Permit (107) CITY OF TIGARD F "j' i PLUMBING PERMIT
COMMUNITY DEVELOPMENT �i Permit#: PLM2016-00076
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/16/2016
Parcel: 1S136DD00801
Jurisdiction: Tigard
Site address: 11565 SW 67TH AVE
Project: Green Office Subdivision: WEST PORTLAND HEIGHTS Lot: 6
Project Description: Adding(2)lays,(1)garbage disposal,replacing(1)hose bib,(2)lays,(2)water closets&(1)water heater. 3/6/17,
REPRINTED to correct scope of work:Adding(1)new lay and replacing(3)existing lays. All other work remains
the same.
Contractor: AGS CONSTRUCTION 1 LLC Owner: GREEN OFFICE LLC
24606 NW 4TH CT ATTN: JOESPH E GREEN
RIDGEFIELD,WA 98642 11560 SW 67TH AVE
TIGARD, OR 97223
PHONE: 360-500-0999 PHONE: 503-806-3004
FAX:
FEES
Quantity Description Date Amount
1 ea Garbage Disposal 02/16/2016 $25.02
Specifics: 1 ea Hose Bib 02/16/2016 $25.02
4 ea Lavatories 02/16/2016 $100.08
Type of Use: COM 2 ea Water Closet 02/16/2016 $50.04
Class of Work: ALT 1 ea Water Heater 02/16/2016 $37.52
Type of Const: 1 12%State Surcharge- 02/16/2016 $28.52
Occupancy Grp: Plumbing
Stories:
Total $266.20
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 que to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued Ey: er, Permittee Sign.tures 1 /
Call 503.639.4175 by 7:00 a.m.for the next available in .ection 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.
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DAT RECEIVED:
DEPT: BUILDING DIVISION RECEIVE
APR - 6 2016
FROM: •
COMPANY: CQ,Lf. ,3 GLi--c. r'
PHONE: 5O3- 7
RE: L 15 l,S 4- Z L 74 ✓-tv N.Hd ( la- 0007ea
(Site Address) (Permit umber)
� ��� rle,�c. ��� otott, - coo )9
( ro�ect name or subdivision name and 1. nu ber)
ATTACHED ARE THE FOLLOWING l'1g1S:
Copies: Description: Copies: Description:
Additional set(s) of pl Revisions:
Cross section(s) and tai► . / Wall bracing and/or lateral analysis.
Floor/roof framing. / Basement and retaining walls.
Beam calculations Engineer's calculations.
Other
(explain):
REMARKS: CET t tA.E,H ' n� o ( t) AD.?)g D Lvv 1)
nn+- (3ALpr e.f_►-1 4-r--6, 6.)0--- (a-) / t-t...3 (X) k.-PLA-e€-H t, rs
P E i-f rT "1-
FOR
+FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: [' Yes �,, ❑ No Fee Description: Amount Due:
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc
CITY OF TIGARD PLUMBING PERMIT
YF�
n
$ ° COMMUNITY DEVELOPMENT Permit#: PLM2016-00076
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/16/2016
Parcel: 1S136DD00801
Jurisdiction: Tigard
Site address: 11565 SW 67TH AVE
Project: Green Office Subdivision: WEST PORTLAND HEIGHTS Lot: 6
Project Description: Adding(2)lays,(1)garbage disposal,replacing(1)hose bib,(2)lays,(2)water closets&(1)water heater.
Contractor: AGS CONSTRUCTION 1 LLC Owner: GREEN OFFICE LLC
24606 NW 4TH CT ATTN: JOESPH E GREEN
RIDGEFIELD,WA 98642 11560 SW 67TH AVE
TIGARD, OR 97223
PHONE: 503-806-3004
360-500-0999
FAX:
FEES
Quantity Description Date Amount
1 ea Garbage Disposal 02/16/2016 $25.02
Specifics: 1 ea Hose Bib 02/16/2016 $25.02
4 ea Lavatories 02/16/2016 $100.08
Type of Use: COM 2 ea Water Closet 02/16/2016 $50.04
Class of Work: ALT 1 ea Water Heater 02/16/2016 $37.52
Type of Const: 1 12%State Surcharge- 02/16/2016 $28.52
Occupancy Grp: Plumbing
Stories:
Total $266.20
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 i not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to f ow e rules adopted by the Oregon
Utility b,: enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00 . Y, ay obtain a copy of the rules
or. ect questions to •► C by calling 503.232.1987 or 1.800.332.2344.
Is ued By: k / / Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspe.•'on 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.
f -i
Plumbing Permit Application
Building Fixtures RECEIVE!)
Received .
Ci of Tigard }},A,ll^) Permit No.: L/ /�p ooO7
City 8 pateiBy: /(o i(Q I �
13125 SW Hall Blvd.,Tigard,OR 97223111114
Plan Review
Phone: 503.7182439 Fax: 50 ' .l6 016 Date/By: Other Permit No.6/,01..90/6,OC ?
