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Permit CITY OF TIGARD PLUMBING PERMIT 111 • COMMUNITY DEVELOPMENT Permit#: PLM2015-00134 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/04/2015 Parcel: 1 S 134 BC00401 Jurisdiction: Tigard Site address: 12442 SW SCHOLLS FERRY RD 100 Project: Providence Scholls Clinic Subdivision: GREENWOOD TERRACE CONDO Lot: 17 Project Description: Add(1)sink and cap(1)sink Contractor: AMERICAN HEATING INC Owner: PROVIDENCE HEALTH SYSTEM-OREGO 5035 SE 24TH AVE ATTN: REAL ESTATE&CONSTRUCTION PORTLAND, OR 97202-4765 4400 NE HALSEY BLDG 2 STE 190 PORTLAND, OR 97213 PHONE: 503-239-4600 PHONE: FAX: 503-239-7038 FEES Quantity Description Date Amount 1 ea Fixture/Sewer Cap 05/04/2015 $25.02 Specifics: 1 ea Sink 05/04/2015 $25.02 1 12%State Surcharge- 05/04/2015 $8.70 Type of Use: COM Plumbing Class of Work: ADD 22 ea Minimum Fee Adjustment- 05/04/2015 $22.46 Plumbing Type of Const: 8 hr Hourly Plumbing Rate 05/04/2015 $720.00 Occupancy Grp: 1 ea Hourly Plumbing 12% 05/04/2015 $86.40 Stories: Surcharge Total $887.60 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 Notifi - •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 direct• estions to OUN► by calling 503.232.1987 or 1.800.332.2344. Issue. By: / ,/ Permittee Signature: (/�_—.==5-��/ s YJC_ 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 RECEIVED FOR OFFICE USE ONLY Received City of Tigard >QY 4 2015 Date/By: 9 y /s (p -/'} PermitNo.: t"Lti�J5-60t%3t� .1114 - " 13125 SW Hall Blvd.,Tigard,OR 97 r' " Phone: 503.718.2439 Fax: 503 Plan Review TIGARD Date/By: Other Permit No.: TIGARD Inspection Line: 503.639.4175 Date Ready/By: funs: I H See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑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) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 111 I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 building SFR(3)bath 500.32 ❑Accesso ry g ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOR SITE INFORMATION AND LOCATION Site utilities: Job site address: 12442 SW Scholls Ferry Road Catch basin or area drain 18.76 City/State/ZIP:Tigard OR 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: `OD I Project name:Prov Scholl Clinic Phasel 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 Add(1)sink and cap(1)sink -- --- - -- ----__--_-- _----- Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 1 25.02 0 ' Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( I Ice maker 12.51 ID APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02 Business name:American Heating Inc. Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Brandon Hutchinson Roof drain(commercial) 12.51 Address:5035 SE 24th Ave. Sink/basin/lavatory 1 25.02 ,,, 5---,c'y City/State/ZIP:Portland,OR.,97202 Solar units(potable water) 62.54 Phone:(503)239-4600 Fax::(503)239-7038 Tub/shower/shower pan 12.51 E-mail:b.hutchinson @americanheating.net Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name:American Heating Inc. Water piping/DWV 56.29 Address:5035 SE 24th Ave. Other: 25.02 City/State/ZIP:Portland,OR,97202 Subtotal Phone:(503)239-4600 Fax:(503)239-7038 Minimum permit fee: $72.50 70/. 51H CCB Lie.:33135 Plumbing Lic.no.:PB982 Plan review (25%of permit fee) ` State surcharge(12%of permit fee) g,7V Authorized signature: TOTAL PERMIT FEE g( .9l0 Print name:Brandon Hutchinson I Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. �7w L LL /A15/4 �`1 � *Fee methodology set by Terri--CCount �B•ui/�ldi�ngg Inndustry Service �t I:\Building\Permits\PLMU-PennitApp.doc 10/01/09 440-46/166T(10/02/COM/WEB) ,47 4 .q/ /,"'^_ - ` L �T,/E � ‘a3 5•/ i t g'7-4' 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$7250 Storm&Rain Drain-each additional 100' 37.52 i $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to P 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 El New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defmed 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 defmed 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 diagram is required for new buildings Garbage -Domestic-non-food 9 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 1 1 -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: H:\ Hutch\Permits\City of Tigard\Tigard Plumbing Application(Buildinggixtures).doc Accumulative Sewer Tally ;I Tenant Name: Providence SchollsClinic SWR# N/A Site Address: 12442 SW Scholls Ferry Rd PLM# 2015-00134 Parcel#: 1S134BC00401 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values Baptisery/Font 4 0 0 0 0 0 Bath: -Tub/Shower 4 0 0 0 0 0 -Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash: -I ach 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 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 0 0 0 -3 inch 5 0 0 0 0 0 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 HP) 16 0 0 0 0 0 -Commercial(to 5 HP) 32 0 0 0 0 0 -Industrial(over 5 HP) 42 0 0 0 0 0 Ice Machine/Refrigerator Drain 1 0 0 0 0 0 Living Unit 16 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 1 2 1 2 0 0 -Bradley 5 0 0 0 0 0 -Com/Serv/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 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 0 0 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 1 2 1 _ 2 0 _ 0 Current Fixture Value 0 divided by 16= 0.000 Current EDU 1 EDU= $4,900.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 0 divided by 16= 0.000 over (under) $ - Enter EDU Change Here 0.000 Notes: No change in EDU's Authorized Name/Signature: Debbie Adamski Date: 5/4/2015 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. I:\Building\Sewer Tally\SewerTallySheet_4900._070114.xlsx 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 12442 SW SCHOLLS FERRY RD 100, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2015-00134 George Heimos Jeffk@inline-cc.com Violation Summary: Inspector Contractor