Permit -
CITY OF TIGARD PLUMBING PERMIT
` s COMMUNITY DEVELOPMENT Permit#: PLM2020-00198
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/15/2020
i E ' O Parcel: 25101 BA00500
Jurisdiction: Tigard
Site address: 7600 SW DARTMOUTH ST
Project: Walmart Subdivision: HERMOSO PARK Lot: 8
Project Description: CAP(1)water heater, (1)sink, (1)hose bib and(3)3"floor drains.
Contractor: PMSI LLC Owner: WAL-MART REAL ESTATE BUSINESS TR
8295 NW EVERGREEN PKWY#204 BY PROPERTY TAX DEPT STORE 5935-00
HILLSBORO, OR 97124 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Quantity Description Date Amount
6 ea Fixture/Sewer Cap 05/15/2020 $150.12
Specifics: 1 12%State Surcharge- 05/15/2020 $18.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $168.13
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to
OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B /I / ) Permittee Signature:
y �'`x'%22 �� 9 c.'211/ F[. iC; e/../
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
'AEC
Plumbing Permit Applicaticl ""Building Fixtures APR 3 0 2020 1 OR I)1 Fit i•s 1 SI UN1-1
City of Tigard ' Ty OF ! GARD Date;Beyd fri/1-0 42a Permit tyPt11.20,2(2 --OOP'?f
N. 13125 SW Hall Blvd.,Tigard,OR,' ('
3 Phone: 503.718.2439 Fax: 503 ..7rr .t�!llt U DIVISION
Plae/Bn Review Other Permit No.:
Inspection Line: 503.639.4175 DatalRy.
1 •'. A t' Internet www.ti rd or. ov Dale Read th V!/ ! ,/9 loot$; S see Pane 2 for
g NdtfledlMethod�/ N! suppiemental information
TYPE UP WORK ( �` :'9"71--, - FEE' SCIIEDULE -,._s
❑New construction 0 Demolition Fors vial information use checklist
Description �1 Qty. J Ea. j Total
.eAddition/alteration replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
IIII-and 2-family dwelling F Cummercialiindustrial Skit(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory ❑Multi-family
Each additional bathlkitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: -- �:.',
Catch basin orarca drain 18.76
" i-NA„„...e- r" "� Drywell,leach line,or trench drain 18.76
City/State/ZIP: T.-,Gyr`s..r'c) O <A l 2 2
�,) 1 �� Footing.drain(no..linear(I.:_) Page 2
,,
Suite/bldg./apt.no.: Project name: td.\\tar. -- 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 tl.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
t r 64 ESCRIPTIOT WORK Backwater valve 2.51
/fl yc nt. y Clothes washer 25.02
t..,-.� e,),..l� "irs ) C.)Yt,'�): 4- -\ , r,rvl*. c,t,,$c,,11 i 2 Py Jr1, - Dishwasher 25.02
ci,A,4ent,r.4t, 4 7J ,. v'?pr.t- (_-_..)61en•, --1<. Drinking fountain 25.02
Ejectors/sump 25.02
Air PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name. Fixture/sewercap 25.02
.0.1f\rY (vi Floordrain/floor sink/hub r/j ...,....3-- 25.02
Address:1 o(`() ,cx t.l .j`x'x r k-elin,A-V 't"
Garbage disposal 25. 20..
City/State/ZIP: r,4n,rr , (] 2.3 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
E»APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: pM<' !i Medical gas(value:S_) Page 2
Primer 12.51
Contact.name: Ar rs ..r'rtl&J. 'CJs,r`j t, Roof drain(commercial) 12.51
Address: - `E. I v '. l een 2 w. 1')" LI Sink/basin/lavatory 25.02
City/State/ZIP:t t,.5 - , 012 4....I1 Zl-1 Solar units(potable water) 62.54
Phone:(!:):,‘,0 44
G 2 2 7 Fax: :( ) Tub/shower/shower pan 12.51
E-mail' Urinal 25.02
E t- Water closet 25.02
CONTRACTOR /
Water heater /( 37.52
Business name: 1))). .....c` <` Water piping/DWV 56.29
Address:' 6 k)S Eve,fer,t,t1 1 Jv G t„� Other: 25.02
City/State/ZIP: \., ;t }k7r% o ac)c 7 , on 12,t4 Subtotal LS0,/Z-
Minimum permit fee: S72.50
Phone:(t dl3) L €,CQ " Z-22 (:r Fax: )
Plan review (25%of permit fee)
CCR Lie.: (Gj j(ty Plumbing Lie.no.:65 f> 23?
State surcharge(12%of permit fee) If.Q/
Authorized signature: .# 1,4 %wr �� it TOTAL PERMIT FEE /(pr>/..3
Print name: p,,,t.n, .,, t,y Date: 4 O pQ/Q This permit applkatiun expires if a permit is not obtained within Igo days
t t1 1'^v"�' after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1auildutg\Pennits'PLMU-PermaApp.doe I0101N9 440-4616T(10'021(:OM/WCH)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qri. Fee teat cola/ Square Footage: Permit Fee:
Footing drain-1" 100' 50.03 0 to 2,000 $121.90 _.---------.
Footing drain-each additional 100° 37.52 2,001 to 3,600 $Ib9.(r9
3,601 to 7,200 S233.20
Sewer-1st 100' 62.54 7.201 and greater $327,54
Sewer-each additional 00' 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 S72.50
Storm&Ram Drain-each additional 100' 37.52 $5.001.00 m S 10,000.00 $72.50 for the frat$5.000.00 and$1.52 for
Qty. Fee(ea) Total- each additional S 100.00 or fraction thereof to
Other Inspections or Fees and including$10.000.00.
Inspection of existing plumbing or for $10.001.00 to$25,00001 $145.50 for the first$100011,00 and$1.54 for
which no fee is specifically indicated 90,00/hr each additional S 100.00 or fraction thereof,to
(minimum charge—1/2 hour) and including$25,000.00.
Inspections outside of nomxil business 90.00Por $25,00I 00 to$50,000.00 $379.50 for the Grst S25,000,00 and Si.4S fur
hours(minimum charge—2 hours) each additional 5100,00 or fraction thereof,to
Reinspection Fees 90.003rr and including$50,00000,
Additional plan review for revisions 90.00,11r $50.001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge—1/2 hour) _ each additional S 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.
FixtureType for Replace/ Please check all that apply.
Work Performed: Calmed Added Relo ate 0 Any new commercial building with water service 2„_ and
BaptisnyiFont greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
• engineer.
-Jacuzzi/Whirlpool
Car wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive That
❑ Medical gas and vacuum systems for health care facilities.
Cuspidor%Water Aspirator
Dishwasher. Commercial 0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Fyc Wash Submit 2 sets of plans with any of the above.
Floor Drain,/sink: -2"
Isometric or Riser Diagram
4" ❑ 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: -t.av/Bar non-food related
-Bradley
-Com(Serv/Util food related
-Service 1 *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:
l:\Buildingyf'ennits\PLMF_PermitApp.dac 08/04/2011 2