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Permit CITY OF TIGARD PLUMBING PERMIT s COMMUNITY DEVELOPMENT Permit#: PLM2014-00150 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/04/2014 Parcel: 2S113AB00500 Jurisdiction: Tigard Site address: 16083 SW UPPER BOONES FERRY RD 320 Project: Bridgeport Family Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37 Project Description: ADD plumbing fixtures for new tenant: (1)dishwasher,(1)floor drain,(1)primer,(1)lay,(1)breakroom sink,(4) exam room sinks,(1)autoclave sink,(1)water closet and(1)water heater. 5/22/14:Changed project name from Test Fit to Bridgeport Family Medicine per Bartel Contracting. Contractor: MIKE PATTERSON PLUMBING Owner: G&S FC LLC 15028 S MITCHELL LN 16083 SW UPPER BOONES FERRY RD, OREGON CITY,OR 97045 STE TIGARD, OR 97224 PHONE: 503-632-7374 PHONE: FAX: 503-632-5647 FEES Quantity Description Date Amount 1 ea Dishwasher 06/04/2014 $25.02 Specifics: 1 ea Floor Drain/Floor Sink/Hub 06/04/2014 $25.02 1 ea Primer 06/04/2014 $12.51 Type of Use: COM 6 ea Sink 06/04/2014 $150.12 Class of Work: ALT 1 ea Lavatories 06/04/2014 $25.02 Type of Const: 1 ea Water Closet 06/04/2014 $25.02 Occupancy Grp: 1 ea Water Heater 06/04/2014 $37.52 Stories: 1 12%State Surcharge- 06/04/2014 $36.03 Plumbing Total $336.26 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: " Permittee Signature: l . - �J _ . -AV Akdall _ .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 AnnlicatifiECEIVED Building Fixtures City of Tigard MAY 7 2014 Received Date/By:By: -77 ir Permit N9.91/1070/9--00/50 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ■ Phone: 503.718.2439 Fax: 503.590 Other Permit N 9 Inspection Line: 503.639.4175 �/1 r�� nA Date/By: � �/ O�O" T I(_.:1 R P Internet: www.ti rd-or. ov BUILDtN(�� 11.1ISIO `' Note Readyety: huts: &1 See Page 2 for g0/ 8 Notified/Method: Supplemental Information '1"lt'p g or wow . FEZ* 'SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I Qty. ] Ea. I Total ®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CAGY OF CONSTRUCTION SFR(I)bath 312.70 El 1-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 IffrAt INPORMANION AND LOCATION Site utilities: Job site address:16083 SW Upper Boones Ferry Rd Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.:320 Project name:Faencrereek 7E 7 FiT 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 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Plumbing for tenant improvement. 7 77,V6-/LQ Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 1 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ❑ APPLICANT 0 CONTACT.PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 1 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 7 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 ' Water closet 1 25.02 CONTRACTOR Water heater 1 37.52 Business name:Mike Patterson Plumbing,Inc. Water piping/DWV 56.29 Address:15028 S Mitchell Ln Other: 25.02 City/State/ZIP:Oregon City,OR 97045 Subtotal Phone:(503)6327374 Fax:(503)6325647 Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.:81746 Plumbing Lic.no.:3-359PB State surcharge(12%of permit fee) Authorized signature: - TOTAL PERMIT FEE -}�-. Date: This permit application expires if a permit is not obtained within 180 days Print name: SAO l 1 {,\.�.' �/� after it has been accepted as complete.• *Fee methodology set by Tri-County Building Industry Service Board. 1:\Buildin¢Tennits\PLMU-PennitApp.doc 10/01/09 440-4616f(10/02/cOM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities . lreiS Tom Square Footage: Permit Fee: Footing drain-181 100' 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 � � each additional$100.00 or fraction thereof,to Other '. 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/br $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/ Plan review is required for any of the following. Performed: Capped Added Relocate Please check all that apply. y g Baptistry/Font 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 Thin ❑ 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 ❑ 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 / L 191/ Shower -Gang -Stall / .B,eE79 oof'I Sink/Lav -Non-food related / >C z7M A-O offs = 7 -Bradley / 4-LL77,1 Cali -Commercial-food related -Service i ' 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: C:\Users\Jennifer\Downloads\PLMF-PermitApp.doc 2 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 16083 SW UPPER BOONES FERRY RD 320, TIGARD, OR, 97224 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2014-00150 George Heimos Inspection cancelled as per Brandon Taggart COT Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 16083 SW UPPER BOONES FERRY RD 320, TIGARD, OR, 97224 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2014-00150 George Heimos 1. Work not completed, no inspection made. Recall when ready. 103.5.4 Recall inspection. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 16083 SW UPPER BOONES FERRY RD 320, TIGARD, OR, 97224 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2014-00150 George Heimos 1. Caulking required on ﬁxture(s) at: autoclave sink310.4/407.2 2. earthquake straps for water heaters (Plbg Code Interp 08/12/05) 1 ½”penetration, #12 wood screws with washers each side. 508.212 3. Recall inspection when corrections have been completed. Re-inspection required. 103.5.6.1 mpattersonplumbing@bctonline.com Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 16083 SW UPPER BOONES FERRY RD 320, TIGARD, OR, 97224 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2014-00150 George Heimos Violation Summary: Inspector Contractor