Permit ti CITY OF TIGARD PLUMBING PERMIT
Permit#: PLM2018-00147
COMMUNITY DEVELOPMENT
Date Issued: 04/11/2018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104AB04700
Jurisdiction: Tigard
Site address: 13401 SW BENISH ST
Project: Our Redeemer Lutheran Church Subdivision: None Lot: None
Project Description: Site utilities for a 1,792 sq.ft.modular classroom building: 184 ft.of footing drain,(1)rain drain connector,30 ft.of
sanitary sewer,23 ft.of storm sewer,and 100 ft.of water service. All plumbing inspections performed under site
utilities permit PLM2018-00147.
Contractor: MODERN BUILDING SYSTEMS INC Owner: OUR REDEEMER LUTHERAN CHURCH
PO BOX 110 13401 SW BENISH ST
AUMSVILLE, OR 97325 TIGARD, OR 97223
PHONE:
PHONE: 503-749-4949
FAX: 503-749-4950
FEES
Quantity Description Date Amount
184 If Footing Drain 04/11/2018 $87.55
Specifics: 1 ea Rain Drain Connector 04/11/2018 $18.76
30 If Sanitary Sewer 04/11/2018 $62.54
Type of Use: COM 23 If Storm Sewer 04/11/2018 $62.54
Class of Work: NEW 100 If Water Service 04/11/2018 $62.54
Type of Const: 1 12%State Surcharge- 04/11/2018 $35.27
Occupancy Grp: Plumbing
Stories:
Total $329.20
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.:10.332.2344.
Issued By: Permittee Signature:
fteV
47)Ze--0"'
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.
lumbing Permit Application
mik,
Site Utilities1 yr-, -i i
P 1.:( t',1 V FOR OFFICE USE ONLY
City of Tigard lc*f....!. ' - Received ,7
Date/By: --, 9i/6" 077- Permit No.:poi e2vi e-....cuiss 7
, 1114 ,11 13125 SW Hall Blvd.,Tigard,OR 97223 Apf, 5 z nu 18 Plan Review
2 Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:6415A1 eitatiji
Inspection Line: 503.639.4175
T I G A R I) i.. ,e Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov 4. LOWified/Method: Xr3 Supplemental Information
FE
TYPE OF,!9R,C7' 'i Iv,nwtsi ,..,,,,, S:I'SCREDUL
it ''' For special information use checklist.
0 New construction 0 Deitslideie'
Description Qty. I Ea. Total
'Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY.4 CONSTRUCTION Ve SFR(1)bath 312.70
0 1-and 2-family dwelling
(Commercial/industrial SFR(2)bath
0 Accessory building 11
0 Multi-family 437.78
SFR(3)bath
500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other: jsin1der( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION .., Site utiliti,"
,. I. 'atcn-basm or area drain 18.76
Job site address: it_.•\0\ 5 kij .F.761.)5::(--•jkk r
Drywell,leach line,or trench drain 18.76
i City/State/ZIP: ---i vt,....pco a2._ cli z-z z,
4 Footing drain(no.linear ft.:Iii`k) ak Page 2 1 53
Suite/bldg./apt.no.: Project name:air 4124,42..eseme.c. /.1.4_,.-likevz2„.„ 50.03
---.4 Manufactured home utilities
..c) Cross street/directions to job site: t.."/-*;,4,,z4 Manholes 18.76
,.' -C°V-1•\ 01/44i1.- C)( -) FY31.50-4A f?--ri-,A1`-4- 4)\-/3 Rain drain connector 1 18.76 i SP.,7to
W Sanitary sewer(no.linear ft.:30 ) i Page 2 64.511
u...).pcut-301- .1, Storm sewer(no.linear ft.:2",) I Page 2 64 .sii
c /1/91?-reih)y /12ec'75 Nivift-i-tr-kre..e-{ 4` Water service(no.linear ft.:1°C) i Page 2 („,„/ •S-11
Subdivision: uivott r 1-pw'S :ie yiy.; iorej.kLot no.: Fixture or item:
Backflow preventer 31.27
ti Tax map/parcel no.: if IVirr 1*,,,4--..
