Permit (64) CITY OF TIGARD PLUMBING PERMIT
: ' . '. COMMUNITY DEVELOPMENT Permit#: PLM2019-00122
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/27/2019
I t 61:C3 9 Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 300
Project: Health Net Subdivision: None Lot: None
Project Description: Interior plumbing for third floor:Adding(1)sink;Relocating(2)2"floor drains;Installing(2)ice makers,(2)primers,
and(1)water heater.
Contractor: GRIDLINE PLUMBING Owner: GK TRIANGLE CORPORATE PARK III L
14844 SW 109TH AVE ATTN KBS REALTY ADVISORS
TIGARD, OR 97224 P O BOX 28270
SANTA ANA,CA 92709
PHONE: 971-275-6167 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Floor Drain/Floor Sink/Hub 03/26/2019 $50.04
Specifics: 2 ea Ice Maker 03/26/2019 $25.02
2 ea Primer 03/26/2019 $25.02
Type of Use: COM 2 ea Sink 03/26/2019 $50.04
Class of Work: ALT 1 ea Water Heater 03/26/2019 $37.52
Type of Const: 1 12%State Surcharge- 03/26/2019 $22.52
Occupancy Grp: Plumbing
Stories:
Total $210.16
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 folio, • ru- dopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0091 You may obtai a copy of the rules
or direct questions to OUNC by calling 503.232.1987 • :.1 344.
11
Issued By: Permittee Signature: rg
Call 503.639.4175 by 7:00 a.m.for the next available inspection d. e.
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 ` 4�+_•G'_ -
Building Fixtures Holy ()Hi( 1: I SE O11.1
City of Tigard Received
g C�'°�' y. dry-
Plan Permit No.: y�,,0Z/
,IIN 41
13125 SW Hall Blvd.,Tigard,OR 972 C Date/B 3/ �/ / d"�/'/" " 7i fes- ) 1;70
a Phone: 503.718.2439 Fax: 503.598.1960 V�a Review Other Permit No.:
Date/By: ( 1)0/1-rL lnK
Inspection Line: 503.639.4175 MAR
2019 C/K
T I G A R D Hfl 2 6 Date Ready/By: mss: ® See Page 2 for
Internet: www.tigard-or.govNotified Method: Supplemental Information
TYPE OF WOOF TIGARD FEE* SCHEDULE
)LONG DIVISIONFor special information use checklist
❑New construction 0 Demolition
P T
Description Qty. I Ea. Total
%Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF COI ST,RUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION ANI) LOCATION Site utilities:
Job site address: /3i2,..2/ J S� /„ d."-- a i/ Catch basin or area drainDrywe18.76
City/State/ZIl': ���y / �tttvvv 77..1.3 l
Footing
1,leach line,or trench drain 18.76
/ a / Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 340 Project name: . ..� Manufactured home utilities 50.03
Cross street/directions to jol?site: Manholes 18.76
h/ �j�� .� 7 / •
/1/ Rain drain connector 18.76
///��� ' / Sanitary sewer(no.linear ft.:_) Page 2
4A/! /jJ
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.: ,516 44-ce 1 GI c�. Backflow preventer 31.27
,
DESCRIPTION OF WO, Backwater valve 12.51
T. s,% , Clothes washer 25.02
����� �t� Dishwasher 25.02
Drinking fountain 25.02
4 -A[ 7 5-75-7/.- , /�•/�q/ ' Ejectors/sump 25.02
!. zzff�/`,/ Expansion tank 12.51
PROPERTY OWINER. .. . .., s�/s� p
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub X Z 25.02 5 4,`v l
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 74. 2. 12.51 ,6---.,e),2
; 0 APPLICANT ClCONTACT PERSON _ Interceptor/grease trap 25.02
x.r•x.
Business name: �/ Medical gas(value:$ ) Page 2
t ri<i t/-`�1" Primer ) Y 12.51 725: 62.
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory X 2_ 25.02 50
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 37 G
CONTRACT / �/Z
27/
Water heater / 37.52
Business name: - fie /mom/ Wateri in DWV
PP � 56.29
Address: /44 9 V .5) /O 9 A i > Other: 25.02
De
City/State/ZIP: 7T c/! 9 Subtotal/l7,62/1Phone:(p7/ 2/5) ‘./.47 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 7ff/e9iiip Plumbing Lic.no.:49C e' !/�J' StPlan review (25%of permit fee)
/ ate surcharge(12%of permit fee) .S a
Authorized signature: TOTAL PERMIT FEE 4,4"0, 1
` /
Print name: V �-} This permit application expires if a permit is not obtained within 180 days
e �n LL Date: 3-.Z �/ 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-1s'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 ,
Storm&Rain Drain-1st 100' 62.54 Valuation: c Permit=Fee: s
$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. (ea) Toil
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*. Ptan,., 2.e?view for Plat e a i hist �l*tions ,v
Quantity by Fixture Type Plan review is required for any of the following.
FiltoreTYpefor Redac Please check all that apply.
Work Performed: Capped' Added Relocate
Baptistry/Font 0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 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" 2-
3" -Isometrlc:pY`y ,
4„
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
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
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
13221 SW 68TH PKWY 300, TIGARD, OR, 97223 July 9, 2019 at 10:33:48 AM
Record Type: Record ID:
Commercial - Plumbing PLM2019-00122
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor