Permit CITY OF TIGARD
PLUMBING PERMIT
t i; COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00543
T1G'A 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2007
PARCEL: 1S136DB-00201
SITE ADDRESS: 11565 SW PACIFIC HWY ZONING: C - G
SUBDIVISION: FRED MEYER LOT: JURISDICTION: TIG
PROJECT: FRED MEYER
Project Description: Installation of (1) breakroom sink and (1) sump pump.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
FRED MEYER
3800 SE 22ND AVENUE Description Date Amount
PORTLAND, OR 97202 [PLUMB] Permit Fee 12/10/2007 $72.50
[TAX] 8% State Surcha 12/10/2007 $5.80
Phone : Total $78.30
Contractor:
PORTLAND MECHANICAL CONTRACTOR
2000 SE HANNA HARVESTER DR
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 656 -7400
FAX 503- 655 -0620
Reg #:. LIC 151807
PLM 3 -425PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue B l S Permittee Signature: I �
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 FOR OFFICE USE ONLY
City of Tigard Received L Nn M �yS�
y g Date/By: if- �
/t) G Permit No.: / / 7 3
p 13125 SW Hall Blvd., Tigard, OR 97223
Plan Rev
2 ; Phone: 503.639.4171 Fax: 503.598.1960 D ate Bya Other Permit No b 7-�" Q
T I G A RD Inspection Line: 503.639.4175 Date Ready/By: ri: ^ ® See Page 2 for v
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. I Total
® Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ® Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath /kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11565 SW Pacific Hwy Catch basin or area drain 16.60
City/State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Fred Meyer Tigard Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: SW 72 Avenue
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
/ 31�- Fixture or item
Tax map /parcel no.: - ( �� (> r
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Breakroom sink. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump a 16.60 n,Q, (g)
Name: Fred Meyer
Expansion tank 16.60
Address: 3800 SE 22 Avenue Fixture /sewer cap 16.60
City/State /ZIP: Portland, OR 97202 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
® APPLICANT ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Portland Mechanical Contractors, Inc. Interceptor /grease trap 16.60
Contact name: Kevin Miller Medical gas (value: $ ) Page 2
Address: 2000 SE Hanna Harvester Drive Primer 16.60
City/State /ZIP: Milwaukie, OR 97222 Roof drain (commercial) 16.60
Phone: (503) 656 -7400 Fax: : (503) 655 -0620 Sink/basin/lavatory 1 16.60 16.60
Tub /shower /shower pan 16.60
E -mail: kevinm @portlandmechanical.com Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Same as above. Water heater 16.60
Address: Other:
City/State /ZIP: Subtotal 33 t as
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 I Z t `
CCB Lic.: 151807 Plumbing Lic. no.: 3- 425 -PB Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature:
TOTAL PERMIT FEE is, 38
Print name: Kevi • iller Date: 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.
1:\ Building \ Permits \PLM- PermitApp.doc 06/26/06 440- 46t6T(10/02 /COM/WEB)
Accumulative Sewer Tally Parcel # 1S136DB -00201
Tenant Name: F`rcd Meyer This SWR# 2007 - 00298
Sire Address: 11565 SW Pacific I -Iwy This PLM# 2007 - 00543
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptiscry /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
IIVc Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 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 1 -IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Scp (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 - Bar /lavatory 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 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
TOL A!.S _ 0 0 0 0 1 _ 2 1 2
Current Fixture Value 2 divided by 16 = 0.1 Current EDU 1 EDU = S 2,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 2 divided by 16 = 0.1 over (under) S 280.00
Enter EDU Change Here 0.1
Notes:
c
Authorized Name /Signature: Debbie Adamski /��t� Date: 12/10/2007
Bu
il ing Division
Note: The property owner shall retain the ORIGIN:U. 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:A Building \ Forms \Scwcr'1'allyShcet.xls 112/02/07
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -0U& 3
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12110/7007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 "i t. '
INSPECTION WORKSHEET FOR DATE: 12/14!2007 TIME: 7:01AM PAGE: 33 .
SITE ADDRESS: 1155 ° PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FRED F) IV YEP LOT #: TYPE OF USE:
PROJECT NAME: FRED MEYER
DESCRIPTION: Installation of (1) br €:,zkroorn sink and (1) sump pump.
OWNER: FRED MEYER, PHONE #:
CONTRACTOR: PORTLAND MECHANICAL CONTRACTOR PHONE #: 503-6.56-7400
Inspection Request Scheduled For: Date: 12/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 061549 -01 503-969-5423 Y
Corrections /Comments/ Instructions:
C a r e ' - ‘e-QA cr L.J
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: d - b m , - 1 . . 4 . , Date: I ZJ'/ 4 1107 Phone #: (503) 718-