'. e Backwater valve 12.51
DESCRIPTION OF wØRIc
Clothes washer 25.02
Dishwasher 25.02
J l-st,6, C..p Nii.irect- vik-r7.) N- -A-17---<> 11.) Drinking fountain 25.02
Is,
OC, -e- --ji(i2--1.A- t-------71/4-e17 Ejectors/sump 25.02
WPROPERTY OMNER 7:44 :? 04ktqANTf;' ,
5:: Expansion tank 12.51
Fixture/sewer cap 25.02
I Name: 00' V---' (7'(4-3e-C- ,(13?---- V-LICTVeieli•.%c1N) Floor drain/floor sink/hub 25.02
..)-
...) Address: \-;L.1tokc. ,..„1/4_...) F....i.... k\ e.T.i,-- ,
Garbage disposal 25.02
City/State/ZIP: -M...c.i.i<V,0 -cycl„ C-1-1 ill Hose bib 25.02
t
'. Phone:(55?) 5`A.V-LIL414 (.2,. Fax:( ) Ice maker 12.51
- , GYAPPLICANT 4 , 0 CONTACT MOWN , Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
„...-... Business name: ‘.A0-0&c0.i, ‘2)„ .....c)cy..k._,-,- 4-;-,-,t.,;-"&",il...1/4_(>
' PrO Primer 12.51
Contact name: .Art..ipci ir„.-&-Z_ iL,\3 f. ,c _i, .1
Roof drain(commercial) 12.51
Address: el'‘-\9.3 ?0,?„cc..1..... VNO Sink/basin/lavatory 25.02
City/State/ZIP: \-vrke.,;jrpt‘co ... °V1'3743 Solar units(potable water) 62.54
Phone:652, ) "it-ko\-t-E0...kc Fax::(-503) ---p.Acti-Lkcf5,-0 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: AAA..,aliey•',(2_ts.t...t.../0 . 45.):0‘..A...--,-,-.),<--,.-C1.-.`-5>.4-(i'l
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: '5P -t-. p ., ikr ,3 e_ Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal ;213,ti?
Phone:( ) Fax:( ) 7Minimum permit fee: $72.50
/11,10
Plan review (25%of permit fee)
CCB Lie.: .44(L,1-,1 ilVei/ - Plumbing Lie.no.: 74-Z,/3 R8
Authorized signature: ' ' \ 1.....------ State surcharge(12%of permit fee) 35, ).7
TOTAL PERMIT FEE".13,24, k
Print name: p414.,..N) rpc<- frv' ‘'.: .-) Date: 7-ti-i-b 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.
IABuilduig\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Lmbing Permit Application Cityof
AU - Tigard
Pagel - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Sit �tilitles f Qti. Tee(ea) Total
Sgiareootage "ermuit
Footing drain-1"100' 50.03 5'0 7 0 to 2,000 $121.90
Footing drain-each additional 100' ` 37.52 15Z 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' , 62.54 (e,7 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' ` 62.54 (itsik Medical Gas Systems:
Water Service-each additional 100' 37.52
alu ton . ermIt*ee:
Storm&Rain Drain-1st 100' 62.54 (F,2_j` $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
,otber Inspections Q hreeS Qty.; Fee.eal t{xatl w 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: 1-1
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
Fixture Type for Replace? SII Review for Plumbing Installations„
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower
0 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 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 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"
Car Wash Drain Isometric or Riser Diagm {.
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
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
Washer-clothes *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 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\Sales4\Downloads\PLMU_PermitApp.doe 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13401 SW BENISH ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00147
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Correction's are complete, plumbing final approved.
Violation Summary:
Inspector Contractor