Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
■ Permit#: PLM2022-00455
Date Issued: 12/6/2022
T t G A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15989 SW 72ND AVE
Project: Momo Sushi Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Interior plumbing for new restaurant:Adding(2)dishwashers, (5)2"floor drains/sinks,(3)3"floor drains/sinks,
and(7)sinks; Installing(1)ice maker, (1)grease trap,and(3)primers.
Contractor: COLUMBIA MECHANICAL INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 2164 ATTN: N PIVEN
WOODLAND, WA 98674 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE:
PHONE: 360-225-1600
FAX: 360-225-8755
FEES
Quantity Description Date Amount
2 ea Dishwasher 12/06/2022 $50.04
Specifics: 8 ea Floor Drain/Floor Sink/Hub 12/06/2022 $200.16
1 ea Ice Maker 12/06/2022 $12.51
Type of Use: COM 1 ea Interceptor/Grease Trap 12/06/2022 $25.02
Class of Work: ALT 3 ea Primer 12/06/2022 $37.53
Type of Const: 7 ea Sink 12/06/2022 $175.14
Occupancy Grp: 1 Plan Review 12/06/2022 $125.10
Stories: 1 12%State Surcharge- 12/06/2022 $60.05
Plumbing
Total $685.55
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 therules
Issued By: .1 N I / I� �1 Permittee Signature: [ 71/.�//
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
Building Fixtures i tilt Ui i it i i ,,i 0011
City of Tigard Received my: I i/ty _ Permit No.: lei,,,. 6.4_ `{"►L./T -•--
■. 13125 SW Hall.Blvd.,Tigard,OR 97223 Pia Review r �_u f"`�T! V t'
I t Phone: 503.718.2439 Fax: 503.598.1960r r_ L /k1p Other Permit No.:6���6) t ],ems..
DatcBy I�"' -Zd L !Jr' ? l/-J I
t,I,«A J) Inspection Line: 503.6391175 Due Ready/By: ./jht�rn.�� ® See Pege 2 fur
," Internet: www.trgard-or_goy Votiti,d/iicth od_ _. J/ " Supplemental tuforr..auon �•-
TYPE OF WORK .... EC SCHEDULE
❑New construction 0 Demolition Fur special irifor aation use checklist.
•
Description I Qty. I Ea. I Total
tg Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ff.for each utility connection)
+Rr " '; i SFR(I)bath 31
" 2 70
� r:.: r t� s"ITEC.ORY OF �� I �, r> ?
❑1-and 2-family dwelling g[Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
❑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: i Sci g' i/'i 7 r-..'-4 D k til E.` Catch basin or area drain 18.76
a Drywall,leach line,or trench drain 18.76
City/State/ZIP: ` a(use A 4 , 0 i Footing drain(no.linear ft.: ) Page 2
',. Snite/bldgiapt.no.: I Project name: % ldt® j u 5ot Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:._, J Page 2
Storm sewer(no.linear It: .. ) Page 2.
Water service(no,linear ft. _ Page2
Subdivision Lot no.: Picture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve. 12.51
DESCRIPTION OF WORK
�y
Rev p ,. Clothes washer 25.02
Re 14-1c E I SIT Je I LAP . /'r 4 Dishwasher 25.02
/' /9iertl/210-t-.+J dr 6 f 5`� ,4r/v' fig _ Drinking fountain 25.02
F-- /rlz W /2�.4 �/` Ejectors/sump 25.02
_>r
0 PROPERTY OWNER - I 0 TENANT Expansion tank 12.51
Name: Fixttue/sewercap 25.02
Floor drain/floor sink/hub - . 25.02 -, ($
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) ice maker 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap I 25.02 Z r•o2._
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12-51
Address: Sink/basin/lavatory 7 25.02 / 75 /f
r
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax:( ) Tub/showerfshower pan 12.51
A Urinal 2502
E-mail: ita•1, 1 X iv, 1Z` O M
,r Water closet 25.02
dONTRACTOR �a " Water heater 37.52
Business name: C.01,Utt-i[3•SA M€CkLA+JTCA.0 S-/ve-.. Waterpiping/DWV 56.29
Address: O .Q , ft o x a,t 6`( Other. 25.02
CityfState/Z1P: Opp Lra i INA- !d 6/ /'I Subtotal tf --:3, 1
Phone:(360 5p+•-c2_448 Fax:( ) Minimum permit fee: $72.50
u�e Plan review(25%of permit fee) f(f6.
