surface drainage work
on playground at Alberta Rider Elementary School, starting at upper most elevation
along the run to the termination point of the drainage piping. Show any sub surface
drain retention system, if any, or where discharge water terminates.
2. Call for Site inspection Final when ready. SIT2013-00017
3. Recall Final Plumbing after all engineering documentation has been provided and
approved. PLM2013-00220
NOTE: WRG Engineering matt.lewis@cardno.com 503-419-2500
tiaolsen@lauzoncontracting.com 503-709-5387
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14850 SW 132ND TER, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2013-00220
George Heimos
Violation Summary:
Inspector Contractor