I I� I,I Inspection Line: 503.639.4175 Date Ready/By: rurn 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: S ,, emental Information e
,y +w-,fir- p'& x . "' s , ". „ •;. 'I� '
,,,_,.,,1-,--,,, ' k a�- ,= aL s Isi ),t9 5 iii 3! m 2 s +:41--,s t- ,.i. l4� , a _.'• ., .s
❑New construction • ■ Demo idon For special Information use checklist
Description -7-
I Qty. I Ea. I Total 13
(,f Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
101010
' ORY OF COSFR(I)bath 312.70
0 ., CONSTRUCTION
#.. _:ate .. �� . „., .: ,_�_.- _
❑ 1-and 2-family dwelling BSFR(2)bath 437.78'Commercial/industrial -
SFR(3)bath 500.32 QO
❑Accessory building 0 Multi-family Each additional bath/kitchen 25,02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
_ ' kb SITE INFORMATION AND LOCAT ON Site utilities: `` ����
Job site address: j 4 c ski c rrZ /�ue Catch basin or area drain 18.76 V'
Dtywell.leach line,or trench drain 18,76
City/State/Z1P; ' 2 Footing drain(no.linear ft.; ) Page 2
Suite/bldg./apt. no.: Project name: 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 it.:_) Page 2
Subdivision: Lot no.: Fixture or Item:
Tax mapiparcel no.: /61;3 6 D b $0/ Backflow preventer 31.27
ESCRIPTION OF WORKBackwater valve 12.51
Clothes washer25.02
G Dishwasher
25,02
Drinking fountain 25.02
Ejectors/sump 25.02
-��.-
P ERTY OWNS ❑ TENANT Expansion tank
12.51
Name: z-�T,j + Z C Fixture/sewer cap 25.02
Etc .. _
7 ` Floor drainaloor sinkihub 25.02
Address; ` Garbage disposal 25.02 2
City/State/ZIP: 40 Z� Hose bib M
!/ 25.02 zf b t.
Phon Q ) - Q Fax:( ) Ice maker 12.51
F.
C a N TACT PERSON Interceptor/grease trap 25,02
Business name: ~ 0_. Ice � Medical gas(value:$ ) Page 2
/ C� Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: /fie. ..._.S coQ � _ Sink/basin/lavatory 25.02 /450r0
..
City/State/ZIP: s• 4 1 40 If rSalar units(potable water) - 62.54
Phone:(j2 ) !?t, .2 9Z' Fax: :( ) Tub/shower/shower pan 12.51
/� /� -Urinal 25.02
E-mail; .Joe (4i f N e '�I', �• con ascK Z-
Water cl 25.02 +50-0V
`ONTRA Water heater 1 37,52 .37,g2,.
Business name: 4 5 S,� SAJ Water piping'DWV 56.29
Address: !�` L -it C Other: 25.02
City/State/ZIP: g tr I ell W 9r Ir / 2 Subtotal J37.pct
Phone:(Ma cod 0 / 7 9 Fax:( )
Minimum permit fee: 572.50
yell e)Ai I Plan review (23%of permit tee)
CCB Lic.: s;/17/1(00 Plumbing Lic.no.:(' 2
'V/6 State surcharge(12%of permit fee) a$. S
Authorized signature: n TOTAL PERMIT FEE A(re.X0
Print"me: Date: 2.9.16 This permit application expires If a permit is not obtained within ISO days
George Chechelnitskiy after It has been accepted as complete.
*Fee methodology set by Tri-County•Building industry Service Board
I Building Permits KW,-PermitApp.doe 1001 09 340•4616'1(I002('OM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Qt . Fee ta) Total Square Foafage �, 'i t_Pee:
Footing drain-i" 100' 50.03 0 to 2,000 $1 1
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 3,601 to 7.200 $233.20
Sewer- 1st 100' 62.54 7201 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$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 Feesand 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*. Plan Review for Plumbing Installations
Quantit•by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool , 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic ,
Drinking FountainSubmit 1 sets of plans with any of the above.
Eye Wash .
Floor Drain/sink: -2'•
. - IsgmetrlC'or Riser Dila_gram
4" _ 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) a Olt,25, ` ,/tic /`Q'frufri ,e e-4.14 ,p ��
Rec.Vehicle Dump Station
hi2/0--or, .4�a � -D 440 /Shower: -Ganzfr 64,11]-Q�J Cf>1..(. 5
-Stall -7'��(� /��h
Sink: -Lav/Bar non-food related a
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet-Toilet /Z
Urinal /
Other Fixtures: l W't1- « (f I
�
sstt aa . {
L:\Building\Pertn�tt\PLIGIFI rermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11565 SW 67TH AVE, TIGARD, OR, 97223 June 15, 2017 at 2:03:29 PM
Record Type: Record ID:
Commercial - Plumbing PLM2016-00076
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor