Permit CITY OF TIGARD PLUMBING PERMIT
PFS . COMMUNITY DEVELOPMENT Permit#: PLM2018-00288
Date Issued: 06/13/2018
T( t!R L 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AC01300
Jurisdiction: Tigard
Site address: 7105 SW HAMPTON ST
Project: Kaiser Permanente Dental Subdivision: BEVELAND NO.2 Lot: 18-19,P
Project Description: Interior plumbing: Relocating(2)sinks.
Contractor: PORTLAND MECHANICAL CONTRACTORS Owner: KAISER FOUNDATION HEALTH
2000 SE HANNA HARVESTER DR PLAN OF THE NORTHWEST#838
MILWAUKIE, OR 97222 ATTN: GENERAL ACCCOUNTING 11TH F
500 NE MULTNOMAH#100
PORTLAND, OR 97232
PHONE: 503-656-7400 PHONE:
FAX: 503-655-0620
FEES
Quantity Description Date Amount
2 ea Sink 06/13/2018 $50.04
Specifics: 1 12%State Surcharge- 06/13/2018 $8.70
Plumbing
Type of Use: COM 22 ea Minimum Fee Adjustment- 06/13/2018 $22.46
Plumbing
Class of Work: ALT
Type of Const:
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: Oar
r
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
, City of Tigard RFCEIVL Date/1371. (/�//, / /� Permit No.: �'
III ml 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ,
_. Phone: 503.718.2439 Fax: 503.598.1960 JUN UN 13 Ll!
>n18 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read/B Inns• ® See Page 2 for
TIGARD Ready/By:
Internet: www.tigard-or.gov y ified/Method: �'a v Supplemental Information
r
ISIO
❑New construction 0 Dlr.iIt411 '� � �Ji For special information use checklist
Description ! Qty. Ea. Total
17tAddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
4 � I 5 �'"`� e' er ,' SFR(I)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/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
� a i ��* � tfb;
„ o % i. Site utilities:
i� �z
Catch basin or area drain 18.76
Job site address:7105 SW Hampton Street
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:Kaiser Permanente Tigard 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 3127
� '2,4,...;; '''WS,'"'",
®t 4 , �� :Rt ? Backwater valve 12.51
Wiliiia:. , ..,...... ., ,.. '' Clothes washer 25.02
Relocating(2)Sinks about 5 feet down in one of the operative rooms Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
3 .- ' � '� ;,� ,:*'#'<,07:',7 Expansion tank 12.51
25.02
Name: Fixture sewer cap
Floor drain/floor sink/hub 25.02
Address:
25.02
Garbage disposal
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
e " ® ;' � , t o Interceptor/grease trap 25.02
4,4
'.*1';';''
'.*1';v'Y'': ''1 A''' .. ,/G '''' H'.. ..-''N„ ..''''''' ' ,...../,,r• ' 4. -/,'&4w,' it
Medical gas(value:$ ) Page 2
Business name:Portland Mechanical
Primer 12.51
Contact name:Nick Odle Roof drain(commercial) 12.51
Address:2000 SE Hanna Harvester Drive Sink/basin/lavatory 2 25.02 50.04
City/State/ZIP:Milwaukie OR 97222 Solar units(potable water) 62.54
Phone:(503)656-7400 Fax: :(503)656-6367 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:nodle@pmc-g.com
� . ,,,ar„ dF.�: \...:. r•...� � i s ... �\. h - Water closet 25.02
02
% ti ",,s\ `* 37.52
Water heater
Business name:Portland Mechanical Water piping/DWV 56.29
Address:2000 SE Hanna Harvester Drive Other: 25.02
City/State/ZIP:Milwaukie OR 97222 Subtotal
Phone:(503)656-7400 Fax:(503)656-6367 Minimum permit fee: $72.50 72.50
Plan review (25%of permit fee) ---
CCB Lic.:151807 Plumbing Lic.no.:3-425PB
State surcharge(12%of permit fee) 6.7()
Authorized signature: if TOTAL PERMIT FEE -1fil,1%!
Print name:Nick Odle Date:06/13/18 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 10/01/09 440-46161(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule Residential Fire Suppression Systems
Footing drain-1"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-I st 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 „ ; * ;-/e4 d/
`i ` � �•••
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
��rG each additional$100.00 or fraction thereof,to
01 a �� s
%��,,, . �.;... � � ,,.,,,., Y,. � ;.. ... �/,� ..�.� 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:
Other Fixtures:
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 incread sewer fees .
No4Q cant t >F>xturtr` T1)e441045e °
r„,7, ,‘„ fOrtligttbittg 71,J
4rmetl, pC ceded ftfl,f1Fre
Plan review is required for any of the following.
Baptistry/Font
Bath Tub/Shower Please check all that apply.
-Jacuzzi/Whirlpool 0 Any new commercial building with water service 2"and
Car Wash -Each Stall greater,except systems designed and stamped by licensed
-Drive Thru engineer.
Cuspidor/Water Aspirator 0 New exterior plumbing site utilities for any complex structure
Dishwasher Commercial as defined in OAR918-780-0040.
-Domestic 0 Medical gas and vacuum systems for health care facilities.
Drinking Fountain 0 Any multipurpose fire sprinkler system.
Eye Wash 0 Any complex structure as defined in OAR918-780-0040.
Floor Drain/sink -2"
3" Submit 2 sets of plans with any of the above.
Car Wash Drain
Garbage -Domestic-non-food
Disposal -Domestic-food related 0 Isometric or riser diagram is required for new buildings
Commercial-food related that meet the qualifications above.
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station Comments regarding fixture work:
Shower -Gang1RQ_\�;A ", Z 1- tt r4. ft l SlwlC
-Stall .� ollAar e",:0 o f fi"& C t*%^LA'
Sink/Lav -Non-food related oS
-Bradley 1A.3�'� 3 A cs t;+-J 4 c - 4<
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
C:\Users\sadam\AppData\Local\Microsoft\Windows\Temporary Internet l les\Content.Outlook\2J4XYZXA\City of Tigard-Plumbing Fixture Units
(002).doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
7105 SW HAMPTON ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00288
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor