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Permit (67)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT NIr Request for Permit Action T 1 G A R l) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD RECEIVED Building Division JUL 17 2019 13125 SW Hall Blvd.,Tigard,OR 97223 ITY •F TIGARD Phone: 503-718-2439 Fax: 503-598-1960 Tigar BuildingPermi i "s t.3MS ON FROM: ❑ Owner ❑ Applicant ontractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) 1 L,`.� �ov\ I c Mailing Address: 11 City/State/Zip: 6\fj v.)0c4 7 O(2._ -3-1 l{(� Phone No.: 5 3 9 y/ 8 3 (6 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CA E . VOID PERMIT APPLICATION. REFUN P RMIT FEES (attach copy of original receipt and provide explanation below). FOR FEES DUE (attach case fee schedule and provide explanation below). Permit #: /'C/►i J L Site Address or Parcel #: /a/,l3 5 ) Project Name: 6�is �`�v—/ Subdivision Name: �� ��' �d' Lot#: EXPLANATION: r&A itP\ kak keS- \Nos.\ 'lie'rk/e-Ck i Signature: Date: -- t 8/La) Print Name: i�, �r DtAQc Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. /37' $ G /fP /Sf , 09 Route to Sys Admin: Date '/ /77` By 8 T. Route to Records: Date�.?7/.2,r By Refund Processed: Date �/.a By ,�)/ Invoice Processed: Date By Permit Canceled: Date 4I/ By.<324,s Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_120518.doc 111 TIGARD City of Tigard August 9, 2019 Weitman Excavation Inc. 11225 SW Clay St Sherwood, OR 97140 Re: Permit No. PLM2019-00100 Dear Applicant: The City of Tigard has processed a refund for fees on the above referenced permit(s) as follows: Site Address: 12123 SW 69th Ave. Project Name: Compass Oncology Job No.: N/A Refund: ® Check#232965 in the amount of$154.09. ❑ Credit card "return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit" receipt in the amount of$ Comments: Per applicant's request as plumbing fixtures were removed from permit. Refund 100% of permit fees for these fixtures. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov 11 e " City of Tigard T c n iz D Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request forPermit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Weitman Excavation Inc. DATE: 8/2/2019 11225 SW Clay St Sherwood, OR 97140 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 422238 Case#: PLM2019-00100 Date: 3/25/2019 Address/Parcel: 12123 SW 69th Ave Pay Method: CreditCard Project Name: Compass Oncology EXPLANATION: Per applicant's request as plumbing fixtures were removed from permit. Refund 100% of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43 1 0 1 $Amount Plumbing Permit 230-0000-43101 $137.58 12%State Surcharge 100-0000-24001 16.51 TOTAL REFUND: $154.09 APPROVALS: SIGNA R DATE: If under$5,000 Professional Staff 447217-<_. If under$12,500 Division Manager If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board Case Refund Processed: I Date: 7 a-/ I By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 2 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Compass Oncology Site Address: 12123 SW 69TH AVE Receipt Number: 436082 - 08/27/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2019-00100 $-154.09 Total: $-154.09 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 232965 DHOWSE 08/27/2021 $-154.09 Payor: Weitman Excavation Inc. Total Payments: $-154.09 Balance Due: $154.09 Panes 1 of 1 • Wt CITY OF TIGARD RECEIPT �l • 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Compass Oncology Site Address: 12123 SW 69TH AVE /J 2/ir-7471-C--- Receipt Number: 422238 - 03/25/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2019-00100 Drywell, Leach Line or Trench Drain 230-0000-43101 $18.76 PLM2019-00100 Footing Drain 230-0000-43101 $125.07 E PLM2019-00100 Rain Drain Connector 230-0000-43101 $56.28 PLM2019-00100 Storm Sewer 230-0000-43101 $62.54 PLM2019-00100 Backwater Valve 230-0000-43101 $12.51 e PLM2019-00100 Plan Review 230-0000-43109 $68.79 PLM2019-00100 12% State Surcharge-Plumbing 100-0000-24001 $33.02 Total: $376.97 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 515200 DHOWSE 03/25/2019 $376.97 Payor: Patrick Doherty,Weitman Excavation Inc. Total Payments: $376.97 Balance Due: $0.00 4l-2S 07 7 ._ S/ / 3 7 . ST / ,7— / ‘ . S/ /2-47e l /5 ',, D 7 �a Page 1 of 1 IN . CITY OF TIGARD PLUMBING PERMIT ''' COMMUNITY DEVELOPMENT Permit#: PLM2019-00100 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 , .,I Date Issued: 03/25/2019 Parcel: 2S 101 AA02900 WONJurisdiction: Tigard Site address: 12123 SW 69TH AVE Project: Compass Oncology Subdivision: WEST PORTLAND HEIGHTS Lot: B Project Description: Site utilities for new addition: (1)trench drain,268 ft.of footing drain,(3)rain drain connectors,91 ft.of storm sewer,and(1)backwater valve. 