Permit (167) CITY OF TIGARD PLUMBING PERMIT
111
COMMUNITY DEVELOPMENT Permit#: PLM2017-00482
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/29/2017
Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16195 SW 72ND AVE
Project: Option Care Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Relocate(1)break room sink for TI.
Contractor: ALLIANT SYSTEMS LLC Owner: PACIFIC REALTY ASSOCIATES LP
351 NW 12TH AVE ATTN: N PIVEN
PORTLAND, OR 97209 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-619-4000 PHONE:
FAX: 503-230-9238
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/29/2017 $31.27
Specifics: 1 ea Sink 11/29/2017 $25.02
16 Minimum Fee Adjustment- 11/29/2017 $16.21
Type of Use: COM Plumbing
Class of Work: ALT g 12%State Surcharge- 11/29/2017 $8.70
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $81.20
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:
AIWA/ 1/7Z7?
Call 503.639.4175 by 7:00 a.m.for the next available.irfspect on 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 ApplicatiRECEIVED
Building Fixtures FOR OFFICE USE ONLY
City of Tigard v2.011 pare ved /7 17 Permit Nn.
IIII - .. 13125 SW Hall Blvd.,Tigard,OR 97223 dry �y}� Plan Review
Phone: 503.718.2439 Fax: 503.5(8.j'�5V OF i IGARD Date/By: Other Permit N/34020/7 v*-„Z
Inspection Line: 503.639.4175 (gg��(( �qpp z ) Date Ready/By: Juris: ® See Page 2 for
TIGARD Internet: www.tigard-or.gov �)ALltllA�IVISIONotified Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. Total
®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
❑ I-and 2-family dwellingSFR(2)bath 437.78
®Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
"Job site address:16195 SW 72*d Ave Catch basin or area drain 18.76
I 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:Option Care 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
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
installing new sinks and a backflow preventor Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap / 25.02
Name:Pacific Realty Associates LP
Floor drain/floor sink/hub 25.02
Address: 15350 SE Sequoia Pkwy#300 Garbage disposal 25.02
City/State/ZIP:Portland,OR,97224 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
BusinessMedical gas(value:$ ) Page 2
name:Alliant Systems
Primer 12.51
Contact name:Jessica Lozano Roof drain(commercial) 12.51
Address:351 NW 12th Ave Sink/basin/lavatory OWN/4 r20+1 %X 25.02
G1
City/State/ZIP:Portland,OR,97209 Solar units(potable water) t 62.54
Phone:(503)619-4000 Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:j.lozano@alliant-systems.com
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Alliant Systems Water piping/DWV 56.29
Address:351 NW 12th Ave Other: 25.02
City/State/ZIP:Portland,OR,97209 Subtotal
Phone:(503)619-4000 Fax:( ) Minimum permit fee: $72.50 7,:,,2,.Sed
Plan review (25%of permit fee)
CCB Lic.:153420 Plumbing Lic.no.:3-487PB
State surcharge(12%of permit fee) f Y 70
Authorized signatureVt- - ~-' � ,�/'^ TOTAL PERMIT FEE pi, Q
i/ Date: 11/28/17 This permit application expires if a permit is not obtained within 180 days
Print name:Jessica Lozano after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doe 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-U'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
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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 for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 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
0 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 // P29/?
Shower -Sag /2-&-72t1(4/-7-r- SN /L, (j �'�72�--61 4 /2- -r rt ..5/i✓/C_..
Sink/Lav -Non-food related i A.--/Z_. „7-&-.5 St c' ` ,.( -
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\27311 -Option Care\Permits\Optioncare Plumbing Permit App.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16195 SW 72ND AVE, TIGARD, OR, 97224 April 27, 2018 at 1 :41 :46 PM
Record Type: Record ID:
Commercial - Plumbing PLM2017-00482
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor