Permit CITY OF TIGARD PLUMBING PERMIT
.114
COMMUNITY DEVELOPMENT Permit#: PLM2022-00024
Date Issued: 3/31/2022
T f t;AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S136DB02502
Jurisdiction: Tigard
Site address: 11634 SW PACIFIC HWY
Project: Mike's Drive in Subdivision: None Lot: None
Project Description: Interior plumbing for new kitchen.Restrooms are existing:Adding (1)dishwasher, (4)2"floor sinks,(1)3"floor
sink,and(6)sinks; Installing(1)expansion tank, (1)grease trap,(2)primers,(1)water heater,(2)soft serve
machines,and(1)dipper well sink.
Contractor: DP PLUMBING INC Owner: JORORET LLC
15825 NE SPRINGBROOK 888 SW 5TH AVE STE 1600
NEWBERG, OR 97132 PORTLAND, OR 97204
PHONE: 503-537-9492 PHONE:
FAX:
FEES
Quantity Description Date Amount
ea Dishwasher 03/25/2022 $25.02
Specifics: 1 ea Expansion Tank 03/25/2022 $12.51
7 ea Floor Drain/Floor Sink/Hub 03/25/2022 $175.14
Type of Use: COM 1 ea Ice Maker 03/25/2022 $12.51
Class of Work: ALT 1 ea Interceptor/Grease Trap 03/25/2022 $25.02
Type of Const: 2 ea Primer 03/25/2022 $25.02
Occupancy Grp: 7 ea Sink 03/25/2022 $175.14
Stories: 1 ea Water Heater 03/25/2022 $37.52
75 Misc Other Fee 03/25/2022 $75.06
1 Plan Review 03/25/2022 $140.73
1 12%State Surcharge- 03/25/2022 $67.55
Plumbing
1 ea Fixture/Sewer Cap 03/25/2022 $25.02
0 Plan Review 03/25/2022 $6.26
0 12%State Surcharge- 03/25/2022 $3.01
Plumbing
Total $805.51
Required Items and Reports(Conditions)
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rule re set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Permittee Signature: AI I
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application , ,�Ah los A." _ • o I ►3 )•--e
Building Fixtures RECEIVE FOR OFFICE. LSE ONLY
RcaircJ
- City S Tigard reinnt Nr-
JAN 1310Yi ° to
III a 13125 SW Half Blvd..Tigard.OR 97223 '.
Phone" i0371s.2439 Fax: 503.59$.1960 Elm Rea m' -/'/- 2 4C Uthtr t'cr:nit No./�j 14_6.y��1)
I)rtc Ay: (/=1 /-7�(7T 'air 2 tot V"/ ADC
Inspection Line. SOl.fi39.-0175 CITY OF TIGARD 110 Re.uly D). Allis: 0 See Page 2 for
l'I GARD hncruec www.tigard-ur.guv /
�otitied.Method'.3 iD 6'� G Supplemental Information
•rsl'l: OF WORK BUILDING DIVISION , r .9y,i E* SCHEDULE
0 New construction D Demolition For special information once checklist.
Description For
I Ea. Total
ciaAdditia,,,k..ndonircpinceincnt ❑Othm': New I-2-family dwellings i includes 100 0.Cot each wilil) connection)
CATEGORY OF CONSTRUCTION t SIR i I)bath 112.70
❑ I-and 2-tamily dwelling (X('nntm aerci l,indu,liail SFR 12)both 437J8
SFR i3)bath 500.32
❑ Accessory building ❑ Multi-fancily"
_-_ Fact'additional bath kitchen 2.5.1)2
❑ Master builder ❑other: linkler Fire;P ( s4. It.) Page 2 -- --JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: (q Li Catch basin Or urea drain 18.7('
-...... I_._. _sit. s� -411 paci.. V--- ..- ,_____ -- Uryweil,leach line,ur trench drain IR.7b
('it. scuc'ZII':
T i -- R7 Pauline drain(nu linear 1 Page 2
Suitc bldg/apt.no.: Proj ct name: L f p
pace!, brut .. Manufactured home utilities 50.03
(Toss street/directions to job site: Manholes I8.7(i
Rain drain connector I R.76
•
Sanitary.ewer(no.linear li.'._l Page 2
•
Sturm sewer I no.linear ft.:_) Page
Water,en ice Ino.linear II.: ) Page 2
Subdivision: lot lid.: FiNrm re or item:
Tax neap/parcel no.. ,J )3(Q Oa O?S 7 a Back llusv prucemrr 31.27
' tVI, Pv (O 9 Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
P�1JJli '4As �11 f �1fr I.6S�,CDiiier- C-KA h , Dishwasher • ' 25.02 S.Ga
Set griylC(.{d/l.C- �LtJ L Drinking lbunlain 225.02
Fjecturs/.wm(t 25.02
0 PROPERTY OWNER ❑ TENAN1 Expansion tank I 12.51 1,2, y-►
Fixture:sewer cap l 25.02 2,51at
Name: •
Flour drain/hour sink'hub 7 25.02 /7S ,I c-)
Address:
- Garoage lisp eial 25.112
City State'%IP: }lose bib 25.02
Phone:( I Far:I ) Icc iiiiker I 12.51 J„2 .5)
0 APPLICANT 0 CONTACT PERSON Intcrceptur•g ease trap I 25.02 as.t'
Medical gas(value:$_) Page 2
Business name:
---------- Primer 2. 12-51 '),).&,
Contact name:
Root drain(commercial) 12.51
Address: Sink/basin la+away ! 2223.112 i 7 •I t..