7/18/19: REPRINTED permit to eliminate(1)backwater valve and 268 ft.of footing drain from scope of work. Contractor: WEITMAN EXCAVATION, INC Owner: SDC TIGARD CORPORATE CENTER INC 11225 SW CLAY ST ATTN:ANDREW HARPER SHERWOOD, OR 97140 101 CALIFORNIA ST, 26TH FLOOR SAN FRANCISCO, CA 94111 PHONE: 503-682-3322 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Drywell,Leach Line or Trench 03/25/2019 $18.76 Specifics: Drain 268 If Footing Drain 03/25/2019 $125.07 Type of Use: COM 3 ea Rain Drain Connector 03/25/2019 $56.28 Class of Work: ALT 91 If Storm Sewer 03/25/2019 $62.54 Type of Const: 1 ea Backwater Valve 03/25/2019 $12.51 Occupancy Grp: 1 Plan Review 03/25/2019 $68.79 Stories: 1 12%State Surcharge- 03/25/2019 $33.02 Plumbing Total $376.97 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: eWe 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 USE ONLY � IIiM1M1M1 City of Tigard t, ': Received permit No.: `M G - ill Date/By: %�� �� "' �G! "/ �! ��j�l� 13125 SW Hall Blvd.,Tigard,OR rq 1g Phone: 503.718.2439 Fax: 503. 98.1960 1 1 �Q Plan Review Date/By: Other Permit No.: T I G A R D Inspection Line: 503.639.4175 ���` k(u ' tt :,.) m,1 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov �1 , `-AC..t.�' Notified/Method: -'T]x Supplemental Information TYPE OF WORD tta FEE* SCHEDULE 0 New construction t4iolition For special information use checklist Description Qty. Ea. Total ❑Addition/alteration/replacement ❑Other: t `t,.. A t , i yu • New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION OR t SFR(1)bath 312.70 ❑ 1-and 2-family dwelling 0 Commerce. • s nal SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 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: i a/ A.3 5L,ti (0-122) ,Q„ ., Catch basin or area drain 18.76 "`' Drywell,leach line,or trench drain 18.76 City/State/ZIP: Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name: //''� � ��__ �,,� i3(Y��t�S c-�vLdJCey Manufactured home utilities 50.03 Cross street/directions to job site: ii 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 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 .(�C)��V fC /(^h.��" / M(�fi yl/dj Dishwasher 25.02 CO b ei Gtil. v VGi.t(j ewe-, .260r ` . ef- Drinking fountain 25.02 ` i--F,h( of 12i 1�N Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT 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 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: \ _ Medical gas(value:$ ) Page 2 V.'� ✓1 XCr,l � ICE he Contact name �� -I t:.,v�„ e Primer 12.51 �1 Roof drain(commercial) 12.51 Address: i/ a C SC3 S Sink/basin/lavatory 25.02 City/State/ZIP: C✓I.tJCca ! ? / cf0 Solar units(potable water) 62.54 Phone:(sr,S )eit/f 8316 Fax::( ) Tub/shower/shower pan 12.51 E-mail: + ,ram Urinal 25.02 POtotle.ri{ G CA lain e j(LCtu� l ovN . C � Water closet 25.02 11 CONTRACTOR Water heater 37.52 Business name: _/ la?,C J LL/ ,[1• ...tn..) Water piping/DWV 56.29 Address: !�""� "! Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: \ P T 7�it i ino„ Plan review (25%of permit fee) J State surcharge(12%of permit fee) Authorized ignafure: `�/ TOTAL PERMIT FEE Print name eA1e j� Date: �/J 8 er This permit application expires if a permit is not obtained within 180 days (J"� / after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\PLMU-PennitApp.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-I"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 ww.