Permit (109) CITY OF TIGARD PLUMBING PERMIT
.>, COMMUNITY DEVELOPMENT `f Permit#: PLM2017-00102
v Ad ,. Date Issued: 10/02/2017
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243 u t,
� C Parcel: 1 S 135DA02400
,�`-P‘4 Jurisdiction: Tigard
Site address: 11045 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Site utilities for a new 16,327 square feet,32 bed residential care facility. 10/25/18:REPRINTED to correct address
from 11035 to 11045.
Contractor: PR DESIGN&GENERAL CONTRACTORS LLC Owner: BROOKSIDE RCF LLC
919 NE 19TH AVENUE SUITE 155 5987 SE ROBHIL DR
PORTLAND, OR 97232 MILWAUKIE, OR 97222
PHONE: 530-625-8461 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 10/02/2017 $18.76
Specifics: 1 ea Drywell,Leach Line or Trench 10/02/2017 $18.76
Drain
Type of Use: COM 700 If Footing Drain 10/02/2017 $275.15
Class of Work: ALT 255 If Storm Sewer 10/02/2017 $137.58
Type of Const: 40 If Water Service 10/02/2017 $62.54
Occupancy Grp: 1 12%State Surcharge- 10/02/2017 $61.53
Stories: Plumbing
Total $574.32
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: �._ Q 7✓ `r -1 Permittee Signature: ok-N\ `N LA ''\
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.
CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT "fr Permit#: PLM2017 00102
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2017
T[t�t#k�' 9 Parcel: 1 S 135 DA02400
Jurisdiction: Tigard
Site address: 11035 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Site utilities for a new 16,327 square feet,32 bed residential care facility.
Contractor: PR DESIGN&GENERAL CONTRACTORS LLC Owner: BROOKSIDE RCF LLC
919 NE 19TH AVENUE SUITE 155 5987 SE ROBHIL DR
PORTLAND, OR 97232 MILWAUKIE, OR 97222
PHONE: 530-625-8461 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 10/02/2017 $18.76
Specifics: 1 ea Drywell,Leach Line or Trench 10/02/2017 $18.76
Drain
Type of Use: COM 700 If Footing Drain 10/02/2017 $275.15
Class of Work: ALT 255 If Storm Sewer 10/02/2017 $137.58
Type of Const: 40 If Water Service 10/02/2017 $62.54
Occupancy Grp: 1 12%State Surcharge- 10/02/2017 $61.53
Plumbing
Stories:
Total $574.32
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: •ermittee 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.
CITY OF TIGARD PLUMBING PERMIT
.71
COMMUNITY DEVELOPMENT Permit#: PLM2017-00102
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2017
T f g Parcel: 1 S 135DA02400
Jurisdiction: Tigard
Site address: 11035 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Site utilities for a new 16,327 square feet,42 bed residential care facility.
Contractor: PR DESIGN&GENERAL CONTRACTORS LLC Owner: BROOKSIDE RCF LLC
919 NE 19TH AVENUE SUITE 155 5987 SE ROBHIL DR
PORTLAND, OR 97232 MILWAUKIE, OR 97222
PHONE: 530-625-8461 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 10/02/2017 $18.76
Specifics: 1 ea Drywell,Leach Line or Trench 10/02/2017 $18.76
Drain
Type of Use: COM 700 If Footing Drain 10/02/2017 $275.15
Class of Work: ALT 255 If Storm Sewer 10/02/2017 $137.58
Type of Const: 40 If Water Service 10/02/2017 $62.54
Occupancy Grp: 1 12%State Surcharge- 10/02/2017 $61.53
Plumbing
Stories:
Total $574.32
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: - •• ittee 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.
Plumbing Permit Application
Site Utilities FOR OFFICE USE O\1.\
Date/By:eied 0i 7_cbA
City of Tigard PermitNo.:
A 13125 SW Hall Blvd.,Tigard,OR 97223 PlanReview 3 7 1 7 t
'N I Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Other Permit No.: L jj y� 7 y'<
f��`U t7l'..l� / �f..�%�
Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
TA TIGARD y 4_ Y y g
Internet: www.tigard-or.gov s , Notified/Method: /.7<y Supplemental Information
.
