Permit (43) CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM2016-00314
t
TIGARD 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: Interior plumbing for new swim center:(1)backflow preventer,(1)backwater valve,(1)dishwasher,(1)drinking
fountain,(5)2"floor drains,(1)4"drain,(2)hose bibs,(3)primers,(1)ice maker drain,(1)sink,(3)lays,(1)shower
stall,(1)swimming pool filter,(1)urinal,(4)water closets&(2)water heaters. 4/6/2017: Change contractor.
Contractor: G&B PLUMBING&SONS INC Owner: ADLV LAND HOLDINGS LLC
PO BOX 92 BY FORSUM, MICHAEL
ST PAUL, OR 97137 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 503-868-1417 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/21/2016 $31.27
Specifics: 1 ea Backwater Valve 07/21/2016 $12.51
1 ea Dishwasher 07/21/2016 $25.02
Type of Use: COM 1 ea Drinking Fountain 07/21/2016 $25.02
Class of Work: NEW 6 ea Floor Drain/Floor Sink/Hub 07/21/2016 $150.12
Type of Const: 1 ea Ice Maker 07/21/2016 $12.51
Occupancy Grp: 3 ea Primer 07/21/2016 $37.53
Stories: 1 ea Sink 07/21/2016 $25.02
3 ea Lavatories 07/21/2016 $75.06
ea Tub/Shower/Shower Pan 07/21/2016 $12.51
1 ea Urinal 07/21/2016 $25.02
4 ea Water Closet 07/21/2016 $100.08
2 ea Water Heater 07/21/2016 $75.04
25 Misc Other Fee 07/21/2016 $25.02
1 Plan Review 07/21/2016 $170.44
1 12%State Surcharge- 07/21/2016 $81.81
Plumbing
Total $934.02
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 or 1.800.332.2344.
Issued By: 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
PlumbingPermit A licat1 ,z
Building Fixtures
City of Tigard APR 6 ?0 17 Received -1*.'
... ....... . . .. ...v � Y
'V..
��. .. i. Perm
it N� G
6-�' 0
Yy/Vv 13125 SW Mall Blvd.,Tigard,OR 97223 plan '
C Phone: 503.718.2439 Fax: 503.598 )# 1 it.!f Date/By:ipi
Other Permit No.:
TGAInspection Line: 503.639.4175 /BY rums: l�See Page www n and•or ov s 1' ;')P,''''', � fr) r t 2� NDaohfRaMetod lemet l Information
([tO luwNOtAi WOIi{ + SF ' iligganagginitWil00.#00*,„.IONINtgigif.
For special information use checklist
El New construction 0 Demolition
E3
Description I Qty. I Ea. I Total
C Addition/alteration/replacement y� �v ;7 IJ TOther: New 1-2-family dwellings(includes 100 ft,for each utility connection)
i @}x;.L y. .5 . r.'t.:....� $ rif'.!CO,�IY t�F alifiaC.i 'q,N,.¢ .., ; ...
,' t� t ;�; SFR(I)bath 312.70
'', 3,3.14,�,
Igal€-and 2-famiiy llin dweSFR(2)bath. 437.78
g ❑Commercial/industtial
SFR(3)bath 500.32
d Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire
�"' "^t<�O�t ,rl)Bt;SIT ?iNFOR1►+tAT�ON Ahs` 07.40)N \ 4; Site utilities:( ft.) g
s . Page
Job site address: ( 7- 0 ,11/1/ t_ na - Catch basin ca drain 18.76
Drywall,leachh lin Iine,or trench drain 18.76
City/State/VIP:Tigard,OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldgfapt.no.: I Project name:Northwest River Terrace 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
W I Water service(no.linear ft.:„_) Page 2
Subdivision:Northwest River Terrrace I Lot no.: atkr Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
y n �/ M � yy � $ G '#Q k OtYYOR ' - ;k
Backwater valve 12.51
,... .,7::„, �r- w.,,,,.. , >� ," <..., ;. :V d,uh �:...:n F.1
Clothes washer 25.02
chane C.011tra ! Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
S a 3'k r�tp'y,,ry7� !�av/�t i u� } - n 2 i,' > r r �. ♦r�3��'. ' s Ex anion tank
iK.;.,•,F,{ x.,.reu+?VwO�J•Z';.i liMii`. .:. ,�f. ..<< 'ti �..'..::.1. I.ijs ?ti j,a'.n2�' .£ix.,.,. P 12.51
Name:ADVL Land Holdings,LLC Fixture/sewer cap 25.02
Address:7600E Doubletree Ranch Road Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694-4031 Fax:( ) Ice maker 12.51
.. . "+ Interptor/gease trap a4 ! Gi li � t .D5iL $�liR 25.02
Medical gas(value:$ ) Page 2
Business name:William Lyon Homes,Inc
Primer 12.51
Contact name:Angela Grajewski
Roof drain(commercial) 12.51
Address:109 East 13th Street Sink/basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)6957700 Fart::(360)693-4442 Tub/shower/shower pan 12.51
&mail:Angela.Grajewsk€ta�,polygonhomes.com Urinal 25.02
. r.. Watercloset 25.02CN [tAC " R ,, ° i , 4+ ...iSkrz2O. ii'g. .k . , .,V4 Water heater
37.52
Business name: G.t:1-1Iii V,tt� ��, ,4-.vy 1:1,),A4,..... Water piping/DWV 56.29
Address: pa Q, 6- (ii�,, Other: 25.02
City/State/ZIP: 5"�''; a „fr., c:rl(3"'j Subtotal
72.50
Phone:(343.►8(& 114/1 Fax:(all V w"7Q' 1. 4?,� iA) Minimum permit fee:permitfee)
CCB Lie,: 18.413-7,0_, Plumbing Lie.no. (3tf Plan review (25%of fee)
r State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:S"t"f,Vf.- t 14_i� Date: -3 _i b This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete. •
*Fee methodology sat by Tri-County Building Industry Service Board.
