Permit CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit#: PLM2015-00189
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/11/2015
Parcel: 2S 111 ACO2901
Jurisdiction: Tigard
Site address: 9500 SW MURDOCK ST
Project: Templeton Elementary School Subdivision: PINEBROOK TERRACE Lot: 67
Project Description: Replacing 360 ft.of the 1"water service between main building and concession stand.
Contractor: ALLIANT SYSTEMS LLC Owner: TIGARD-TUALATIN SCHOOL
1600 NW 167TH PL#330 DISTRICT 23J
BEAVERTON, OR 97006 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-619-4066 PHONE:
FAX: 503-230-9238
FEES
Quantity Description Date Amount
360 If Water Service 06/11/2015 $175.10
Specifics: 1 12%State Surcharge- 06/11/2015 $21.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $196.11
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 o - .
Issued By: wr -° mittee 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 ��N�j FOR OFFICE USE ONLY
City of Tigard ` / Received Permit No.:
. .0 13125 SW Hall Blvd.,Tigard,OR 97223Y 01� Plate/BY: G �/ i J � �(1 f�(J�S -L� 1 G '
Plan Review
III
Phone: 503.718.2439 Fax: 503.598.1960
'8.. �. Date/By: Other Permit No.:
Inspection Line: 503.639.4175 `\�N 1 ate Read B luris ® See Page 2 for
TIGARD ) R Ready/By: I;
Internet: www.tigard-or.gov ' vry-N. -AO/Method: Supplemental Information
TYPE OF WORK ', r FEE* SCHEDULE
❑New construction ❑Demo;. 61.1% For special information use checklist.
Description I Qty. I Ea. J 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
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
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:9500 SW Murdock St Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Templeton-Water-Line [- - Manufactured home utilities 50.03
Cross street/directions to job site: Sc.L'`alr,(, 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.: 611) I Page 2 175.10
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
Replace 1"water line between main building and concession stand. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Alliant Systems Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:David Russell
Roof drain(commercial) 12.51
Address:1600 NW 167th Place,Suite 330 Sink/basin/lavatory 25.02
City/State/ZIP:Beaverton,OR 97006 Solar units(potable water) 62.54
Phone:(503)572 7761 Fax::(503)230-9038 Tub/shower/shower pan 12.51
E-mail:d.russell@alliant-systems.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Alliant Systems Water P�tn Pi 8/D WV 56.29
Address:1600 NW 167th Place,Suite 330 Other: 25.02
City/State/ZIP:Beaverton,OR 97006 Subtotal 175.10
Phone:(503)572 7761 Fax:(503)230 9038 Minimum permit fee: $72.50
CCB Lic.: 153420 Plumbing Lic.no.:3-487PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) 21.01
Authorized signature: l� TOTAL PERMIT FEE 196.11
Print name:David Russell Date:06/10/15 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\Penults\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-l u 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' 1 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' 3 37.52 112.56
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
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/l Plan review is required for any of the following.Performed: Capped Added Relocate q Y g
Baptistry/Font Please check all that apply.
Bath rub/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,,
-4"
Car Wash Drain Isometric or Riser Diagram
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:
1:\25322-Templeton School-Concession Water\Permits\Templeton waterline permit app.doc
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Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9500 SW MURDOCK ST, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00189
George Heimos
NOTE documentation received from Alliant Pacific NW dated 06/19/2015 regarding
locating water line new installation and accepted.
Violation Summary:
Inspector Contractor