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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2016-00313 TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/21/2016 Parcel: 2S106DB23700 Jurisdiction: Tigard Site address: 17390 SW SABRINA AVE Project: River Terrace Northwest Swim Center Subdivision: RIVER TERRACE NORTHWEST Lot: X Project Description: Site utilities: (3)catch basins,437'of footing drain,(4)rain drain connectors,27'of sanitary sewer, 182'of storm sewer,27'of water service&(1)backflow preventer. Contractor: NORTHWEST EARTHMOVERS INC Owner: ADLV LAND HOLDINGS LLC PO BOX 1609 BY FORSUM, MICHAEL SHERWOOD, OR 97140 7600 E DOUBLETREE RANCH RD STE 1 SCOTTSDALE,AZ 85258 PHONE: 503-625-3100 PHONE: FAX: 503-625-3108 FEES Quantity Description Date Amount 3 ea Catch Basin or Area Drain 07/21/2016 $56.28 Specifics: 437 If Footing Drain 07/21/2016 $200.11 4 ea Rain Drain Connector 07/21/2016 $75.04 Type of Use: COM 27 If Sanitary Sewer 07/21/2016 Class of Work: NEW $62.54 182 If Storm Sewer 07/21/2016 $100.06 Type of Const: 27 If Water Service 07/21/2016 Occupancy Grp: $62.54 1 ea Backflow Preventer 07/21/2016 $31.27 Stories: 1 Plan Review 07/21/2016 $146.96 1 12%State Surcharge- 07/21/2016 $70.54 Plumbing Total $805.34 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 Co q ' l.,,,,,k,„ or directns-to OUNC by calling 503.232.1987 or 1.800.332.2344. 9 - Issued y: v Perm ittee Signature: ir ,,,..,,,,, 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. Plumbin' Permit A I t lication Site Utilities ,. 4 CO FOR OFFICE LSE ovl.1 Ci SW Hall Blvd., ' City of Tigard .;,,„_ i '�41� ReceiveY In l , � /6 3/ IIIIDateB �[ / �� Permit No.: L Tigard,OR 9�7L22 Plan Review a Phone: 503.718.2439 Fax: SOHK.1 6 Other Permit No.:61-`"�j(6,� b� Date/By: T I G n K D Inspection Line: 503.639.4175 4 Date Ready/By: Internet: Line:g / �� y y: 7uris: ® See Page 2 for �'4��yt� Notified/Method: j�t S �+ �IVd�I� Supplemental Information TYP a.14` Wk' ',, • ^=FEE* SCHEDULE New construction ❑Demolition For special information use checklist Description Qty. Ea. Total 0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 0 1-and 2-family dwelling El/Commercial/industrialSFR(2)bath 437.78 0 Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Catch basin or area drain Job site address: ) 18.76 5 / 1-1 10 8 LL Gilor 1p, f4YLe. �. City/State/ZIP: C R. q-.---7.0---- -Lt Drywell,leach line,or trench drain 18.76 I T'��� t� I Footing drain(no.linear ft.:?Peej 4Y? Pae 2 g Suite/bldg./apt.no.: Project name:NG( C1UoeSt4-eY Tea Manufactured home utilities 50.03 -Tel. Cross street/directions to job site: Sup t•-L QFez 7-4-2- Manholes 18.76„?S,oet, Rain drain connector 4 C11 64,s,,„,,23,4 . +18.76 (P2,FAiy Sanitary sewer(no.linear ft.:4430 ) a7 v Pa 2 1-Z5-15-7 - Storm sewer(no.linear ft.: /u•V/00.044. Pai�• 0 Water service(no.linear 8.:4t34.) AR% Page 2 (ppni.1 ,,,-- Subdivision: (\®r4-h Sk- (2_i ye,- Te f riA Ck I Lot no.: T rC.4 Fixture or item: Tax map/parcel no.: nW,C`c j V+'\A-e l_ Backflow preventer ( 31.27 31,29 DESCRIPTION OF WORK Backwater valve 12.51 , � , Clothes washer 25.02 '---- t / �- L(-(/ Lir I -.5 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 E PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: (\D V L Lc kAC\&,cS L Fixture/sewer cap 25.02 J 1 n Floor drain/floor sink/hub 25.02 Address: -1 to 00 F 8 encee v_" A- - 4C '\Ch V cxgc_S Garbage disposal 25.02 City/State/ZIP: S co•-{k s c_Ct.L&. i\-z_ -z_ fl 5',)13---(Z- Hose bib 25.02 Phone:((p('L) (oC� Lt 03 Fax:( ) Ice maker 12.51 ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: I*k\\ 61� LJ b n t\U Y-�,e S 1 h Medical gas(value:$ ) Page 2 Contact name: I Primer 12.51 1 e,c0,_ 6nRoof drain(commercial) 12.51 Address: \0C E&S ( '°'` '\--ree... 11 Sink/basin/lavatory 25.02 City/State/ZIP: Vu n e U u4.( lAi A Solar units(potable water) 62.54 Phone:(%b) (09-tj- -'r 1 Q O Fax: :(N,p) C;,Gt- _y{N 4 a Tub/shower/shower pan 12.51 E-mail: GZ,111NA0. . Veyi.�SWi Q. {` 7© y cr t'l0mcs. Corn Urinal 25.02 ' CONTRACTOR Water closet 25.02 r`� Water heater 37.52 Business name: Nor.4k1v5.� ciArthmovev-c \nL Waterpip 1 m g/DWV 56.29 Address: l7 p 60)c k tOGI ,r� Other: 25.02 5$9.84 City/State/ZIP: Cz-,h�t' (WOO 1`O c7 4 L U Subtotal 1" Phone:(502)) 2__� 0 t Fax:( 21 (00-5_ (O8 Minimum permit fee: $72.50 CCB Lic.: 3 L� B Plan review (25%of permit fee) /4L 9 . ("AV/ Plumbing Lic.no.: ?j4" (l n 9-5,60- Authorized rj4 State surcharge(12%of permit fee) Authorized signature: .) a 3 K� TOTAL PERMIT FEE '. �' Print name: A , Cl ri j e l i,>1_" Date: (�I f I ( (0 This permit application expires if a permit is not obtained within 180 days 1 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 2 I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Jo.