I:LBiilding\pcmiuPLMU•PmmtApp,doc 10/01/09 44046t6T(te/02/COM/WEB)
CITY OF TIGARD PLUMBING PERMIT
11111 8 . COMMUNITY DEVELOPMENT Permit#: PLM2016-00314
TIG AR D 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: Interior plumbing for new swim center:(1)backflow preventer,(1)backwater valve,(1)dishwasher,(1)drinking
fountain,(5)2"floor drains,(1)4"drain,(2)hose bibs,(3)primers,(1)ice maker drain,(1)sink,(3)lays,(1)shower
stall,(1)swimming pool filter,(1)urinal,(4)water closets&(2)water heaters.
Contractor: ALLIANCE PLUMBING LLC Owner: ADLV LAND HOLDINGS LLC
PO BOX 386 BY FORSUM, MICHAEL
TROUTDALE, OR 97060 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 503-899-9912 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/21/2016 $31.27
Specifics: 1 ea Backwater Valve 07/21/2016 $12.51
1 ea Dishwasher 07/21/2016 $25.02
Type of Use: COM 1 ea Drinking Fountain 07/21/2016 $25.02
Class of Work: NEW
6 ea Floor Drain/Floor Sink/Hub 07/21/2016 $150.12
Type of Const:
1 ea Ice Maker 07/21/2016 $12.51
Occupancy Grp: ea Primer
Stories: 3 07/21/2016 $37.53
1 ea Sink 07/21/2016 $25.02
3 ea Lavatories 07/21/2016 $75.06
1 ea Tub/Shower/Shower Pan 07/21/2016 $12.51
1 ea Urinal 07/21/2016 $25.02
4 ea Water Closet 07/21/2016 $100.08
2 ea Water Heater 07/21/2016 $75.04
25 Misc Other Fee 07/21/2016 $25.02
1 Plan Review 07/21/2016 $170.44
1 12%State Surcharge- 07/21/2016 $81.81
Plumbing
Total $934.02
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct to OUNC bcalling 503.232.1987 or 1.800.332.2344.
Is ued By: k ca_____04/ i/r_A
Permittee Signature: I /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
r
Plumb n• Permit A t i licit'I , ' ' P-09cico GSD (0O
Building Fixtures 1Or� 01 I i( t ,i ��>1.1
City of Tigard .UN ' �a16 Received /� �/
n Da y. Ly: Le 11, 1 C , t� Permit Na.: ,t tile:9.6/6` ,�Jj 511
13125 SW Hall Blvd.,Tigard,OR 97223 r+�"
Phone: 503.718.2439 Fax: 50 ..4Q{ �, /,01 - e 1 't 11 t Other Permit Na-:Q
Inspection Line: 503.639.4175 `✓`` 1(''' 1-? ' ; �Q l ag P fur
15_06 3
[i C,',f`i aspect ��4"t�`t _ Date ReadyiBy. 7uris. See t'age 2 for
Internet: www.tigard-or.gov , U !,.t Notified/Method: , Supplemental Information
# �$ 1 ..V.,(',. � ' , lei*1-4101)
New construction For special information use checklist
Demolition
Description #, Qty. I Ea. 1 Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 R.for each utility connection) t
CA1'F`s' OF' SFR(I)bath il 312.70
0 I-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
0 Accessory building SFR(3)bath 500.32
Multi-family
Each additional bath/kitchen " 25.02
Master builder 0 Other Fire sprinkler( sq.ft.) Page 2
. . INCA A ��y s Site utilities: _
Job site address:
7 3 10 Su) 5n lir, 1 la 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: No(L(huk[S{River Ter((44.- Manufactured home utilities 50!03
Cross street/directions to job site: t,...)t,e-t..-Cfw 2 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
a5/64 T n ;3-7bv Storm sewer(no.linear R.: _) P 2
/� Water service(no.linear ft.: ) Page 2
Subdivision:.pO,(41\WAST River Terrrace Lot no.:Ti Fixture or item:
Tax map/parcel no X Backflow preventer/ ( 31.27 3 .�
- �` Backwater vatve ` 12.51
0..5/ ' -
� �-� Clothes washer 25.02
'r_.v t C --N Dishwasher / 1 25.02 05.0 2r/.
