Permit (17) CITY OF TIGARD PLUMBING PERMIT
S "- COMMUNITY DEVELOPMENT Permit#: PLM2016-00002
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/16/2016
T I t' R_ � 9 Parcel: 2S1060001801
Jurisdiction: Tigard
Site address: 17480 SW CLEMENTINE ST
Project: Clean Water Services River Terrace Pump Station Subdivision: 2002-032 PARTITION PLAT Lot: 3
Project Description: New sewer pump station: (1)catch basin, (1)trench drain,334'footing drain,(2)manhole/wet well, 145'of sanitary
line, 133'of storm sewer,64'of water service, (1)backflow preventer,(2)ejectors pumps, (1)floor drain,(2)hose
bibs, (1)primer&(3)roof drains.
Contractor: ROTSCHY INC Owner: CLEAN WATER SERVICES
9210 NE 62ND AVE 16060 SW 85TH AVE
VANCOUVER,WA 98665 TIGARD, OR 97224
PHONE: 360-334-3100 PHONE:
FAX:
FEES
Quantity Description Date Amount
ea Catch Basin or Area Drain 05/16/2016 $18.76
Specifics: 1 ea Drywell, Leach Line or Trench 05/16/2016 $18.76
Drain
Type of Use: COM 334 If Footing Drain 05/16/2016 $162.59
Class of Work: NEW 2 ea Manholes 05/16/2016 $37.52
Type of Const: 145 If Sanitary Sewer 05/16/2016 $100.06
Occupancy Grp: 133 If Storm Sewer 05/16/2016 $100.06
Stories: 64 If Water Service 05/16/2016 $62.54
ea Backflow Preventer 05/16/2016 $31.27
2 ea Ejectors/Sump 05/16/2016 $50.04
2 ea Hose Bib 05/16/2016 $50.04
1 ea Primer 05/16/2016 $12.51
3 ea Rain Drain-Single Family 05/16/2016 $37.53
Dwelling
1 Plan Review 05/16/2016 $170.42
23 ea Info Process/Archiving-Lg 05/16/2016 $46.00
$2.00(over 11x17)
Total $979.90
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 -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or ect questions to O by - g 503.232.1987 or 1.800.332.2344.
ssued By: "Ce/(,k.-16M Permittee 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.
I Plumbing Permit Application
Site Utilities FOR OFFICE LSE O\I.N
(� e1 Received / .�, `Ll
City of Tigard V�' `Et) Date/By: I V /t, Permit No.: Q`d l52tl
■ 13125 SW Hall Blvd.,Tigard,OR qqCC / �`� 1C
• C Phone: 503.718.2439 Fax: 503.598.196Ni 4 201v Plan Review
Q^*'' Date/By: /-S----14 Other Permit No.:3:tra ,i nf'oo i'
Inspection Line: 503.639.4175 J�,V n Date Rea /B Jur s: H See Page 2 for V
TIC,ARI) L� Y Y B
Internet: www.tigard-or.gov of It A Notified/Method: /Olt/ / l' >i Supplemental Information
"'y g) 41-:-,;:-;',,,r;',...441, .z fix Zw , ii a 14, ,!' 1 ..ii;'°.:Y.(74'9 t'42,9$4",=:;,-.1',-.0':,
®New construction ■ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
.4,7,;11:" . t'-'i iii s sit i a e+ s a 3W P,x 3��4,; SFR(1)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder El Other: Fire sprinkler( sq.ft.) Page 2
.°1 e 1 . ,, J ;a� Site utilities: o�
Job site address:17480 SW Clementine St Catch basin or area drain 1 18.76 18.76 ✓
City/State/ZIP:Tigard,OR 97007 Drywell,leach line,or trench drain ( 18.76 fig,?6
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:River Terrace North PS Manufactured home utilities 50.03
Cross street/directions to job site:1100'West of SW Roy Rogers Rd., Manholes /c.„,.01- 4,u4( 2_ 18.76
1350'South of SW Scholls Ferry Rd. Rain drain connector 18.76
Sanitary sewer(no.linear ft.:145) Page 2
Storm sewer(no.linear ft. ' 133 1 Page 2 62.54
Water service(no.linear ft.:64) 1 Page 2 62.54 t ,
Subdivision: I Lot no.: 1801 Fixture or item:
Tax map/parcel no.: 1S 1 06 Backflow preventer / 31.27 31 al
nE~r1I0N Pf *Ow..
mr Backwater valve 12.51
Clothes washer 25.02
Construction of a new sanitary sewage pump station and 12-inch diameter sewer Dishwasher 25.02
force main. Drinking fountain 25.02
Ejectors/sump No.,i.,S 2.. 25.02
Expansion tank 12.51
'7,,,,;,:,°,t;•••,,;,,,;,, ,..::',''',,, P
•
Fixture/sewer cap 25.02
Name:Mike Kebbe,Clean Water Services ,5ft.,
Floor drain/floor sink/h �t,00/ 25.02 25.02
Address: 16060 SW 85th Ave 7,0-*ri
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 2 25.02 50.04
Phone:(503)547-8187 Fax (503)547-8196 Ice maker 12.51
.;;,,C0.7:0 sd i0cAN't ,. 1:...: * Interceptor/grease trap 25.02 I
Business name:Murray,Smith&Associates,Inc. Medical gas(value:$ ) Page 2
Primer 12.51 a,5/
Contact name:Alex Bargmeyer
Roof drain(commercial) 3 X 12.51 .12.11.