�, '$1.00'to'55,000.00 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 ec Ins tions or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to p 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*. Plan Review 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 0 Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru 0 Medical gas and vacuum systems for health care facilities. ? Cuspidor/Water Aspirator Dishwasher: Commercial El 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" Isometric or Riser Diagram 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food 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 cORGAN RFI Transmittal Corgan PROJECT: McK_OR-Tigard CC Tenant DATE SENT: 5/23/2019 Improvements 18055.0000 SUBJECT: No Footing Drains Indicated on RFI ID: RFI-00165 LINAC Plans - ANSWERED TYPE: RFI TRANSMITTAL ID: 00811 PURPOSE: Answered VIA: Info Exchange QUESTION: LINAC Contract Documents do not indicate the requirement for any footing drains on the project. Per email correspondence between Turner, VLMK and Corgan, the • Geotechnical Report did not indicate the need for drains around the LINAC. The only requirement was for drains at any below grade building areas and retaining walls. SUGGESTION: Please confirm if footing drains are required for LINAC Vault and Site work. If required provide dimensioned locations. ANSWER: See below for response to RFI-00165 - No Footing Drains Indicated on LINAC Plans - ANSWERED TERRACON Response: Correct, footing drains were not required from a geotechnical support perspective. Kristopher T. Hauck, PE Thanks, EDGAR GALLEGOS CORGAN 20 Greenway Plaza,Suite 410 Houston,TX 77046 D 832 652 3642 coroan.com I facebook I twitter FROM NAME COMPANY EMAIL PHONE EdEdgar Gallegos Corgan cogmr.Gallegos@Corgan 832-652-3642 Page 1 of 2 CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2019-00100 T I,;Al; D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/25/2019 Parcel: 2S 101 AA02900 Jurisdiction: Tigard Site address: 12123 SW 69TH AVE Project: Compass Oncology Subdivision: WEST PORTLAND HEIGHTS Lot: B Project Description: Site utilities for new addition:(1)trench drain,268 ft.of footing drain,(3)rain drain connectors,91 ft.of storm sewer,and(1)backwater valve. Contractor: WEITMAN EXCAVATION, INC Owner: SDC TIGARD CORPORATE CENTER INC 11225 SW CLAY ST ATTN:ANDREW HARPER SHERWOOD, OR 97140 101 CALIFORNIA ST, 26TH FLOOR SAN FRANCISCO, CA 94111 PHONE: 503-682-3322 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Drywell,Leach Line or Trench 03/25/2019 $18.76 Specifics: Drain 268 If Footing Drain 03/25/2019 $125.07 Type of Use: COM 3 ea Rain Drain Connector 03/25/2019 $56.28 Class of Work: ALT 91 If Storm Sewer 03/25/2019 $62.54 Type of Const: 1 ea Backwater Valve 03/25/2019 $12.51 Occupancy Grp: 1 Plan Review 03/25/2019 $68.79 Stories: 1 12%State Surcharge- 03/25/2019 $33.02 Plumbing Total $376.97 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 B Permittee 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. I Plumbing Permit Applicatioifi Site Utilities MAR 13 2019 FOR OFFICE USE ONLY City of Tigard Received 13125 SW Hall Blvd.,Tigard,OR 97223CITY OF TIGARD Date/By: 5 /2 ii A it J-V1 IN ■ ' Phone: 503.718.2439. Fax: 503.598.BULD I N G DIVISION Dan Review 3�a4....II 104 19(0,47)19 x2.613 l t t li l Inspection Line: 503.639.4175 Date Ready/By: ) J r s: Page 2 for Internet: www.tigard-or.gov Notified/Method:ri i`t - Supplemental Information TYPE OF WORK FEE* SCHEDULE 0 New construction 0 Demolition For special information use checklist. Description Qty. 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 ❑ 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 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:12123 Southwest 69th Avenue Building A Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard Oregon 97223 Footing drain(no.linear ft.:268) 2 Page 2 Suite/bldg./apt.no.:A Project name:Compass Oncology Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Located on the southwest corner of SW 69th Ave.