Permit CITY OF TIGARD PLUMBING PERMIT
" COMMUNITY DEVELOPMENT Permit#: PLM2015-00180
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/11/2015
Parcel: 2S 102AD01700
Jurisdiction: Tigard
Site address: 9025 SW BURNHAM ST
Project: Zuber House-Ash Avenue Dog Park Subdivision: TIGARD HIGHWAY TRACTS Lot: 21
Project Description: Extension of 4"sanitary sewer service by 17'and installation of catch basin.
Contractor: 1ST CALL PLUMBING& DRAIN CLEANING LLC Owner: TIGARD, CITY OF
6615 SE 42ND AVE 13125 SW HALL BLVD
PORTLAND, OR 97206 TIGARD,OR 97223
PHONE: 971-409-7463 PHONE:
FAX: 503-961-7108
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 06/11/2015 $18.76
Specifics: 1 ea Manholes 06/11/2015 $18.76
17 If Sanitary Sewer 06/11/2015 $62.54
Type of Use: 1 12%State Surcharge- 06/11/2015 $12.01
Class of Work: Plumbing
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 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 i sir • 2-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 800.332.2344.
Issued By: .Permittee Signature: , C
Ii xi)
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.
si Plumbing Permit Applicati 11
,
Site Utilities 1 C FOR OFFICE USE ONLI
Received /� / `,
City of Tigard /s Permit No.: � 8V
• 13125 SW Hall Blvd.,Tigard,OR 97M
Date/By: ���!!!
111 I - 3 2 t I Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
inspection Line: 503.639.4175 7 Date Rea /B kris: ® See Pa e 2 for
TIGARD Internet: www.tlgard Or.gov ( 1 1 OF TIGARD' Notified!Method:10/to /3.. �/!V Supplemental Information
C41,,,QF,:, . etz- Te7mE* SCHEDULE
®New construction ❑Demolition For special in f ormation use checklist.
Description 1 Qty. I Ea. I Total
❑Addition/alteration/replacement ®Other: Dog Park New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION < SFR(1)bath 312.70
❑ 1-and 2-family dwelling SFR(2)bath 437.78
y g ®Commercial/industrial
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:9025 SW Burnham St Catch basin or area drain 1 18.76 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.: Project name:Zuber Property Dog Park Manufactured home utilities 50.03
Cross street/directions to job site:Located at northeast corner of Manholes 1 18.76 18.76
intersection of Burnham Street and Ash Avenue Rain drain connector 18.76
Sanitary sewer(no.linear ft.:17) 1 Page 2 62.54
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.:2S102AD01700 Backflow preventer 31.27
111 DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Extension of 4"sanitary scANer scrsice,installation of catch basin Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:City of Tigard
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13125 SW Hall Blvd
Garbage disposal 25.02
City/State/ZIP:Tigard OR 97223 Hose bib 25.02
Phone:(503)718-2466 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
• Medical gas(value:$ ) Page 2
Business name:City of Tigard g
Primer 12.51
Contact name:Jeff Peck
Roof drain(commercial) 12.51
Address:13125 SW Hall Blvd Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)7185-2466 Fax::( ) Tub/shower/shower pan 12.51
E-mail:jeffp @tigard-or.gov Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:GSE,Inc Water piping/DWV 56.29
Address:9812 SE Wichita Avenue Other: 25.02
City/State/ZIP:Milwaukie,OR 97222 Subtotal 100.06
Phone:(503)654-4734 Fax:(503)652-2333 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:99793 Plumbing Lic.no.: State surcharge(12%of permit fee) /a,e/
Authorized signature: C;� TOTAL PERMIT FEE /1„,R,07
Print name:Jeff Peck Date:6/3/15 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PennitApp.doc 10/01/09 440.4616T(10/02/COM/WEB)
f
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qt . Fee(ea) Total Square Footage: Permit Fee:
Footing drain- I" I00' >U.0; 0 to 2,000 $I21.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 1 62.54 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 I 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 Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
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 90.00,11r
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
and including$25,000.00.
Inspections outside of normal business 90.00 lii $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 InstallatiQ
Fixture Type for Replace/ Plan review is required for any of the following.
Performed: Capped Added Relocate 9 Y g
Baptistry/Font Please check all that apply.
Bath Tub/shower 11 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 El 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.
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
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:
I:\ENG\l -Active Projects\97025 Zuber House Ash Ave Dog Park\PERN TS\Site Plumbing Sewer Permit-Ash Ave Dog Park.doc
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
9025 SW BURNHAM ST, TIGARD, OR, 97223
Commercial - Plumbing
340 Storm drain
FAIL
PLM2015-00180
George Heimos
1. Add to existing permit. Water service (100') 1-ea double check valve and 1-ea drinking
fountain. 103.1.1
NOTE. There is no storm sewer piping to inspect, should be underslab plumbing
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
9025 SW BURNHAM ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00180
George Heimos
Violation Summary:
Inspector Contractor