City State/ZIP: Solar units(potable waled 62.54
Phone:( ) Fax::( ) Tull shnwershnwer pan 12.51
L-road: Urinal 25.02
i • Water closet 25.02
CONTRACTOR t a _
pi) E Water heater ► 37.52 3) y
Business name: UY--S4W,L-�JYW�!�Lt./ Water pipingU\\'V 50.29
Addre.w: I�CI GJ •it: Spr �f /y Ai.
Other, �. S Jam'�y 25.02 7 s-.e t,
City Slate/7IP: �iwLt,Yl \7(31L Ct�C,(r /Le f.//s,c y Subtotal
Phone: ) "`"'tt"�� I- � I Fax:1 1 l(inien ii - lice: S72S(1
Isu3s�4 �KKB
CCB Lie.: 2.2,4 6gs- 1 Plumbing Lie.no.: pc ?All
Plan reh nac I h,/�of pcl nut lac) -
Sue iunh n t I I e of putt Icc)�/ ✓,
Ir Authorized signature ek , / __.. iii AI II ItPIII III
Print name U �,r - L 1�',G/4F' - - - -1 I)itC y Tula permit application rprl it a pa I nni i S not Iht.thl d date
�Cit v.{/L �.d(.. . __.1 'Z' I niter a hasi'14 t eepuda au,ih Ir I4!
r/y _ 'tee meamdtdgey.el by Ilia Ponidiur'Inilwari Sec ii
/y
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' ' 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- I" I00• 50.03 0 to 2.000 $121.90
Footing drain-each additional lap 37.52 2,001 to 3.600 $1b9(9
3,601 to 7200 i $233.20
Saxe[ -1st 1(10' 62.54 7,201 and(,roger $327.54
Server-each additional 100' 37.52 ---
Water Service- ISt I00' (2.54
Medical Cas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-Ise 100' 62.64 Valuation: Permit Fee:
$1.00 to S5.000 00 Minimum Ice$72.50
Sntmt&Rain Drain-each.tdditiunal IOW 17.52 55.0111.00 to$10.000.0n $72.50 Ior he Best$5,l(0O,O(1 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total i each additional S IOO.00 w fraction thercol.to
`` and including S10,000.00.
Iutipectiun of existing plumbing or fur S 111.001.00 to S25,000.00 S 146.50 tut the tint$I0 000.00 and S 1.54 for
which no Fee is specifically indicated 90-00 hr i
each additional S 100.00 or fraction thereof to
(minimum charge-12 hour) and including S25AO0.00.
Inspections outside of normal business 90.00 hr S25.ia11 JNi to S50,000.l0 S379.5(1 for the(i1T1 S25,1000.00 and SI.45 fur
hours(minimum charge-2 hours) each additional S I!twirl or traction hereof:to
Reinspen ion Fees 90.110 hr _ and including S511.O00.00.
Additional plan review fur revisions 90.00 hr S511.001.00 and up S742,00 lot the first SSO,llu0.00 and$L211 for
(minimum charge-12 hourI _ ___ each additional S tll(1.00 or traction hereof.
Subtotal:
Commercial Fixture Work:
Arc 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 lecicw is requ'red for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new wmlncreiui building with water service 2-and
Baptistry Font
greater.except systems designed and stamped by licensed
Bath: -Tub Shower
engineer.
-Jacuzzi.WI)irlpool
Car Wash: -each Sw1i 0 New exterior plumbing site utilities for any complex structure
-Deice tall as defined in(')AR91 S-780-0040.
0 Medical gas a+hd vacuum systems for health care facilities.
Cuspid Asp
irator
b }
Dishwasher: 4'onnercial i 0 Any multipul3 Osc lire sprinkler system.
I)nncstic ❑ Any complex'Structure as defined in OAR918-780-0040.
Drinking Fountain —
Eyc Wash � Submit t sets of plans with am of the above.
Floor Drain/sink: -2" f� L t. Z .
3 1 I isometric or Riser Diagram
1
-4 ❑ Isometric or riser diagram is required for new buildings
-Cat Wash Oran
that meet Mil qualifications above.
Garbage -Domestic non-fond q
Disposal: -Domestic titod[elated
-I ionwnercial lend related 411 FAiI reCt vat-Indust;ial food related
Ice Mach/Rchig.Drains Comments regarding fixture work:
Rec.
