Permit CITY OF TIGARD PLUMBING PERMIT
11111 s COMMUNITY DEVELOPMENT Permit#: PLM2015-00255
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2015
Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Interior plumbing:Capping(4)sinks;Adding(6)sinks;Relocating(1)sink.
Contractor: RELIANT PLUMBING&MECHANICAL Owner: PROVIDENCE HEALTH SYSTEM-OREGO
11575 SW PACIFIC HWY SUITE 219 ATTN: REAL ESTATE&CONSTRUCTION
TIGARD, OR 97223 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-246-1201 PHONE:
FAX: 503-246-1205
FEES
Quantity Description Date Amount
4 ea Fixture/Sewer Cap 08/05/2015 $100.08
Specifics: 7 ea Sink 08/05/2015 $175.14
1 12%State Surcharge- 08/05/2015 $33.03
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $308.25
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 requ - •u to follow the rules .•,,•ted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR • -001-0090. --�ay obt- a cool of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. IP►
Issued y: Permittee Signature: ��jr/�
--.rl119 2 "If7
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 L i 4 ( / -
Building Fixtures I"t)i< OI l It I til; t)\i l
City of Tigard Received
Date/By: S 15 Permit No:
Q
II,- V 13125 SW Hall Blvd.,Tigard,OR 97223 / � �
C Pita B,:. S
Phone: 503.718.2439 Fax: 503.59�.t9y DateB,: Other Permit No.: `_ �, • 5 ��_ S
T I(:A It I) Inspection Line: 503.639.4175 ` 't(.� 01� Date Ready/By: ] El See Page for
Internet: www.tigard or gov c Notified/Method. Supplemental information
TYRE Q)r BYO_RK: N 1` ,t' Q FEE*SCHEDULE :-
❑Ne onstruction ❑Dtaliol�ti� �11\
St For s ecial b onuatlor]use ch eckllst.
f(�,�t� ....,v,,:±, t Description Ea. Total
ddition/alteration/replacement ❑QtK.t: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATECORY_OF CONST N SFR(I)bath 31230
El 1-and 2-family dwelling ommercial/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: y 2 y L.+ z .5 l.L) -(C►(,l.S FEZ tp A �� Catch basin or area drain 18.76
"e 1 Drywell,leach line,or trench drain 18.76
City/State/ZIP:
• ■ t■► Y r - Lam, _. •• -. ' ' .ting drain(no.linear ft.: ) Paget
Suite/bldgJapt.no.: I 0 Project name: M )1 L tOnUE. 9.- AtOpl?t4Aanufactured 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 it.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: ( Lot no.: Fixture or item:
Tax map/parcel no.: 1G 1 - zi.F G (7014.0 1 Backflow preventer 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
Clothes washer 25.02
...64) RCA.• t 0 2.L2 $F f/- LTC` 1 14-Mf vt2 t-trn..t - Dishwasher 25.02
'3 Q j CrtAfl.A.C. f 2.firA, p Irt.(_, tri„t I (`(�. or= Drinking fountain 25.02
" "
Ejectors/sump 25.02 d n �co.a'tcx. 4 ,•� RORTY OWNER ❑ PE1114AT C Expansion tank 12.51
5 / •U$
Fixture/sewer cap `L� 25.02
Name: (7�,0V t.0%V-t CM l�'Wt Al 1 G, u(fig Floor drain/floor sink/hub / 25.02 l)
Address. 11.14 oQ 11CLS> I)bi 2 -SJ ITI I qa
p }1 Garbage disposal 25.02
City/State/ZIP: M� c_94_,1 17 2...4 3 Hose bib 25.02
Phone:(9)3) 09' -..(j757 Fax:( ) Ice maker 12.51
APP)G.Ic N r pi CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: 37--'8 MirN ltT3CTS u-C�
Contact]lame: / .. ` Primer 12.51
T� J fa•. l�J(jif�,C�E L � tr1/ t(..1C 1 Pli . Roof drain(commercial) 12.51
Address: 1v-I cc- N V 3 &I t/ 4 q FA 0 OA MIL PVCW 1.j St.,int uvq sink/basin/lavatory , 7.. 25.02 757/y
City/State/ZIP: -3TL ra„Tr4.4 q7 (49 Solar units(potable water) 62.54
Phone:(9)3) ciao -11, I Fax::( 3) (C(O -011'7. Tub/shower/shower pan 12.51
E-mail. uJ�pirkc CP 1 ��'{.,( ■CA
Urinal 25.02
`'�,°_' -r Water closet 25.02
CONT! RACTOR Water heater 37.52
Business name: f e l i ,t1n,. 4)((_t nil of it N n iCd( Water piping/DWV 56.29
Address: 1!s--76-- f? .&I L n �, 211 Other: 25.02
City/State/ZIP: Ti �� � q ,3 Subtotal ',L7S
�y, n I , `-r Fax; Minimum permit fee: $72.50
Phone:(Jv`,� )�'�'!� Ito� (�3) ZLi!Co-I'L CaS'
q r ,
Plan review (25%of penult fee)
CCB Lie.: I t `--1 Plumbing Lie.no.: t I 4- State surcharge(12%of permit fee)
Authorized signahlre: TOTAL PERMIT FEE,; J _ p
f r c a J�_„pl&Ia_..)
/A 7/2 b //5 This permit application expires if a permit is not obtained ai .in 180:aye
Print name: Ir�[(� �'(�� [GCS Date: O/1
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:1Buiiditg\PermitslPLMtt-PensitApp.doe 10;01109 440-46I6T(1001/CO\UWEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
• Qty. Fee(ea) Total
Site Utilities 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
3,60I to 7,200 $233.20
Sesser-1st 100' 62.54 7,201 and greater $327.54
Sever-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
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 Replacer Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuz2i/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Drive Thru 111 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.
4" Isometric orRiser Diagram
Car Wash Drain
Garbage Domestic-non-food El 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) Coiinments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related 4j
-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:
http://wryt v.tigard-or.gov/document_centerBuilding/PLMF PermitApp.dIe •
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
November 12, 2015 at
11:11:42 AM
PLM2015-00255
Don Sylvester
1. Plumb. Final for new sink in room#10034- ok
Violation Summary:
Inspector Contractor