Address: 121 SW Salmon,Suite 900 Sink/basin/lavatory 25.02
City/State/ZIP:Portland,OR 97204 Solar units(potable water) 62.54
Phone:(503)225-9010 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:Alex.BargmeyerCumsa-ep.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name PO (, 74( Water piping/DWV 56.29
Address: 91 /6 NI (n a t Other:kr,04,401,e644.-- 25.02
1
City/State/ZIP: 1/4,,,..c tiff-/ 4.//1 7 r a y Subtotal 206.39
Phone:(iSO) ?f'-( ?/ 0 Fax:( )
Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 56 nPlumbing Lic.no.: pb Lf it y State surcharge(12%of permit fee)
iii II
Authorized signature: TOTAL PERMIT FEE
Print name:Alex Bargme Date: 12/31/15.C4....,__.......--- --
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 I'LMU-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:
leek. -04Toldt
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' 1 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' I 62.54 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
+ each additional$100.00 or fraction thereof,to
1 'z. ° '> u .. 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:
Other Fixtures: I
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
Fixture Type for Replace/ �p
Work Performed: Capped Added Relocate
Baptistry/Font Plan review is required for any of the following.
Bath -Tub/Shower Please check all that apply.
-Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and
Car Wash -Each Stall greater,except systems designed and stamped by licensed
-Drive Thm engineer.
Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure
Dishwasher -Commercial as defined in OAR918-780-0040.
-Domestic ❑ Medical gas and vacuum systems for health care facilities.
Drinking Fountain El Any multipurpose fire sprinkler system.
Eye Wash El Any complex structure as defined in OAR918-780-0040.
Floor Drain/sink -2"
3" Submit 2 sets of plans with any of the above.
-4"
Car Wash Drain Diatiam
Garbage -Domestic-non-food Isomet iC or i
Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings
-Commercial-food related that meet the qualifications above.
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station Comments regarding fixture work:
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes
Water Extractor *Note: If the fixture work under this permit results in an
Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
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Litr1-4((coUoZ RECEIVED'
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_ AN 42016
U11Ot MAKI)
Murray Smith&Associates,Mc. BUILDING DIVISION
Engineers/Planners 121 S.W.Salmon,Suite 900 !i Portland,Oregon 97204-2919 r PHONE 503.225.9010 FAX 503.225.9022
LETTER OF TRANSMITTAL
To: City of Tigard, Building Division Date: December 31, 2015
13125 SW Hall Blvd. Job No. 14-1611
Tigard, OR 97223 Re: Clean Water Services, River Terrace
Pump Station Design Project, Site
Attn.: Utilities Permit
WE ARE SENDING YOU: El Attached ❑ Plans ❑
Copies Date Description
1 Dec - 2015 Site Utilities Permit Application
2 Dec - 2015 River Terrace North Pump Station Plans—Site Utilities Permit
THESE ARE TRANSMITTED as checked below:
Q For approval ❑ For your use ❑ As requested ❑ For review/comment
REMARKS:
City of Tigard:
Please find enclosed the above listed documents required for the building permit review.
Let me know if you have any questions or require additional information.
Thank you.
COPY TO: SIGNED: .iIuLt l`
Alex M. argmeyer, P.E.
G:PDX_Projects,14 1611-River Terrace North PS&FM 0205-Approvals&PermitsTransmittalsCity of Tigard 12-31-15.docx
MSA
Murray,Smith&Associates,Inc.
Engineets/Planners 121 S.W.Salmon,Suite 900 n' Portland,Oregon 97204-2919 PHONE 503.225.9010 FAX 503.225.9022
LETTER OF TRANSMITTAL
To: City of Tigard, Building Division Date: January 6, 2016
13125 SW Hall Blvd. Job No. 14-1611
Tigard, OR 97223 Re: Clean Water Services, River Terrace
Pump Station Design Project, Site
Attn.: Jim Dunlap Utilities Permit
WE ARE SENDING YOU: ❑ Attached EI Plans ❑
Copies Date Description
2 Dec - 2015 River Terrace North Pump Station Plans, Sheets M-5 through M-7— Site
Utilities Permit
THESE ARE TRANSMITTED as checked below:
Il For approval ❑ For your use ❑ As requested ❑ For review/comment
REMARKS:
Mr. Jim Dunlap:
Please find enclosed the above listed requested plans required for the Site Utilities permit review.
Let me know if you have any questions or require additional information.
Thank you.
COPY TO: SIGNED:
Ale •. Barg eyer, P.E.
G:PDX_Projects l4 1611-Riser Terrace North PS&FM 0205-Approvals&Permits Transmittals City of Tigard-Jim Dunlap 01-06-16.docx