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Permit ""wJV! PLUMBING PERMIT � CITY OF TIGARD COMMUNITY DEVELOPMENT Permit #: PLM201000159 Date Issued: 05/18/2010 ,,T f GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102AB03600 Jurisdiction: Tigard Site address: 12271 SW MAIN ST Subdivision: Lot: 0 Project: Rojas Market and Gifts Project Description: (A PPtb 0)7- / L fT 9' 41j1,21) 6 � di n t ^ �� �d ))�� /5 /O1iC'o ) � '1 • Owner: FEES JOHNSON FAMILY TRUST & Quantity Description Date Amount JOHNSON, REES C TRUST &, JOHNSON, MARYANNE G TRUST, 3112 SW SANTA 73 da Plumbing Permit 05/18/2010 $72.50 PHONE: 9 da 12% State Surcharge 05/18/2010 $8.70 Contractor: JOHN D PLUMBING 7472 SW FIR STREET TIGARD, OR 97223 PHONE: 503 - 620 -7600 FAX: 503- 598 -9355 Type of Use: COM Class of Work: ALT 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 Notifica '= Center. TtIc e rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct q - stions to OUNC b calling 503.246.6699 or 1.800.332.2344. Issued By: '!r Permi‘e Signature: ----""111111 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. mff PLUMBING PERMIT ' : : CITY OF TIGARD 13 : . COMMUNITY DEVELOPMENT Permit #: PLM2010 00159 fin Date Issued: 05/18/2010 ,TIGAR L7 13125 SW Hall Blvd., Tigard OR 97223 503.639 t , , '• ,,; Jy,lo-a Parcel: 2S102AB03600 Jurisdiction: Tigard Site address: 12271 SW MAIN ST Subdivision: Lot: 0 Project: Rojas Market and Gifts Project Description: Owner: FEES JOHNSON FAMILY TRUST & Quantity Description Date Amount JOHNSON, REES C TRUST &, JOHNSON, MARYANNE G TRUST, 3112 SW SANTA 73 da Plumbing Permit 05/18/2010 $72.50 PHONE: 9 da 12% State Surcharge 05/18/2010 $8.70 Contractor: JOHN D PLUMBING 7472 SW FIR STREET TIGARD, OR 97223 PHONE: 503 - 620 -7600 FAX: 503 - 598 -9355 Type of Use: COM Class of Work: ALT 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 • if work is s , - nded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility i otification Center. Th. e rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or dir •ct questions to OUNC by • -I •- . 5.3.246.6699 or 1.800.332.2344. Issu =d By: _oh Permittee Signat e: ► / / l L� ` � r 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 ppr r : . , - c 1.02, c9/ -06073 Building Fixtures 4 - = i Ou_ t,a. i Il 1-_ 1 '.I ( }\.1___\ _ pity of 'l and MAY 17 2010 nare/By: 5 (7 4O �., -(/� Permit xo.: POI a�l� O •- b0 S( I 13125 SW Hall Blvd., Tigard, OR 97223 plat, Review per permit No.: 18“ p Phone: 503.639.4171 Fax: 503.598.196CI-�/ OF I IGARD Daie/By: 18 “ 4,10 "ery, , 7 -�. , '. 1 1 Inspection Line: 503.639.4173 DateReady,�y: JUAN E� See Page 2 for Internet: www.iigatd-or.gov B UILDING DIVISIOP Notifee sh Sa p temeotallnformadan . . TYPE OF WORK FOE* SCMEDULE ❑ New construction 0 Demolition Fur special information use checklist Description 1 Qty. 1 Ea. I Total ^ ❑ Addition/alteration/replacement ❑ Other: New i- 2- family dwellings (includes 100 ik for emit' utility connection) CATEGORY ; OF CONSTRUCrIQV. SFR (I) bath 31170 Q 1- and 2- family dwelling %Commercial/industriai SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ 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: 12_2_1 1 SGo M A- 1 1.1 51 , Catch basin or area drain 18 -76 City/State/ZIP: T1 G R.t 0 �' - ' ( Z Z 3 Footing 1, ram lure, lior near trench drain Page 2 L Footing drain (no. linear n.: _) Page 2 SuitelbldgJapt. no.: l Project name: ( '183 1 , 4 f}e_REr Manufactured home utilities 50.03 _ Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sever (no. linear it.: _-) Page 2 Storm sewer (na- linear ft.: Peg?' 2 Water service (no. linear ft: _) Pag 2 Subdivision: f 1 A no.: Fixture or item: Tax map/parcel no.: L It p b 0.27600 Backflow preventer I 31 27 - ' Backwater valve 12.51 ' DESCRIPTION' OF •WORK • - P.O V Gii - (b•i AO D i lV 5 (1-. &Y W 51 t� tC clothes warner 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 . tit PROPERTY OWNER ( • 0 .TENANT 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 ': D API?LICANT r 0 CONTACT PERSON • Interceptor /grease trap 25.02 • Business name: Medical gas (value: S ) Page 2 Primer _ Contact name: Roof drain (commercial) 1251 Address: Sink/basin/lavatory / 25.02 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: 10 f� IQ 1 . -p, m i3 FtJC� Water P pi i n WV 56.29 Address: - 7 ( .1-1 5 rA.0 F I R 3- Other: 25.02 City/State/ZIP: it G R- b 1 Q e. 172.2 3 - Subtotal Phone: (5 @W- 7� ©d Fax: (5O3 SW -el 35 Minimum pemtit fee: 572.50 7 2.SD CCB Lie.: ,g. ef 53 7 Plumbing Lic. no.: -2 57f73 Plan review (25% of permit fee) --t5' State surcharge (12 %of permit fee) S.9 0 Authorized signature: / TOTAL PERMIT FEE R 1 • P Print name: _Taff► Ill � O M ( (?„ ` Date: 51 1 7 I/O ( This permi e pplk*Uaa expires if a permit 19 not obtained within 180 days ((( after it bas been accepted me complete. 'Fee methodology net by Tri- County Building l dnstry Service Board lA Validineermits\4LML4PamitAyp.doc t11/011t9 440-4616T(I0102/COM/WHB) Plumbing Permit Applicatio ��1! n A1JA V U� _ . 07c ''r � *S k ! r ,- z.. r ,-- r- D 5 ; } t i Building Fixtures ,,x ' � ' .� ��1 .''�.