CCB Lic.: "l/j �_ Plumbing Lic.no.: 37�j 'PE
/,� // State surcharge(12%of permit fee) j/. Olt
Authorized signature l.- !r J1 TOTAL PERMIT FEE i-r).., r!'
Print name:1,6r'dl,s I E. .�- l I J Date: `/0 S"]-7 72•• w This pentad application expires if a permit is not obtained him 180 days
after it has been accepted as complete.
*Fee methodology set by Tri•Couoty Building Industry Service Board.
I:1Building\Parmits1PLMIJ-Pemu)App.doe Itl 1/09 440-46I6T(IOA2/CO 4N/EB) /2 •3 1
0J 6-ocA.. ,levc,.-c4.1.c (crr tt1 „w l,'r.GJ
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: yr Re)sidenttiial(Fire Su. rression yS stems:
., t- ` `"a g ". *3 t'� 'P:E.=tb`.: a3�!S.n"sfs; Cft iY=1lill.'. 't"}'Ia.'1-4 11t'45i . i . , r ._r.''`
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 - -1-1-felliti • <
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
each additional$100.00 or fraction thereof,to
. > .., it:.lF' .., i. 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 90.0041r $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* 41= J Fitaii0.1,,a`f_A I f 1D11{ !1,4 } k .
N-Va`atitytb'yF lifi nifi *' Plan review is required for any of the following.
Fixture 0eibt -. �r � �" 11 riigt„!` Please check all that apply.
wor'kPerfdrrded .; Cap ed .IA eAd r:-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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher -Commercial 1 ❑ Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR91 g-780-0040.
Drinking Fountain
_ye Wash C Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" J ..
3,. .j�F bsx �r8 �;1 a.a i . s.
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 q
-Bradley
-Com/Serv/Util food related 3
-Service *Note: lithe 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\Permits\PLMF_PermitApp.doc 08/04/2011 2
Plumbing Permit Application
A
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
Ilq
• 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: (� ���a' -�,S S
Phone: 503.718.2439 Fax: 503.598.1960 Dan Review �5 ) Q�
Date/By: 1�- -2o Z Omer Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: June ® See Page 2 for
Internet: www.tigard-or.gov Noti lied/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction El Demolition For special information use checklist.
Description I Qty. I Ea. I Total
1.4 Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
building • SFR(3)bath 500.32
❑Accessory ❑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: i5/89 std. 92w4au, Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: i IsJ Qr�t CR, Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: G m C SUS 14 r 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
.i.L'lCri Utr Pk,. 6 i 1 Dishwasher 2, 25.02 s-6 OLf
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: q ‘I,Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 8 25.02 . 1O �
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker j 12.51 ia,
5
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap j 25.02 gsAI,
Business name: Medical gas(value:$ ) Page 2
Primer 3 12.51 31,53
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatoty 17 25.02 I;75 Ai
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
. - Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water pp PP t m DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal san.ya
Fax: Minimum permit fee: $72.50
Phone:( ) ( )
Plan review (25%of permit fee) OS,10 •
CCB Lie.: Plumbing Lic.no.:
State surcharge(12%of permit fee) 130,Q
Authorized signature: TOTAL PERMIT FEE 6$5,5!r
This permit application expires if a permit is not obtained within 180 days
Print name: Date: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I9Bui[ding\Permits\PLMU-PemdtApp.doc 10/01/09 440-4616T(I 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard c •
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-i 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
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 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 Thm
Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
Domestic El 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" ,BrN
3" '3 Isometric or Riser Diagram
❑ 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 +- �JraWtt3�`
Ice Mach./Refrig.Drains Comments regarding fixture work: Ln
Oil Separator(Gas Station) One 3't tboa Si nit fov- 4.71u- Otte_ atriasa Str4k
Rec.Vehicle Dump Station .fipr Fnc $init, one. ^p r S ffot- ev.4
Shower: -Gang 3-Lo0,113,it k nhR a"F/eeur Sink for slkss f..a.sker
-Stall Y
Sink: -lav/Bar non-food related ()tut )" Ft'-' $i hlC.f""- Zc - Qih
-Bradley
-Com/Serv/Util food related ;2f)1
-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:
i:\Building\Pennits\PLMF_PetmitApp.doc 08/04/2011 2