Permit CITY OF TIGARD
71 COMMUNITY DEVELOPMENT PLUMBING PERMIT
_ Permit#: PLM2022-00051
T I G A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/17/2022
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: SAFEWAY Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Interior plumbing: Relocating (1)3"floor sink for a new sales case.
Contractor: EVOLUTION PLUMBING LLC Owner: ROIC OREGON LLC
7210 NE 47TH AVE BY PROPERTY TAX RESOURCES LLC
PORTLAND, OR 97218 PO BOX 130339
CARLSBAD, CA 92013
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 02/17/2022 $25.02
Specifics: 1 12%State Surcharge- 02/17/2022 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 02/17/2022 $47.48
Class of Work: ALT Plumbing
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
Issued By: cyt _ O. n Permittee Signature: �a-ttr,,7'1 .0
lL t ll/l� (U l Call 503.639.4175 by 7:00 a.m.for the next available inspection date. ` \[l ) �)
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 Applicat ECEIV D al
Building Fixtures FOR OFFICE USE ONLY
City of Tigard JAN 3 12022 Received
/7,� Permit
No.:
13125 SW Hall Blvd.,Tigard,OR 972 �teBy /����' �r ������_��C�S�
yy OF TIGAH1 Plan Review
Phone: 503.718.2439 Fax: 503.5ya. 60 Other Permit No.:
pee 3UILDING DIVISION Date Re: �1 -
Ins Inspection Line: 503.639.4175 Ready/By: ® See Page 2 mr l I l A 1:I) Date Ree /�
Internet: www.tigard-Or.gov Notified/Method:a f/te/14 � Supplemental Information
TYPE OF WORK ® .cf t e..! Clvl§c, FEE* SCHEDULE
❑New construction 0 Demolition Far special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑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 0 Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:15570 SW PACIFIC HWY Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State2lP:TIGARD, OR 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:SAFEWAY PRODUCE CASE 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 floor sink for new sales case Dishwasher 25.02
---71///O b ..-t-./Y,✓ oT �.tIYC.a.iA Drinking fountain 25.02
v Ejectors/sump 25.02
❑ PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name:Safeway Fixture/sewer cap 25.02
Floor drain/floor sink/hub 1 25.02 25.02
Address:15570 SW PACIFIC HWY Garbage disposal 25.02
City/State/ZIP:TIGARD OR 97224 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Evolution Plumbing, LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Chelsea Roof drain(commercial) 12.51
Address:7210 NE 47th Avenue Sink/basin/lavatory 25.02
City/State/ZIP:Portland, OR 97218 Solar units(potable water) 62.54
Phone:( 503)655-3388 Fax: :( ) Tub/shower/shower pan 12.51
F-mail:chelsea.woods@evoplumbing.net Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Evolution Plumbing, LLC Water piping/DWV 56.29
Address:7210 NE 47th Avenue Other: 25.02
City/State/ZIP:Portland, OR 97218 Subtotal 25.02
Phone:(503)655-3388 Fax:( ) Minimum permit fee: $72.50 72.50
CCB Lie.:189876 Plumbing Lic.no.:Pg834 Plan review (25%of permit fee)
�]��� / State surcharge(12%of pennit fee) ,,^70
Authorized signature: G149.44ri TOTAL PERMIT FEE/�'1,it
Print name:Chelsea Elford (J Date:1/31/2022 This permit application expires if a permit is not obtained wi n 180 days
after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
1:1Building1PermitsVPLMU-PernolApp.doc 10/01/09 440-4616T(10/02/COMJWEB)
1
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' 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 ' 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/lu 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 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
❑ Any new commercial building with water service 2"and
Baptistry/Font 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 Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
Domestic ❑ My 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"
1-3-floor sink Isometric or Riser Diagram
a ❑ 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
IceMach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/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:
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