Permit CITY OF TIGARD PLUMBING PERMIT
•
COMMUNITY DEVELOPMENT Permit#: PLM2021-00138
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/13/2021
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: None Lot: None
Project Description: Relocate(1)hub drain
Contractor: D&F PLUMBING CO Owner: FRED MEYER STORES INC
4636 N ALBINA AVE STORE#375
PORTLAND, OR 97217 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503-282-0993 PHONE:
FAX: 503-288-0604
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 05/07/2021 $25.02
Specifics: 1 12%State Surcharge- 05/07/2021 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 05/07/2021 $47.48
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: H0 Vavi De/WCge Permittee Signature: onliApplicatlxm
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 � 3 t 121
Building Fixtures i ���
_ City of Tigard R 2 .,'. Date/By DS1 �G 20L1 . PermitNo.: V(t��2(.(61n
Iiii • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Bu)p702-! n lr 7j7�
Phone: 503.718.2439 Fax: 503.598.1960;I Y OF TIGARD Dardgy: ��2�C���as�� ,Other Permit No. 00
TIGARD Inspection Line: 503.639.4175 IJILDING DIVISION DateReadyBy:�A 21 eV
^-^ _'l� See Paget for
Internet: www.tigard-or.gov Nolified/Method: / Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I 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
0 I-and 2-family dwelling Q(]Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11565 SW Pacific Highway Catch basin or area drain 18.76
City/State/ZIP: Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Fred Meyer Grocery Pick Up Expansion 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: 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
Relocate 1 hub drain
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 6 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Fred Meyer-Karena Zevely I Floor drain/floor sink/hub 1 25.02 25.02
Address: 3800 SE 22nd Ave. Garbage disposal 25.02
City/State/ZIP: Portland, OR 97219 Hose bib 25.02
Phone:(503 ) 797.3511 Fax:( ) Ice maker 12.51
® APPLICANT Cil CONTACT PERSON Interceptor/grease trap 25.02
Business name: Western Construction Services Medical gas(value:$_) Page 2
Primer 12.51
Contact name: Pam Deegan Roof drain(commercial) 12.51
Address: 2300 E.3rd Loop,Ste. 110
Sink/basin/lavatory 25.02
City/State/ZIP: Vancouver, WA 98661 Solar units(potable water) 62.54
Phone:(360 ) 953.8517 Fax: :(360 )694.7818 Tub/shower/shower pan 12.51
E-mail: pam@westernconstruction.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
c
Business name: Tee . c (2Y\tserib;rn Water piping/DWV 56.29
Address: 12Q0 \ kJ? '\S t'"N S\..__. Other: 25.02
City/State/ZIP:\)G-y OU U-,,f W CN e)CO a L Subtotal 25.02
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: / -1(sS Plumbing Lic.no.: 2J •^2�PQ Plan review (25°/a of permit fee)
q /� State surcharge(12%of permit fee)
Authorized signature: - // / J ,,,,! A^-- TOTAL PERMIT FEE
Print name: Pamela A. Deegan Lf� !r` `e Date: 03.24.21 This permit application expires if a permit is not obtained within Igo days
�/ after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
can.Aeirrnnmvrn"envcn,
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
1110 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 $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 -
Storm&Rain Drain-1st 100' 62.54 1$ aluation: '� Per im
.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. > ) MI each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for S10,001.00 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 Installatio
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
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ElMedical 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"
3" Isometric or Riser Diagram IF
4 ❑ 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: -LavBar 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
Water Extractorfees assessed for the sewer increase must be.paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures: Hubdraln X
-Relocate
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2