&SW Dartmouth Street Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:90) 1 Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.:2S101AA02900 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 1 12.51 Clothes washer 25.02 New Site Storm Utilities For Building Addition Permit#BUP2019-00003 Dishwasher 25.02 Site Work Permit SIT2019-00001 Drinking fountain 25.02 Ejectors/sump 25.02 C, PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name:SDC TIGARD CORPORATE CENTER INC. Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:101 CALIFORNIA ST,26 FLOOR Garbage disposal 25.02 City/State/ZIP:SAN FRANCISCO, CA 94111 Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:WEITMAN EXCAVATION INC. Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:PATRICK DOHERTY Roof drain(commercial) 12.51 Address:11225 SW CLAY STREET Sink/basin/lavatory 25.02 City/State/ZIP:SHERWOOD,OR 97140 Solar units(potable water) 62.54 Phone:(503)941-8390 Fax::(503)682-3366 Tub/shower/shower pan 12.51 E-mail:pdoherty®weitmanexcavation.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name:Weitman Excavation,Inc. Water piping/DWV 56.29 Address:11225 SW CLAY STREET Other: 25.02 City/State/ZIP:SHERWOOD,OR 97140 Subtotal Phone:(503)682-3322 Fax:(503)682-3366 Minimum permit fee: $72.50 CCB Lic.:217837 ` Plumbing Lic. o.:3�3LPB Plan review (25%of permit fee) i State surcharge(12%of permit fee) _ Authorized signature: \� � TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days Print name:Patrick Doherty Date:3/13/19 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"100' 1 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 1 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 1 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 Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to h 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/ Plan review is required for anyof the following.Performed: Capped Added Relocate owg' 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 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic 0 Any multipurpose fire sprinkler system. Drinking Fountain ❑ 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 Shower -Gang -Stall Sink/Lav -Non-food related -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: W:\Projects\18 Projects\18039 Compass Oncology\Permits\Storm Permit\12LMU_PermitApp(2).doc II Iif Site Utilities — Plumbing Permit Application Plan Submittal Requirements TIGARD A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer and potable water systems on private property. 1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn to scale) labeled with: A. ❑ map&tax lot# E1 project name ❑ site address ❑ suite number ❑ zoning ❑ applicant name [] phone number B. North arrow. C. Scale (architectural or engineering only). D. Street names. E. Building pads with project location. 2. PLUMBING PLANS-Two (2) complete sets, civil only. All details listed below shall be incorporated into the plumbing plans: A. Storm drainage plan showing: 1) Finish elevations throughout the developed site. 2) Grade breaks determining area serving each catch basin. 3) Location of catch basins. 4) Pipe size. 5) Type of material. 6) Slope of piping. 7) Manholes and field drains. 8) Cleanouts provided for each 100 feet or fraction thereof. 9) Roof drain laterals specifying cleanouts at each upper terminal. 10) Location of existing or proposed connection to a public sewer line. B. Utilities plan showing: 1) Sanitary sewer line location,pipe size, type of material, slope of piping,manholes and cleanouts provided as required for storm. 2) Size and location of domestic water piping and drainage. 3) Proposed location of connection to a public water or sanitary sewer line. I:\Building\Permits\PLMF-PermitApp.doc 12/30/05 Plumbing Permit Application Site Utilities FOR OFFICE USE ONLY � City of Tigard Received ,� >f�' Permit No.: p JVD ,)0t _�1O t� III13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: / �-+ t `'lJv ■ Plan Review Phone: 503.718.2439 Fax: 503.598.1960 y Other Permit No.: Inspection Line: 503.639.4175 Date/By: �� 'd�-(( �, ��/d4i , T I C A R D Date Ready/By: Juris: Ea See Page 2 for /111Internet: www.tigard-or.gov Notified/Method:� /1 Supplemental Information TYPE.