Correspondence (2) CITY OF TIGARD PLUMBING PERMIT
•
s COMMUNITY DEVELOPMENT Permit#: PLM2021-00241
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/30/2021
Parcel: 1 S 136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 3
Project Description: Interior plumbing for Bakery remodel: Relocating(2)3"floor sinks and(1)4"floor sink.
Contractor: PMSI LLC Owner: COSTCO WHOLESALE CORPORATION
8295 NW EVERGREEN PKWY#204 PROPERTY TAX DEPT 111
HILLSBORO, OR 97124 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Quantity Description Date Amount
3 ea Floor Drain/Floor Sink/Hub 06/18/2021 $75.06
Specifics: 1 12% State Surcharge- 06/18/2021 $9.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
'4 Plumbing Permit Application Building Fixtures FECEIV ' _ FOR OFFI(F: I. (Ai.)
City of Tigard gryq Received /<
III-ra OR 97223 JUN 1 0 2021 Date/Ay: (�7/ r/it0 677.
Permit No.: �g f�r'�-V r'
r 13125 SW Hall Blvd.,Tigard, Plan Review
Phone: 503.718.2439 Fax: 503.59$.1960 ,.� Other Permit No. 7,,.,y-/_arc?
Inspection Line: 503.639.4175 may' {'" 2 for lL1�a
11e�"�It 11 CITY OF TIGA totedIM th r. Jura Supplemental See Page for
Internet: www.hgard-or.gov =t „ . y �d/�,tegt�, /�Y �`,7� Information
TYPE OF WORK 4''' .i1dt I#1tr-.,
" " >-_tom"'=-„-,,,, „«.- ,f...e.,e«gFEE..SCHEDULE
❑New construction ❑Demoli r a ' For special information use checklist
- "Addition/alteration/replacemen[ ❑Other. r Description I Qty. I Ea. j Total
p New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTItUCTIa(reiRin.r, r= r ,ice/1° SFR(1)bath 312.70
❑ I.-and 2-family dwelling ,a CommerciaUindusr'al SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
=,JOB SIu' . INFORMATION AND LOCATION;-. Site utilities:
Job site address:`1 S i6 r}ram Catch basin or area drain 18.76
Citysite a fires Drywell,leach line,or trench drain 18.76
Ti q`a(-it i d G1'�?.7�� Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 0 Project name:('''\sr.(c _" ? ,\ 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: J Lot no.• Fixture or item:
Tax map/parcel no.: Backilow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
I -n1c:.,rc. `r r 1C:cr‘-kr c.xr. I"ir1a‘ i I:1'X 1-1./CIrDishwasher 25,02
U Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER -[y'[TENANT `is Expansion tank 12.51
' Fixture/sewer cap 25.02
Name
,r': 7{ cC; Floor drain/floor sink/hub •3 25.02
Address: 18nf .sl A) t 7rf,C'•4-(Y1 0 L/jt 4
Garbage disposal 25.02
City/State/ZIP: I er)a rrA I C7l ci-?..2:z Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
-a-APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: . ,; Medical gas(value:S_) Page 2
_.
j `�,;r,,.i_..l ! .)w Primer 12.51
Contact name: Ay."ar-�:'t R"er\
�ry _ �l Roof drain(commercial) 12.51
Address:0.�.,CtS A Y, p Vr�-c,crl ?V, \I I `�1•c- .2 C.L Sink/basiMavatory 25.02
City/State/ZIP: 1-�I 1\.\6c)'(T) (-)2- Gl-1 I Solar units(potable water) 62.54
Phone: 3 ) (.j(e(o_22,2,? Fax::( ) Tub/shower/shower pan 12.51
E-mail 0,.t- �eS mS i -S S-I-Gry3S CUCy.1 Urinal 25.02
Water closet 25.02
- Water heater 37.52
Business name:
Water piping/DWV 56.29
Address:g7 -6 VCC"�trren �j�Yt�`+,s q Other: 25.02
City/State/ZIP: 1111cb0 �U, G�y7./ pl Subtotal
Phone:(5 3) („%�( .-7.7 a.� Fax:( ) Minimum permit fee: $72.50
Cell Lic.: I S8 2R G� Plumbing Lic.no.: �sf� Plan review (25%ofpermit fee)
(4 ' F'1J State surcharge(12%of permit fee)
Authorized signature: ..e.r„-e BG-. � � TOTAL PERMIT FEE
Print name: 1 3r IP�l l�tC Date: c I `�IThispermit application expire if a permit is not obtained witbla 180 days
7 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:lauildinglpamduWPLM[7-PamitApp.doe I11/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(es) Total 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 $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- Ist 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$2.5,000.00 $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) w_,Y 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 pP y'
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 as defined in OAR918-780-0040.
Cuspidor/Water Aspirator CIMedical gas and vacuum systems for health care facilities.
Dishwasher: Cmmmercial 0 Any multipurpose fire sprinkler system.
-Domestic ElAny 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" 2 ,Isometric or Riser Diagram
a^ t 0 Isometric or riser diagram is required for new buildings
• -Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food q --
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/i3ar 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 ex actor fees assessed for the sewer increase must be paid before the
Water Closet-'toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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