�a 805,31 1 PagePlumbing2Supplemental Permit ApIplicationformation- City of Tigard - n Fee Schedule: Residential Fire Suppression Systems: Site Utilities: Qty• Fee(ea) Total Square Footage: Permit Fee: Footing drain-151100' i 50.03 50,c,6 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 150.08 2,001 to 3,600 $169.69 4 3,601 to 7,200 $233.20 Sewer-1st 100' ( 62.54 is R 54 7,201 and greater $327.54 Sewer-each additional 100' 0 37.52 Water Service-1st 100' I 62.54 UA ,7a4 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee'' Storm&Rain Drain-1st 100' ( 62.54 toa,5 - $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' t 37.52 Atitirki 3'l,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/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; 4X5,A 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/ Plan review is required for any of the following. Work Performed: Capped Added Relocate Please check all that apply. Baptistry/Font Bath -Tub/Shower ❑ Any new commercial building with water service 2"and -Tub/Sower 1pool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. Drive Thru ID 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', Isometric or Riser Diagram. Car Wash Drain ❑ Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food 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 increase of sewer EDUs,a sewer permit will be issued and Water Extractor Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: ' I:\Building\Permits\PLMU PermitApp.doc 2 Plumbing Permit Application - City of Tigard Page 2 Supplemental information Fee Schedule: Residential Fire Suppression Systems: m S.itrE'"tltihties" LL• 90' F (ea) 't'otat:. Squir e . FWcl,otage•, Perinit Fee �'�3,44 / Footing drain-1''100 50.03 Oto 2.000 , 51199 g ` Footing drain-each adcfitiatta1100` 37.52 2,001 to 3,Cr00 5169.69 �`(lt� Sewct-1st 100' ( 62.54 62.�r t 3,601 to 7,2(10 $233.20 `i 7.201 and greater 53227.54 Sewer-each additional 100 ( 37.52 57.52 Water Service-1st 100' l 62.54 (o2_ Water Service-each additional 100' 1- 37.52 i5.04 Medical Gas Systems: hautaiagl. Permit Fee: / Rain Dram 1st 100' fit 54 P �, On Storm& •.te m Storm&Rain Drain each additional 10() 37 52 S1.00 to$5,000.00 Minimum fee$72.50 ► $5,001.00 to$10,000.00 $72.50 for the first$5.000.00 and 51.52 for 1�l'""�D t1l',TITSpe1Gillansur Faees'' iea} Teat each additional S100.00 or fraction thereof,to Inspection of existing plumbing or for and including510.0(x).00. which no fee isexisting specifically indicated 90 $10,001.00 to$2_5.000.00 $148.50 for the first$10,000.00 and$1.54 for .(x).1rr each additional 51(10.00 or fraction thereof,to (minimum charge-1,2 hour) Inspections outside of normal bus) 9(1.00.1ar and including$25.000,00. hours(minimum charge-2 hours) 525.00100 to$50.000.00 $379.50 for the first$25,0(1{),00 and$1.45 for Reinspection Fees 90.00`hr each clu additional S5000.O0 or fraction thereof,to and including 550,000.00. Additional plan review for revisions 90.0011r $50,001.00 and up ( $742.00 for the first$50.000.00 and$1.20 for (minimum charge-1/2 hour) I J 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*. Plan Re;y iew foie Plumbing i`ustallations -: Quantity by Fixture Type Plan review is required for anyof the following. Fixture:Type for u1 Relocat' Ple e check all that apply. Vi urk Performed: Capped Added Relocate Baptistry%Font Any new commercial building with water service 2-and Bath: Tub/Shower greater,except systems designed and stamped by licensed -Jacurri:Whiripool engineer. Car Wash Each Stall El Nein exterior plumbing site utilities fear any complex structure Drive Thru as defined in OAR918-78(1-0040. Cusptdsv'-Water As ire T 0 Medical gas and vacuum systems fi>r health care facilities. Dishwasher: Commerc=ial 0 Any multipurpose fire sprinkler system. -Domestic ❑ Any complex structure as defined in OAR918-780-0040; Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Dtain'sink: -2" 1 3- 1 '' � ' Inietrlic�r Riser Diagram -Car Wash Drain 3 Isometric or riser diagram is required for new buildings Garbage -Domestic non-food ,,11 " that meet the qualifications above. Disposal: -Domestic food related w -Commercial food related t r1/ -Industrial food related Ice Mach.-Rettig Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang V -Stall Sink: -lav:'Barnon-ti,od relatedc. -Bradley -Com Serv/Util food related -Service Swimming Pool Filter If the fixture work under this permit results in an Washer-Clothes / 1 increase of sewer EDUs,a sewer permit will be issued and Water Extractorfees assessed for the sewer increase must be paid before the Water Closet-Toilet y plumbing permit can be issued. Urinal 1 Other Fixtures: I:13uildineennits,PLMF_PermitApp.dae 08/04/20l 1 2