Permit _ f
CITY OF TIGARD PLUMBING PERMIT
. COMMUNITY DEVELOPMENT Permit #: PLM2009 -00268
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/29/2009
Parcel: 1 S 136AD06503
Jurisdiction: TIGARD
Site address: 10900 SW 68TH PKWY
Subdivision: WAY LEE Lot: 2
Project: Changs Mongolian Grill
Project Description: Install up to 100' new water service, cap (5) 2" floor drains, add (2) new 2" floor drains, relocate
ice maker, replace grease trap, primer (1) service sink and add (2) new service sinks.
Owner: FEES
WAY W LEE GENERAL CONTRACTOR Quantity Description Date Amount
5210 SE 26TH AVE
PORTLAND, OR 97202 100 If Water Service 09/29/2009 $55.00
PHONE: 5 ea Fixture /Sewer Cap 09/29/2009 $83.00
2 ea Floor Drain/Floor Sink/Hub 09/29/2009 $33.20
1 ea Ice Maker 09/29/2009 $16.60
Contractor: 1 ea Interceptor /Grease Trap 09/29/2009 $16.60
PUREFLOW PLUMBING LLC 1 ea Primer 09/29/2009 $16.60
16869 SW 65TH AVE #351 3 ea Sink 09/29/2009 $49.80
LAKE OSWEGO, OR 97035 1 12% State Surcharge - 09/29/2009 $32.50
PHONE: 971 - 219 -9313 Plumbing
FAX: NA
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $303.30
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 arted within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the les adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You pa obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: I, J Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business • ay.
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.
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City Of Tigard Received (.(.
II
n 13125 SW Hall Blvd., Tigard, OR 97223 Date/By. tJ Q PermitNo.: PLrn zoo4. OO
Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 SEP Other Permit No.:
Inspection Line: 503.639.4175 J E P 2009 •
- t - �'�; A K t3 Date Ready/By: finis: 65 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: ¶f C- Supplemental Information
TYPE OF WOR� CITY OF TIGARD
'BUILDING DIVISION 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)
s ` CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling I�Commercial /industrial SFR (2) bath 350.00
El Accessory building ( Multi- family SFR (3) bath 399.00
12 Master builder Each additional bath/kitchen 45.00
❑ O ther: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: Q // �� -
�Q ! Q 0 540 � (p / Catch basin or area drain 16.60
City/State /ZIP: Drywell, leach line, or trench drain 16.60
I j / �1e S /C `„ Footing drain (no. linear ft.: Page 2
Suite/bldg./apt. no.: Project name: (..rT. , lTU g
Cross street/directions to job site: Manufactured home utilities 110.00
fL L Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) y � Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Egz oo_ €�1n/(J/? P E Backwater valve 16.60
W • M L' Al Clothes washer 16.60
� J�j ,Q l Dishwasher 16.60 •
12 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap tea" 16.60
City/State /ZIP: Floor drain/floor sink/hub 2, 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON
Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 1, 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 1 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( )
Sink/basin/lavatory '3 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Pgg51.663 PLUM .'r * - . , LLe-- Water heater 16.60
Address: 14,901 ( fig J I Other:
City/State /ZIP: L AKE (5,515:40 Q� Subtotal
Q Minimum permit fee: $72.50
Phone: (q9 ) 7 n . 13 15 Fax: ( 503 ) 215° 3 Residential backflow minimum permit fee: $36.25
Plan review (25% of permit fee)
CCB Lic.: ��'� Plumbing Lic. no.: 3� 54�
Authorized signature s 1 �` State surcharge (12% of permit fee)
• � -� TOTAL PERMIT FEE ,&C)' .
Print name: - r-ii, A A &Le4 t Date:' • i i j ° 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.
Pl�aln�a Pelrltnitt Applicattno i - City of Tigard
Page 2 - Supplei» ental Information
Fee Schedule: Subtotal:
Site Utilities Qty. Fee (ea) Total - I
Footing drain - 1" 100' 55.00
1RpeitlnntisJ 1I?irtA @nppraccinn cyetslrnc•
Footing drain - each additional 100' 46.40 Square Footage: Permit Fee:
Sewer - 1st 100' 55.00 0 to 2,000 $115.00
2,001 to 3,600 $160.00
Sewer - each additional 100' 46.40 3,601 to 7,200 $220.00
7,201 and greater $309.00
Water Service - 1st 100' 55.00
Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Storm & Rain Drain - each additional 100' 46.40 additional $100.00 or fraction thereof, to and
including $10,000.00.
Fixture or Item Qty. Fee (ea) Total $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
each additional $100.00 or fraction thereof, to
Commercial Back Flow Prevention Device 46.40 and including $25,000.00.
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $50,000.00.
Rain Drain, single family dwelling 65.25 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Inspection of existing plumbing or
specially requested inspections - per hour 72.50
Urinal 1
Other Fixtures: I
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) Work Performed Plan review is required for any of the following.
Fixture Type: Replace Please check all that apply.
Previous Capped Added Existing ❑ 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
-Drive Thru as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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" 5 $2,
3" Isometric or Riser Diagram
4 " ❑ Isometric or riser diagram is required for new buildings
Car Wash Dram
Garbage Domestic that meet the qualifications above.
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
00 Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station •
Shower -Gang •
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet - Toilet