Separator(Gas titans i /1.� u� to _ I, �
Rtt..Vehicle Dump Station
--�1 M�/ �3 r t i' Ate,
tL 1
1 3 k
Shower ([any[ T ,__eye- WQ1-Stull y ^' ''
Sink: -I-av Aar non-fond relatedp� ( I
-Bradley f e
-Cant/Sery Ulil food reh.9"ii j I t
-Service _L.l I *Note: If the fix ore work under this permit results in an
Swimmhte Pool Filter t �t increase of sewer EDLis,a sewer permit will be issued and
W'asltel-(ladies Si)
Water rrtracn,r tees assessed for the sewer increase must be paid before the
UWatei rinal 'loses-Yoder plumbing tpermith'im b; issued.
I.J"',VVrH,jIjI--.•�t kek r,l,EKpay)itoh,�peruse `
l:'BuFixuucs: G.
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Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
Cityof Tigard Received
gan Dute/B Permit No.:
' I • 13125 SW Ha11 Blvd.,Tigard,OR 97223)1AR 2 3 Z02Z Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Date/By: Other Permit No.:
T IGARD Inspection Line: 503.639.4175 OF TIGARL Date Ready/By: Jut EaSee Page 2 fur
Internet: www.tigard-or.gov CITY Notified/Method: Supplementa l Information
TYPE OF WOI&JILDING DIVISION ' FEE* SCHF.DULE
❑New construction ❑Delnoli i i oii'•h A For special information use checklist.
$. Description I Qty. I Ea. I Total
El Addition/alterabon/replacement ❑Other.
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUC�OIV�1A"f°' 1- ' SFR(1)bath 312.70
❑ 1-and 2-family dwelling Ili Commercial/industrial
SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
i Fire sprinkler( sq.H.) I Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 1 b' 4 6 i t 1 Par�-4L i-I-wr Catch basin or area drain 18.76
J_l W Drywell,leach line,or trench drain 18.76
City/State/ZIP: r 0R- q'2Z3
T�(� t Footing drain(no.linear ft.:_) Page 2
g
Suite/bldg./apt.no.: Project name: 1I F t
l ! CJ ('llft"It1 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Al • 1, 1 I Sanitary sewer(no.linear ft.: ) Page 2
►l e)idi �l+Livthi C Q e0 / Stalmsewer(no.linearft.: ) Page 2
J ,J r bC In lGY r IR ITG/ of Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
e Clothes washer 25.02
1 c .FJ7 C,CO�OUr 4i�s is t 6-)���^�"orrr 4t1,4 3-1 Dishwasher 25.02
/CII(P O✓A J. C �3�-CWv) j/�NK a CeytotkJot UellL, Drinking fountain 25.02
6,44,44l lb dr'i trV�-K 3Gc2Btt d'f k/dlKal rAtOJ Ejectors/sump 25.02
ElPROPERTY OWNER I 0 TENANT�r't r Expansion tank 12.51
t
Name: q
Fixture/sewer cap _i 25.02
3/r' Floor drain/floor sink/hub 25.02
Address:
-T. Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
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/showet/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: pp pivh 1 �VC Waterpiping/DWV 56.29
Address: is-Q,,,s' Air SDI t't 0 f-0A. Other: _ 25.02
City/State/ZIP: v j�`wIti, fn VI Q f Cl'1i3Z -� Subtotal
Phone:(�3) Slq-'ut Fax:( ) Minimum permit fee: $72.SU
CCB Lie.: aa 4(C s' Plumbing Lic,no.: pe a Ii I Plan review (25%of permit fee)
t+ Q ,q State surcharge(12%of permit fee)
Authorized signature: ,// TOTAL PERMIT FEE
J �JJ-Jfj-
Print name: This permit application expires if a permit Is not obtained within 180 days
)UU t,F Ctt Date:LI/1 �)2 DI 'Z? after It boa been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:`.Building\Permits\PCMU-PermitApp.doe 10/0IN9 4 616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
• Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ca) Total Square Footage: Permit Fee:
Footing drain-I"100' 50.03 0 to 2,000 5121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $t 69.69
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 S10,000.00 $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 fur
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspectien Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up 5742.00 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 pet-formed 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
Baptistry/Font 0 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 0 New exterior plumbing site utilities for any complex structure
- -Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator
❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system.
Uomestic ID 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" rkth4-3" Isometric or Riser Diagram
-4„ .�iQ
-Car Wash Doh' 0 isometric or riser diagram is required for new buildings
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: j
Oil Separator(Gas Station) 4- cap l - 2, -�NQot- M'll , .7 C, -Ow OOdw 'risik
Rec.Vehicle Dump Station levt n Sr i i`al
Shower: -Gang Or w rM1
-Stall ,,y,, / A r'' r
•
/
Sink: -1var non-food related _A'°- 17 in. Aiors f.w�
-Bradley !N 01 !-f -Ail '2' C Wtpl Q till ' 'I/9hr glgicS,
-Com/Serv/Util food relat k,"
-Service X ote: 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:
I:\Building\Pennits(PLMF_PermitApp.doc U8/04/2011 2