Permit (10) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00108
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/28/2017
T[ n� Parcel: 2S112DB00500
Jurisdiction: Tigard
Site address: 15065 SW 74TH AVE
Project: Interstate Roofing Subdivision: FANNO CREEK ACRE TRACTS Lot: 15
Project Description: Site utilities for a New 16,893 sq.ft.two-story building:(4)catch basins,470 ft.of footing drain,(1)manhole, 100 ft.
of sanitary sewer,800 ft.of storm sewer, 100 ft.of water service,(1)backflow preventer,and(1)backwater valve.
Contractor: CIVILWORKS NW INC Owner: INTERSTATE DEVELOPMENT LLC
PO BOX 5698 15065 SW 74TH AVE
VANCOUVER,WA 98668 PORTLAND, OR 97224
PHONE: 360-694-8849 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 ea Catch Basin or Area Drain 03/28/2017 $75.04
Specifics: 470 If Footing Drain 03/28/2017 $200.11
1 ea Manholes 03/28/2017 $18.76
Type of Use: COM 100 If Sanitary Sewer 03/28/2017 $62.54
Class of Work: ALT 800 If Storm Sewer 03/28/2017 $325.18
Type of Const: 100 If Water Service 03/28/2017 $62.54
Occupancy Grp: 1 ea Backflow Preventer 03/28/2017 $31.27
Stories: 1 ea Backwater Valve 03/28/2017 $12.51
1 12%State Surcharge- 03/28/2017 $94.55
Plumbing
Total $882.50
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 ore; ;4.
A
Issued By: �� gee Signature: r/�
G
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
Building Fixtures „ ,, . ; FOR OFFICE [SE ONE)
City of Tigard " ' Received
(3,0/A/117 .31. - Permit No.: /j' v �,:)I' 7- ol:0'
74
• 13125 SW Hall Blvd.,Tigard,OR 9x72 3 s, Plan Review tJJI /`r l J V V
III Phone: 503.718.2439 Fax: 503*,j960Date/By: Other Permit Na: � _
� -tt'� ']V
Inspection Line: 503.639.4175 ` Mate Read /B Innis: See a e 2 for
TIG ARD Ready/By: -�-��� g
Internet: www.tigard-or.gov YY. Tiotified/Method: ---- -to,.. Supplemental Information
TYPE OF WORK \ Q . 4., 44-75 FEE*FEE* SCHEDULE A,:
� t-•
VI New construction D Detttolition For special information use checklist
Description I Qty. I Ea. Total
0 Addition/alteration/replacement 0 Other, ` New 1-2-family dwellings(includes 100 ft.for each utility connection)
V,
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
ID1-and 2-family dwelling NCommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND.LOCATION Site utilities:
Job site address: -1L- 4��c
/ Catch basin or area drain 18.76 7c---,,,,,.1
5oc5 ..3� 74
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 124.-
�c(L 1�+4 a�7 „2 Q 7 Footing drain(no.linear ft./Tto) Page 2
5 6,101c1,it
Suite/bldg./apt.no.: Project name: 1„pl y A yc f2vo., IA Manufactured home utilities 50.03
Cross street/directions to job site: Manholes ` 18.76 1' 76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:t OC) if Page 2 - 69/.,(5.,./
Storm sewer(no.linear ft.: 0 Page 2 32y7 ( r
Water service(no.linear ft.:I 00) V/ Page 2 5- .i
Subdivision: Lot no.: Fixture or item:
t
Backflow prevener
Tax map/parcel no.: 31.27 3 }7
Backwater valve 12.51
DESCRIPTION WORK ' '�. i '� v
_ . .. G Clothes washer 25.02 1
,t)A-U J Z3it1LOi,t)ta- S 1`T. LAX 1 g,&antl.647 Dishwasher 25.02
P, p.1 p1(- Drinking fountain 25.02
Ejectors/sump 25.02
❑ P OI ERTY o a '' -1 0 TEN lsri Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
,` l APPZtC,INT ::? [,1 CONTACT PER$QN Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: L.i J i L ;)ic. g yryr / /NC-
Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: V,V U A $b' ,6 Sink/basin/lavatory 25.02
City/State/ZIP: 0 A NC-c,�u I 04,, q 8 4,;,(c e Solar units(potable water) 62.54
Phone:It:,) ‘,14--S O 4, Fax::(3/c ) &i _gss8 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: 0 t,,�-p,0 0 C t4tt.w;orzy._5 Nii.:. Lunt
Water closet 25.02
', CO ACTOR
Water heater 37.52
Business name: Cl VI(,%ci:7(LK.: til())I 1 N L Water piping/DWV 56.29
Address: ` ,D . 5 '57 / Other: 25.02
City/State/ZIP: jApy CvaL,i; SZ west C 1e)(dOB Subtotal/7 5775
Phone:(3,o) b 14--ge, ," Fax:( ) 1,4 4,Q j Minimum permit fee: $72.50
/yPlan review (25%of permit fee)
CCB Lic.: 15 4,/0 3 p Plumbing Lic.no.: i 6- State surcharge(12%of permit fee) L(L(_
Authorized signature: 414 7/10
TOTAL PERMIT FE �51
Print name: -i '/'iLi /14 _ c 4- Oil Date: q This permit application expires if a permit is not obtained w(thin 180 days
�,✓f+ f X�� ` / �{ 7 Z� C after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-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:
Site Utilities ; Qty Fee(ea
) Total Square Footage: Permit Fee:
Footing drain-1 s'100' 4 To 50.03 56• 0 to 2,000 $121.90
Footing drain-each additional 100' A 37.52 4tQ 2,001 to 3,600 $169.69
Sewer-1st 100' t 62.54 it 3,601 to 7,200 $233.20
(, 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' , 62.54 6,1,511Medical Gas Systems:
Water Service-each additional 100'
Valuation- Permit Fee*
Storm&Rain Drain-1st 100' 1 62.54 teot,)"i $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
Other Inspections or Fees . Tota
each additional$100.00 or fraction thereof,to
" Qty• Fee(ea) l
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: X21
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*. PlanIeview for Plumbing Installations
Quantity 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
Baptistry/Font
0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
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 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"
3" i metricor Riser Diagram
4„
0 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 fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15065 SW 74TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2017-00108
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Plumbing final for site utilities- approved
2. 1 " Febco DC,model 850, serial # HE06543, for irrigation for bioswale, located by mail
box at 15245 - ok with test.
3. 1 " Febco DC, model 850, serial # HE 06443, for irrigation, located in middle of planter,
- ok with test.
4. 1 1/2" watts DC, model LF007M2, serial # 016365, for domestic water service, located
by water meter, - ok with test.
Violation Summary:
Inspector Contractor