Permit (3) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00216
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/9/2022
Parcel: 2S115BA00100
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY M
Project: Trader Joe's Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Adding(1)dishwasher, (1)drinking fountain,(3)2"floor drains,(2)3"floor sinks,(5)
sinks,and(1)water closet;Relocating(2)sinks and(2)water closets; Installing(1)backflow preventer,(1)
expansion tank,(4)hose bibs, (1)grease trap,(1)primer,(1)water heater,and(1)vacuum system.
Contractor: PSR WEST COAST BUILDERS Owner: TECOLOTE RESOURCES INC
3458 MT DIABLO BLVD KELLY'S LEGACY LLC ET AL
LAFAYETTE, CA 94549 BY HESLIN HOLDINGS INC
23421 SOUTH POINTE DR STE 270
LAGUNA HILLS, CA 92653
PHONE: 925-299-0518 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/09/2022 $31.27
Specifics: 1 ea Dishwasher 08/09/2022 $25.02
1 ea Drinking Fountain 08/09/2022 $25.02
Type of Use: COM 1 ea Expansion Tank 08/09/2022 $12.51
Class of Work: ALT 5 ea Floor Drain/Floor Sink/Hub 08/09/2022 $125.10
Type of Const: 4 ea Hose Bib 08/09/2022 $100.08
Occupancy Grp: 1 ea Interceptor/Grease Trap 08/09/2022 $25.02
Stories: 1 ea Primer 08/09/2022 $12.51
9 ea Sink 08/09/2022 $225.18
3 ea Water Closet 08/09/2022 $75.06
1 ea Water Heater 08/09/2022 $37.52
25 Misc Other Fee 08/09/2022 $25.02
1 Plan Review 08/09/2022 $179.83
1 12%State Surcharge- 08/09/2022 $86.32
Plumbing
Total $985.46
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: Permittee Signature: CR, ,
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 Applicattoy-' t''"{
Building Fixtures JUN 9 7022
Ci of Tigard CITY TIGARD Reccrvcd Permit No
a 13125 SW Hall Blvd.,Tigard,OR 7�s1 l 1 � 1113a �' Plan R : T�
S ING DIVISION Plan Review
ft Phone: 503.718.2439 Fax: 503. M4pJ i V ll 1 ��l i i;f �(� : -7 Other Perms No.:
Inspection Line: 503.639.4175 -Date/By:
Date ReadyBy: brig 0 Same 2 Inc
Internet: www.tigard-or.gov Notifrcd/Method: SupplemewhilInformation
TYPE OF WORKFEE• SCHEDULE
❑New construction ❑Demolition iin For special orm e!rrse checklist
'Description I Qty. I Ea. Total
10 Addition/alteration/replacement ❑Other: New I-2-famUy dwell) (includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ®Commercialtindustrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional badA Itchen 25.02
❑Master builder ❑Other. Fire sprinkler(_sq.ft.) Page 2
jos SITE wFORMATION AND LOCATION Site utilities:
Job site address:16200 SW Pacific HighmLay
Catch basin or area drain 18.76
City/State/ZIP:
Drywell,leach line,or trench drain 18.76
T r
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:Trader Joe's Manufactured home utilities 50.03
Cross stmet/directions to job site: Pacific Highway Durham Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear R.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear It.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.:2S115BAOOI 00 Backflow prcvcntcr 31.27
DESCRIPTION OF WORK A
Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
nam Drinking fountain 25.02
Ejectors/sump 25.02
,29 PROPERTY OWNER ❑ TENANT Expansion tank 1 12.51 12.51
Fixturctsewer cap 25.02
xame:Heslin Holdings, Inc. floordraiNFlowsinklhub 1 25.02 25.02
Address:23421 South Pointe Dr Suite 270
Garbage disposal 25.02
eity/state/zIP:Laguna Hills, CA 92653 Hose bib 4 25.02 100.08
Phone:(949)297-4460 _ Fax:(949)297-4460 Ice maker 12.51
0 APPLICANT -- --- C CONTACT PERSON Interceptor/grease trap 1 25.02 25.02
s Business-ineSchmidt Architects, PC Medilal gas(value:S_> Page 2
contact name:Frank Schmidt Roof
12.51 12.51
fd 1
Roof drain(commercial) 12.51
Address:16101 SW 72nd Ave. Suite 135 Sink/basin/lavatory 4 25.02 100.08
cityistaterzip:Portland, OR 97224 Solar units(potable water) 62.54
Phone:(503)220-8517 1 Fax::( ) Tub/shower/shower pan 12.51
E-mail.frank schmidtarchitects c.com Urinal 25.02
6) water
Water closet 3 25.02 25.02
Water heater 1 37.52 37.52
Business name:PSR West Coast Builders, Inc. Waterpiping(DWV 1 56.29 56.29
Address:3458 Mt Diablo Blvd. Other: 25.02
city/state/zip:Lafa este, CA 92868 subtotal
Phone:(925)876-3461 Fax:( ) Minimum permit fee: $72.50 384.05
CCB Lic.: 197278 Pltunbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit Ice)
Authorized signature: TOTAL PERMIT FEE
Print name: Date: This permit application expires No permit le not obtained within Igo days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
I RuddioSPcnnasPLMU-Pan%tAppdw 1o:0109 4404616T(IO-Ob'COMWEB)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppcession S stems:
fir. Fee(ea)= {Tali 5 ware F o�ta Peiririoit Peep
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 Cas S stems'
Water Service-each additional 100' 37.52 ,;
Storrs&Rain Drain-Ist 100' 62.54 ,P > > it' 'ee
$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
n- ,r each additional$100.00 or fraction thereof,to
O& Ifuis ectlols „ol Vees ' °Qn, ;KF�w( ►1, foal
and includinz$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-112 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 S50,000.00.
Additional plan review for revisions 90.001hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge- 112 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 foe,Phillabing,Installations
uanti by FirturrType I Plan review is required for any of the following.
Flttture Type for Replace/ Please check all that apply.
Work Performed: capped Added Relocate
Ba list 'Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: TublShowcr
-Jacuzzi'Whirlpool engineer.
Stall ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each S
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water idor/Water As irator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial [I Any multipurpose fire sprinkler system.
Domestic ❑ 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" F
3•' p s• hometnc'�or:Riser"Na ram'
-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/Refri .Drains Comm nts regarding fixture work: 1
Oil Separator(Gas Station) ('f /ks/) t�1..1C e"'A /'1 cem ,C-t
Rec.Vehicle Dump Station T 11
Shower: -Gang Garr• o i/a t:�obG
-Stall
Sink: -Lav/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
Water Extractor 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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Plumbing_ Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) TotAl Foots t' flit Fie-
Square
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-1 st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1 st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52
Valuation " t'
Storm&Rain Drain-]st 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
Qty. Fee`(ea). �Uta1 each additional$100.00 or fraction thereof,to
Otlfrf= IQ . . 1OI1LS UI' 5'' 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 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.�Qj<`Plu`i bin 4nstillations�i
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.
Stall El exterior plumbing site utilities for any complex structure
Car Wash: -Each S
Drive tallThras defined in 0AR918-780-0040.
ElCus
Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic ❑ 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 Rlser biA `ram
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./Refri .Drains Comments regarding fixture work:
Oil Separator(Gas Station
Rec.Vehicle DuTp Station
Shower: -Gang
-Stall
Sink: -Lav/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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