Permit (13) CITY OF TIGARD PLUMBING PERMIT
IN la
COMMUNITY DEVELOPMENT
Permit#: PLM2023-00198
Date Issued: 5/31/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 3
Project Description: TI:Relocate(1)sink for mezzanine remodel.
Contractor: MAX PLUMBING SERVICE INC Owner: COSTCO WHOLESALE CORPORATION
PO BOX 230674 PROPERTY TAX DEPT 111
TIGARD,OR 97281 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 360-773-1318 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 05/26/2023 $25.02
Specifics: 1 12%State Surcharge- 05/26/2023 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 05/26/2023 $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: �� ermittee Signature:
all 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 "
City of Tigard / Received iQ Pern .2 ??- � 7 8
;II . 13125 SW Hall Blvd.,Tigard,OR 97223 ''`,• PlanDat Re: �3 u1 7 l �(,�J [
e Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.:
Inspection Line: 503.639.4175 CITY O f_T j' }� 1` Date Ready/By: / J� /uris: ® See Page 2 for
1 IGA� D 1 ,�.J y y� �-�/
Internet: www.tigard-or.gov ° I1 ( l, 4 r: NotiSed Method: 3
4' a, Supplemental Information
TYPE OF" WORK. strrite"e5f,. "1 SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CA'FEGORY OF CONSTRUCTION N
,-, SFR(1)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
ElAccessory building El Multi-familySFR(3)bath 500.32
El Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB tii t Dits MATION AND Locilitioif, '' -,'':-, ',. Site utilities:
Job site address. W Dartmouth Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:T g rd, OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Costco Tigard 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
oN i, Backwater valve 12.51
Clothes washer 25.02
Remodel of costco and mezzanine addition
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ci FRorat'i"il O J u llititth Expansion tank 12.51
Name: Fixture/sewer cap 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
.. APIuiCANT ; Interce tor/ rease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 1 25.02 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
NTRACTOR Water closet 25.02
Water heater 37.52
Business name:Max Plumbing Service Inc Water t in WV
Pip g� 56.29
Address:706 N 4th Ave Other: 25.02
City/State/ZIP:Cornelius, OR, 97113 Subtotal
Phone:( 503)980-5111 Fax:( ) Minimum permit fee: $72.50 72.50
CCB Lie.:205392 Plumbing Lic.no.:PB1583
Plan review (25%of permit fee) 18.13
��A State surcharge(12%of permit fee) 8.70
Authorized signature: rr` 4,5TOTAL PERMIT FEE 99.33
Print name:Madi Burney Date:5/22/2023 This permit application expires if a permit is not obtained.within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Unlit es oey =mem uare footage: PeOnit,PCe
Footing drain-Pt 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
Vuatlal; 'erll»it V' e;
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
other inspections A3'Fees 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*. lan Review or 11
Quottly by Fixture Type Plan review is required for any of the following.
Fixture Type for - Rephuoi Please check all that apply.
Work Performed:. Cappt4, Added *emote ❑ 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
C ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial-Domesticmer ❑ 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" Sri
3„ Lsolmet ric or
4" 0 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 _ t
-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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