Permit (18) CITY OF TIGARD PLUMBING PERMIT
l a COMMUNITY DEVELOPMENT Permit#: PLM2023-00372
Tf GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/6/2023
Parcel: 1 S136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Winco Foods Subdivision: 1995-013 PARTITION PLAT
Lot: 2
Project Description: Interior plumbing for new case layout:Adding (3)2"floor sinks and replacing(3)2"floor sinks.
Contractor: WILLIAMS MECHANICAL INC Owner: WINCO FOOD LLC
3903 SMITH AVE ATTN:TAX DEPARTMENT
EVERETT, WA 98201 PO BOX 5756
BOISE, ID 83705
PHONE: 425-303-0828 PHONE:
FAX: 425-339-9244
FEES
Quantity Description Date Amount
6 ea Floor Drain/Floor Sink/Hub 08/22/2023 $150.12
Specifics: 1 12%State Surcharge- 08/22/2023 $18.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $168.13
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: c%�S? 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.
Plumbing Permit Anplicat CEIVED / ,i All ► • ► �rl 1/
Building Fixtures I:()R III.I II I• I Sl „\l.\
Cityof Tigard AUG 2 1 2023 Received ///��I///fff 1
g Dateiit \ i 1,i(J\ •A 1 Permit Na.:11 I i+sv1.
13125 SW Hall Blvd.,Tigard,OR 97� Plan ` rt V
• ' Phone: 503.718.2439 Fax: 503.59► ke OF TIGARD Plan Review ' Other Permit No.: u 1/ a LOU
Inspection Line. 503.639.4175 BUILDING DIVISION f l
1 Ir,.1 I.1) Internet. www tigard-or gov Daleied/Metiy. Jena ® See ent l rOT
Inf
\uli tied/\9eihod Supplemental Information
TYPE OF WORK FEE' SCHEDULE
❑ New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea 1 Total
®Addition/alteration/replacement ❑Other: New I-2-Gtuily dwellings(includes 100 Il.tor each utilittcotulcction)
CATEGORY OF CONSTRIJCCION SFR(I)bath 312.70
III1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437,78
SFR(3)bath 500 32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: lire aprinkkr(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:7501 SW Darthmouth St. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard, OR 97223
Footing drain(no.linear It:_) Page 2
Suite/bldg./apt.no.: \ I Project name:WinCo Foods#23 Tigard Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear fl.: ) Page 2
Storm sewer(no.linear R: ) Page 2
Water service(no.linear ft:___) Page 2
Subdivision: I Lot no.: Fixturc or item:
Tax map/parcel no.:1 S136DC04500 Back flow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Install floor sinks to accomodate new case layout. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:W nco Foods LLC Fixture/sewer cap 25.02
_---- Floor drain/floor sink/hub 6 25.02
Address:p0 Box 5756
Garbage disposal 25.02
City/State/7IP:Boise, ID 83705 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
la APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Williams Mechanical, Inc. Medical gas(value:$_) Page 2
Contact name:Charlie Dean �i" 2s1
Roof drain(commercial) 12.51
Address:3903 Smith Ave Sink basin/lavatory 25 02
City/State/ZIP:Everett, WA 98201 Solar units(potable water) 62.54
Phone:(425 )303-0828 Fax::(425)339-9244 Tub/shower/shower pan 12.51
e-mail:info@williams-mechanical.com Urinal 25 02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Williams Mechanical, Inc. Water piping/DWV 56•29
Address:3903 Smith Ave Other: 25.02
City/State/ZIP:Everett, WA 98201 Subtotal
Phone:(425 )303-0828 I Fax:(425 )339-9244 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.:126975 Plumbing Lie.no.:37-424PB
i State surcharge(12%of permit fee)
Authorized signature: I►�7 i/f.� TOTAL PERMIT FEE 1b ct p•ys
Print name:Justin Williams Date:08/21/2023 This permit application expires ifa permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology rseett by Tri-County Building Industry Service Board.
I Vluilding'Permils1PLMU-PerimtApp doe IOl01N9 440-9616 rti WWO2/COMliF11) a 3$ E 1"U \1 1(Xi) 11\'r/
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(a) 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 $32754
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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Feesand including$10,000.00.
Inspection of existing plumbing or for S 10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$134 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$25,000.00 and$IA5 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:
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 review is required for any of the following.
Fixture Type for Report/ Please check all that apply.
Work Performed: Capped Added Relocate
0 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
Cuspidor/Water Aspirator Any
El Medical gas and vacuum systems for health care facilities.
❑ Any multipurpose fire sprinkler system.
Dishwasher.
-Domestic El Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eve Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" 3 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
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station) ,
Rec.Vehicle Dump 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
Swimmine 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:
l:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
` Accumulative Sewer Tally
Tenant Name: WINCO SWE# 2023-00259
I i G n h n Site Address: 7501 SW DARTMOUTH ST SUITE 100 PLM# 2023-00372
Parcel#: 1 S 136DC04500
Fixture Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 3 6 3 6
-3 inch 5 0 0 0 0 0
-4inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-industrial(over 5 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 0
0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 3 6 3 6
Current Fixture Value 6 divided by 16= 0.375 Current EDU 1 EDU= $6,824.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 6 divided by 16= 0.375 over (under) $ 2,593.12
Enter EDU Change Here 0.380 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: ANNA PINA EX 2452 Date: 8/21/2023
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\SewerTallySheet_6625_070122.xlsx