Drinking fountain j 25.02 A5.L ✓
Ejectors/sump 25.02
141/11101,00/NEI 1 ci� " R Expansion tank 12:51
Name:ADVL,Land Holdings,LLC Fixturefsewercap 25x02
`�.
Address:7600'E Doubletree Ranch Road Floor drain/floor sink/hubC0) 4346 25.02 a /D /50.12.
Garbage disposal 25.02
City/State/ZIP Scottsdale,AZ 85258Hose bib 25.02
Phone (602)694-4031 Fax ( ) Ice maker12.51
Interceptor/grease trap 25.02
Business name:William Lyon Homes,Inc Medical gas(value:$ ) Page 2
Primer 3 12.51 37.53_
Contact name:Angela Grajewski
Roof drain(commercial) 12.51
Address:109 East 13th Street
SinbasinRavatoty`v-t, -
1 -3 LA, 25.02 100•08 '/
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 TubEshowe�t shower pan 1 12.51 )a J .51 /
E-mail:Angela.Grajewskitipolygonhomes.eem= Urinal 25.02 ,r25•0o! ,>
T:::17,7;;;7: ,., 7 Water cls 25.02Inc
1
/�
_, - n.:' ,,.,.,, ... . _ Water heater � 37.52 3 7 5 4
Business name:Alliance Plumbing LLC Water piping/DWV 56.29
Address:146 W Historic Columbia River Hwy Other:,W1HMi i Pool,Alit,/_/ 25.02 015;0
City/State/ZIP:Troutdale,OR 97060 Subtotal -f3454
Phone:(503)492-3490 Fax:(503)912-6438 Minimum permit fee: $72.50 (pti•1
Flan review (25%of permit fee) 1e.4,18 110•q0
CCB Lic.:184601 A, Plumbing Lic.no.:PB732
State surcharge(12% -1 of permit fee) ;5*rj£}.r.8 j
Authorized signature: 1 TOTAL PERMIT FEE f,81•'1
Print name:Robert Dishman Date:5/23/2016 This permit appli atdan expires if a permit is net obtained within 1811 days
after it has been accepted as complete.
"Fee methodole&v set by Tri-County Building Industry Service Board
/�
1lntildingtPermetaTLMU-Peta hAppdoc 10/0109 440.4616T(10102/COM(WEB) - t--9'
'
99y,Oa
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
' Qty Fie{ea) I
Footing drain- 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' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain 1st 100' 62.54 - • �� _ .�-. , � -3.�- ..
$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
v �
eeS {ty Fges) ' Tatal ; 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
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
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 Fit<t#tre'lnype Plan review is required for any of the following.
Fixture Tyle for / Please check all that apply.
Work Performed: �. Cappeid Mkled Te te- 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system.
-Domestic r 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" 5
-3 Iso> et '' r Riser Diagr m
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-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 '
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
11111 CITY OF TIGARD FEE AND PAYMENT HISTORY
' 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TiGARD JLt�A
PLM2016-00313 - 17390 SW SABRINA AVE, BEAVERTON, OR 97007
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Catch Basin or Area Drain 230-0000-43101 $56.28 $56.28 $56.28
Footing Drain 230-0000-43101 $200.11 $200.11 $200.11
Rain Drain Connector 230-0000-43101 $75.04 $75.04 $75.04
Sanitary Sewer 230-0000-43101 $62.54 $62.54 $62.54
Storm Sewer 230-0000-43101 $100.06 $100.06 $100.06
Water Service 230-0000-43101 $62.54 $62.54 $62.54
Backflow Preventer 230-0000-43101 $31.27 $31.27 $31.27
Plan Review 230-0000-43109 $146.96 $146.96 $146.96
12%State Surcharge-Plumbing 100-0000-24001 $70.54 $70.54 $70.54
Totals for Fees $805.34 $805.34 $0.00 $805.34
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
Total Payments: $0.00
Balance Due: $805.34
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17390 SW SABRINAAVE, BEAVERTON, OR,
97007
Record Type: Record ID:
Commercial - Plumbing PLM2016-00314
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 3/4" watts RP device, model LF009M3QT, serial # L32861 , for make up water to pool,
located in pool pump room - ok with test.
2. Corrections are complete, plumbing final - approved
Violation Summary:
Inspector Contractor