TYPE OF WORT£ r. 1 $0 (vii FEE* SCHEDULE
f� For special information use checklist
eN XNew construction ❑Demolition
Description Qty. Ea. I Total
rl ❑Addition/alteration/replacement ❑Other'.' New 1-2-family.dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTR kl(* a SFR(1)bath 312.70
0 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
d 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: 110 35 5(, HAV IA- au p Catch basin or area drain 18.76 l i�-
City/State/ZIP: .L Drywell,leach line,or trench drain 1 18.76 j _'�`,
�� 61172.2,/ Footing drain(no.linear ft.:7 Page 2 .. 5t ( 5-
Suite/bldg./apt.
-
Suite bldg./apt.no.: Project name: ioatc1"(ol i its l lt�' Manufactured home utilities 50.03
-1 Cross street/directions to job site: Manholes 18.76
I Rain drain connector 18.76
l Sanitary sewer(no.linear ft.: ) Page 2
, Storm sewer(no.linear ft.1$4 Page 2 0,37 5-g
_ Water service(no.linear ft.:40) Page 2 Co) .54/
S Subdivision: Lot no.: ixture or item:
‘,& Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
A� � Clothes washer 25.02
1`�W ljrvOMw Cht2-c ritrAcate Dishwasher 25.02
r�
1"lZ (nlp re Drinking fountain 25.02
3
Ejectors/sump 25.02
( PROPERTY OWNEyI
R�� ❑ TENANT Expansion tank 12.51
Name: '` j RMA A.N Fixture/sewer cap 25.02
Address: 5v107 �( (u, IX. Garbage
drain/floor sink/hub 25.02
Garbb agee disposal 25.02
City/State/ZIP: M(( 44V IC4F, 0- ci 222 Hose bib 25.02
Phone:503) efgf$.... 4/13-'M Fax:( ) Ice maker 12.51
14.APPLICANT %CONTACT PERSON Interceptor/grease trap 25.02
Business name: el „ o / j<<,,. Medical gas(value:$ ) Page 2
�1" �a�GtPrimer 12.51
Contact name: '_rl ��
Roof drain(commercial) 12.51
Address: cm Mv Oft AC �r I55- Sink/basin/lavatory 25.02
City/State/ZIP: pov(A -p ti Da- v Solar units(potable'water) 62.54
Phone:( p3) 9,4„r-N(01 Fax: :( ) Tub/shower/shower pan 12.51 I
i
E-mail: elk,e /✓d ss it G,vim Urinal 25.02
�-f" Water closet 25.02
'CONTRAUTOR
Water heater 37.52
Business name: 1 OES1(d/ 1 CleAl cp/ 'G LAZwater piping/DWV 56.29
Address: (lig ill' S' (555 Other: 25.02
City/State/ZIP: pb/ogLt7r44 1 at Ch 71-2-- Subtotal
Phone:( )) US:-EMU.l Fax:( ) Minimum permit fee: $72.50 ,5-42, 1 Y
CCB Lic.: ' /3 Plan review (25%of permit fee) -
21 Plumbing Lic.no.: /
State surcharge(12%of permit fee) -(�i/.,Z 3
Authorized signature: TOTAL PERMIT FE ,
Print name: klown 1J �bSG�t, Date: J 7 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.
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 Qtr. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1'100' 1 50.03 50103 0 to 2,000 $121.90
Footing drain-each additional 100' Co 37.52 75 0f 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
(p1.511 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
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' Z. 37.52 04 $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
(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 Fixture Type Plan Review for Plumbing Installations
Fixture Type forReplace/
Work Performed: ftZ.Ve Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower I; ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial _ 1 0 Medical gas and vacuum systems for health care facilities.
-Domestic 1 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Z Submit 2 sets of plans with any of the above.
-4„
Car Wash Drain Isometric Or Riser Diagram
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related 1 that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains 2-
Oil
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall I I
Sink/Lav -Non-food related 2. 144
-Bradley
-Commercial-food related I
-Service (.I
Swimming Pool Filter 4
Washer-Clothes I *Note: If the fixture work under this permit results in an
Water Extractor _ increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet Z„ LI o 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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11045 SW HALL BLVD, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00102
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Water service-Approved
2. Note: verify proper grounding of electrical system as per sec.604.10 OPSC.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11045 SW HALL BLVD, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00102
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Correction's are complete, plumbing final approved.
Violation Summary:
Inspector Contractor