Permit CITY OF TIGARD PLUMBING PERMIT
^ COMMUNITY DEVELOPMENT Permit#: PLM2019-00362
TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/10/2020
Parcel: 2S 101 BA00300
Jurisdiction: Tigard
Site address: 7350 SW DARTMOUTH ST
Project: Basecamp Subdivision: None Lot: None
Project Description: Site utilities for a new mixed-use senior living building with a restaurant and apartments.
Contractor: PR WORTH INC Owner: BASE CAMP I LLC
2690 COWEEMAN PARK DR 1399 FRANKLIN BLVD
KELSO, WA 98626 EUGENE, OR 97403
PHONE: 360-636-4296 PHONE:
FAX:
FEES
Quantity Description Date Amount
g ea Catch Basin or Area Drain 02/10/2020 $168.84
Specifics: 5 ea Drywell, Leach Line or Trench 02/10/2020 $93.80
Drain
726 If Footing Drain 02/10/2020 $312.67
Type of Use: MF
Class of Work: NEW 7 ea Manholes 02/10/2020 $131.32
Type of Const: 193 If Sanitary Sewer 02/10/2020 $100.06
Occupancy Grp: 1411 If Storm Sewer 02/10/2020 $587.82
Stories: 22 If Water Service 02/10/2020 $62.54
1 ea Backflow Preventer 02/10/2020 $31.27
1 Plan Review 02/10/2020 $372.08
1 12%State Surcharge- 02/10/2020 $178.60
Plumbing
Total $2,039.00
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: -
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
Site Utilities RECEIVE I FOR OFFICE USE ONLY
City of Tigard Received
g Permit No.:
11111 U 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 5 2019 Date/By: `!fi , -- f'L/ /q- 3�a
e Plan Review /f
Phone: 503.718.2439 Fax: 503.598.1960 Other PermitNo.:�/.�_)�S/P -�jZt,Z)
Inspection Line: 503.639.4175 CITY OF TIGARD Date/By: 1,25 41 �/„_
TIGARD 'l !IL-DING DIVISION- Date Ready/By: , Juris: Ea See Page 2 for
Internet: www.tigard-or'.gov Notified/Method: ,tt aLi /' r_ Supplemental Information
TYPE OF WORK
®New construction 0 Demolition For special information use checklist
Description I Qty. Ea. Total
II]Addition/alteration/replacement ❑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 laCommercial/industrial SFR(2)bath 437.78
❑Accessory building El Multi-family
SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder El Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
r ;
Job site address:7350 SW DARTMOUTH ST. Catch basin or area drain 8 18.76 150.08
Drywell,leach line,or trench drain 4 18.76 75.04
City/State/ZIP:TIGARD OR 97223
Footing drain(no.linear ft.:600) Page 2 237.63
Suite/bldg./apt.no.: I Project name:BASECAMP Manufactured home utilities 50.03
Cross street/directions to job site:SW 72ND Ave.&SW Dartmouth St. Manholes 7 18.76 131.32
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:200) Page 2 100.06
Storm sewer(no.linear ft.:600) Page 2 237.63
Water service(no.linear ft.:125) Page 2 71.92
Subdivision:n/a I Lot no.:300 Fixture or item:
Tax map/parcel no.:Map 2S 1 01BA Backflow preventer 2 31.27 62.54
tikeiWitikaru r^1 e + , Backwater valve 12.51
,. "
s Clothes washer 25.02
Civil Site Work,Underground Utilities,Concrete Foundations&Podium design. Dishwasher 25.02
Phase 2 of 3 Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:Basecamp 1,LLC
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:4000 Ridge Ln,
Garbage disposal 25.02
City/State/ZIP:West Linn,OR 97068 Hose bib 25.02
Phone:(503)880-5623 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:CB Two Architects LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Matthew Stoffregen/Dylan Chavez
Roof drain(commercial) 12.51
Address:500 Liberty St.SE Sink/basin/lavatory 25.02
City/State/ZIP:Salem OR 97301 Solar units(potable water) 62.54
Phone:(503)480-8700 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:dylan@cbtwoarchitects.com Urinal 25.02
' Water closet 25.02
r:
:: ,.;en =CONTRACTOR y„; Water heater 37.52
Business name: (t 1 •uth I,. Water piping/DWV 56.29
Address::a 670 (�,,y,,yyr 4+, Q T 4 D t- Other: 25.02
City/State/ZIP: 1.e/sty `,1/i A f Ve..2_G Subtotal
Phone:q6c):‘3 4 129 4, Fax:1 )
Minimum permit fee: $72.50
CCB Lic.: 1 7 3 q 62 di pc-ht Plumbing Lic.no.: p g 14 6
y Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized sign -74/it TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:
�, , e .- Date /rzQ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building1Permits\PLMU-PermitApp.doc 10/01/09 440-46 16T(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' I 50.03 50.03 0 to 2,000 S 121.90
Footing drain-each additional 100' 5 37.52 187.6 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 1 62.54 62.54 7,201 and greater $327.54
Sewer-each additional 100' 1 37.52 37.52
Water Service-1st 100' 1 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' .25 37.52 9.38
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 1 62.54 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm R Rain Drain-each additional I00' 5 37.52 187.6 $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
1) 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 increased sewer fees*.