{OF WORK FEE* SCHEDULE; 0 New construction ❑Demolition For special information use checklist Description Qty. I Ea. Total Addition/alteration/replacement 0 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) w v, ATF 9A' OF CONSTRUCTION , ,ti. SFR(1)bath 312.70 ID1-and 2-family dwelling , m Comercial/industrial SFR(2)bath 437.78 buildingSFR(3)bath 500.32 ❑Accessory ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: �rro. Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION A LOGATIOf . Site utilities: 1 Catch basin or area drain 18.76 D.Job site address: in s aI W' b R k Z(tt A City/State/ZIP: Drywell,leach line,or trench drain,./ I 18.76 ig,74,r.` Footing drain(no.linear ft.:a16� 3 Page 2 /05.01-1 Suite/bldg./apt.no.: 4 I Project name: Lo w1 p cu s (D K1Ce(Cts y Manufactured home utilities 50.03 Cross street/directions to job site: (J Manholes 18.76 Rain drain connector 3 18.76 SC•) Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:91 ) j Page 2 4,;,t..54 Water service(no.linear ft.:_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 a DESCRIPTION OF wok a Backwater valve / 12.51 ids s vS i ( ,--" Clothes washer 25.02 S t 42- 0.--t;\l t t 2 f Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 : 1. TY OWNER . Expansion tank 12.51 ® TENANT; ti 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 ` 0 APPEC ' s 0 CONTACT N; Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 ..:_ Water closet 25.02 r F TCONTRAsCTOR ,, {; , Water heater 37.52 Business name: Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal )'i.5, 11, Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) 68.71 State surcharge(12%of permit fee) :33.0 a Authorized signature: TOTAL PERMIT FEE 3?4,g7 Print name: Date: 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 Qty. Fee(ea) Total, Squar ootage: Permit F r , Footing drain-151 100' / 50.03 50,63 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 rl 544 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 Storm&Rain Drain-1st 100' 62.54 l',;) 'Valuatioll 'Permit Fee: 4� .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 z , Tatal each additional$100.00 or fraction thereof,to ether 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: 187.61 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 Plat I.eview for Plumbing Installations Fixture„ype for Plan review is required for any of the following. Work Performed: Capped Added *elticate 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 ❑ 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. Is©metlr(c-err 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 MachiRefrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lay -Non-food related -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:\Building\Permits\PLMU_PermitApp.doc 2 1r 1 ® Site Utilities — Plumbing Permit Application Plan Submittal Requirements TIGARD A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer and potable water systems on private property. 1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn to scale) labeled with: A. ❑ map&tax lot# ❑ project name ❑ site address El suite number El zoning El applicant name El phone number B. North arrow. C. Scale (architectural or engineering only). D. Street names. E. Building pads with project location. 2. PLUMBING PLANS-Two (2) complete sets, civil only. All details listed below shall be incorporated into the plumbing plans: A. Storm drainage plan showing: 1) Finish elevations throughout the developed site. 2) Grade breaks determining area serving each catch basin. 3) Location of catch basins. 4) Pipe size. 5) Type of material. 6) Slope of piping. 7) Manholes and field drains. 8) Cleanouts provided for each 100 feet or fraction thereof. 9) Roof drain laterals specifying cleanouts at each upper terminal. 10) Location of existing or proposed connection to a public sewer line. B. Utilities plan showing: 1) Sanitary sewer line location,pipe size, type of material, slope of piping,manholes and cleanouts provided as required for storm. 2) Size and location of domestic water piping and drainage. 3) Proposed location of connection to a public water or sanitary sewer line. I:\Building\Permits\PLMF-PermitApp.doc 12/30/05