� 2" City of Tigard MAY 2 5 2010 Received Permit No.: • "OM •o - /S V 13125 SW Hall Blvd. Tigard, OR 97223 y: Date C Phone: 503.639.4171 Fax: so3a98• F TIGARD Plan y iew Other Permit No.: Inspection Line: 503.639.4175 ` " ° Plan R D ace Read /B Iuris: ®S Page 2 for T16 AIM Y Y B Internet: www.tigard- or.gov BUILDIN DIVISION Notified/Me _ Supplemental Information TYPE OF WORK - : - FEE* .SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) . CATEGORY OF CONSTRUCTION : SFR (1) bath 312.70 ❑ 1- 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: Fire sprinkler ( sq. ft.) Page 2 • JOB ,SITE .INFORMATION AND LOCATION Site utilities: Job site address: Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: I Project name: 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 11.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DE CRIPTION OF WORK • Backwater valve 12.51 /i ` / �� , \ N Clothes washer 25.02 T � ( � J \ r-F v 1 1d�1 ' Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT . 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 ❑ APPLICANT . ❑ CONTACT PERSON ' •• Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 1 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower/shower pan 12.51 E -mail: Urinal 25.02 ' CONTRACTOR Water closet 25.02 • Water heater 37.52 Business name: Water P�P� � I in WV 56.29 Address: Other: 25.02 City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 Plan review (25% of permit fee) CCB Lic.: Plumbing Lic. no.: State surcharge (12% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: 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. 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 Utilities • Qty. Fee(ea) Total :Square'Footage: Permit Fee: Footing drain - 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 - 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 Other Inspections or Fees Qty. 'Fee (ea) , Total each additional $100.00 or fraction thereof, to p 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 ", Plan Review for Plumbing Installations . please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees*. Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure -Tub/Shower as defined in OAR918- 780 -0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive tall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash • ' Isometric or.Riser.'.Diagram Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. - 4" Car Wash Drain Garbage - Domestic Disposal - Commercial - Industrial Comments regarding fixture work: Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial *Note: If the fixture work under this permit results in an - Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: I:\Building \Permits \PLMF - PermitApp.doc 2 Accumulative Sewer Tally Parcel # 2S102AB03600 Tenant Name: Rojas Market & Gifts This SWR# Site Address: 12271 SW Main St This PLM# 2010 - 00159 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 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 I?ye 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 1 -IP) 16 0 0 0 0 0 - Commercial (to 5 1 -IP) 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 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 - Bar /Lavatory 2 0 0 0 0 0 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 1 3 1 3 - 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 lixtractor 6 0 0 0 0 0 Water Closet - Toilet 6 0 1 6 0 -1 -6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 '1'O'1'ALS 0 0 1 6 1 3 0 -3 Current Fixture Value -3 divided by 16 = -0.2 Current EDU 1 EDU = $ 3,600 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -3 divided by 16 = -0.2 over (under) $ (720.00) Enter EDU Change Here -0.2 Notes: Authorized Name /Signature: Debbie Adamski Date: 5/18/2010 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: \ Buil ding \Sewer Tally \SewerTallyShect- 3600.xls 06 /25/08 Accumulative Sewer Tally Parcel # 2S102AB03600 Tenant Name:' Rojas Market & Gifts ** *REVISED ** 'Phis SWR# Site Address: 12271 SW Main St This PLM# 2010 - 00159 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 Baptistry /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 1- ;ye Wash 1 0 0 0 0 0 Floor Drain /Sink - 2 inch 2 0 0 0 0 0 - 3inch 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 1 -IP) 32 0 0 0 0 0 - Industrial (over 5 LIP) 42 0 0 0 0 0 Ice Machine /Refrigerator Dram 1 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 - Bar /Lavatory 2 0 0 0 0 0 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 1 3 1 3 - Service 3 0 0 •' 1' 3 1 3 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 1 6 0 -1 -6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 _ 1 6 2 6 _ 1 0 Current Fixture Value 0 divided by 16 = 0.0 Current EDU 1 EDU = S 3,600 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 0 divided by 16 = 0.0 over (under) S - Enter EDU Change Here 0 Notes: * *REVISED ** 5/25/10, adding additional hand sink, applied last of the demo credits. Authorized Name /Signature: Debbie Adamski Date: 5/18/2010 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 \Scwcr'l'allyShcet- 3600.xls 06/25/08