Quantity by Fixture Type
Fixture Type for Replace/ Plan Review for Plumbing Installations
Work Performed: Capped Added Relocate
Baptistry/Font Plan review is required for any of the following.
Bath -Tub/Shower Please check all that apply.
-Jacuzzi/Whirlpool ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Dishwasher -Commercial as defined in OAR918-780-0040.
-Domestic ❑ Medical gas and vacuum systems for health care facilities.
Drinking Fountain ❑ Any multipurpose fire sprinkler system.
Eye Wash ❑ 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 Isometric or Riser Diagram
Garbage -Domestic-non-food
Disposal -Domestic-food related ❑ 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 -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
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
K:\Basecamp-Tigard\0-ARCHIVE\1 -ISSUED\2019-09-05_EWA_10lermit Submittal Set\Forms\2019_09_05_PLMU Site
Utilities_PermitApp.doc
r
plumbing permit can be issued.
I:ABuilding\Permits\PLMF-PermitApp.doc 12/30/05
A
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N . 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 ❑ 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. 1
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
Received pull 60362
- City of Tigard Permit No.: 1'L
11 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
Plan Review //� 6
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: �3-,y�;s--l'1 ad Other Permit No.:
T l G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
ONew construction ❑Demolition For special information use checklist
Description Qty. Ea. Total
❑Addition/alteration/replacement El 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 ❑Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11350 S 41, ,bct -t� a k �jt`. Catch basin or area drain 18.76
City/State/ZIP:/State/ZIP: 4 Drywell,leach line,or trench drain 18.76
ty l ao.r-�l C0RZ. qq 223
`� Bets
Footing drain(no.linear ft.:�_) Page 2
Suite/bldg./apt.no.: Project name:
-�. �?<V✓LP Manufactured home utilities 50.03
Cross street/directions to job site: Manholes il 18.76 J 3/,32
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: '_' ) Page 2 r
Storm sewer(no.linear ft: �; '') Page 2
F-
Water service(no.linear ft.: a , ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1' 31.27
DESCRIPTION OF WORK Backwater valve 12.51
+ Clothes washer 25.02
i tk 1)`'.1 S;ke- LL*,-\i �r'e S Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 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
Medical gas(value:$ ) Page 2
Business name:
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
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) r''
Authorized signature: TOTAL PERMIT FEE ;
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 Square Footage: Permit Fee:
Footing drain-Is'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
Other Inspections or Fees Qty. Fee(ea) Total 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*.
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 ID 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 El New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial El Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain El 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 ❑ Isometricriserdiagramrequired for new buildings
Garbage -Domestic-non-food or is ildin g
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 increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
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
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# El project name ❑ site address El suite number
❑ 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
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
II = Transmittal
s ttal Letter
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: - • DATE VED:
DEPT: BUILDING DIVISION j,„.$
SEP 18 2019
rc
FROM: C1\l(� ) h)C BUILDING CITY
OF TIGARD
KB
_(`( G DIVISION
COMPANY: A 10 , --0.M1- `�
PHONE: So` - 5 )—. �'l S I By: iid ---
RE: .1\ (vre M 09 P1-4/0.0(vI ''-U(/3(O.?
Site
( Address) (Permit Num erb )-
73c7 Sk) VA7/7-1/ u71
(Ploject name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copes: Description:il Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: Ih ad�0 w,�( ' r a) 9\
(--)Sc) � -'ems Nor'i'
G 1 �Ua�5 � �-
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Description: Amount Due:
$
$
$
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc
Submittal
415 Tra im
AKS Engineering &Forestry LLC 12965 SW Herman Rd. Suite 100 Tualatin, OR 97062 S E P 1 8 2019
CITY OF r1GARD
FROM: Chris Knight 6UILDING DIVISION
AKS Engineering & Forestry LLC TO: Don Sylvester
12965 SW Herman Rd. City of Tigard Community Development
Suite 100 13125 SW Hall Blvd.
Tualatin, OR 97062 Tigard, OR 97223
KnightC@aks-eng.com 503-718-2462
503-563-6151
PROJECT: 72nd Avenue MOB DATE SENT: 9/18/2019
4762
SUBJECT: Final Civil Engineering Plans ID: 00065
Submittal 1.1 Additional Sets of
Plans
PURPOSE: As Requested VIA: Delivered by AKS
Engineering
REMARKS: Permit Sub 1.1
CONTENTS
QTY: DATED DESCRIPTION: ACTION:
2 9/5/2019 100% Private Plans
QTY: DATED DESCRIPTION: ACTION:
2 9/5/2019 100% Public Plans
QTY: DATED DESCRIPTION: ACTION:
1 9/5/2019 Stormwater Report
Page 1 of 1