Permit ,, CITY OF TIGARD PLUMBING PERMIT
'` '- 2: COMMUNITY DEVELOPMENT Permit #: PLM2009-00073
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/08/2009
Parcel: 1S136DC04500
Jurisdiction:
Site address: 7501 SW DARTMOUTH ST 100
Subdivision: Lot: 0
Project: WINCO
Project Description: Bakery Department - TI - Install .
Owner: FEES
WINCO FOOD, LLC Quantity Description Date Amount
ATTN: SUSAN BUSCHE, PO BOX 5756 1 ea Drywell, Leach Line or 04/08/2009 $16.60
BOISE, ID 83705 Trench Drain
PHONE: 1 ea Primer 04/08/2009 $16.60
1 ea Sink 04/08/2009 $16.60
Contractor: 2 ea Floor Drain /Floor Sink/Hub 04/08/2009 $33.20
II S MECHANICAL INC 1 12% State Surcharge - 04/08/2009 $9.96
520 WILLAMETTE AVE Plumbing
STAYTON, OR 97383
PHONE: 503 - 769 -3738
FAX: 503- 769 -4374
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Stories:
Total $92.96
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Issued By: \ '0 t ( Q (031`. Qn A Permittee Signature: , ; ':l •� i li
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
_. - - , A r, .. 2. 2009 l icat No. 4733 P. 2
up E V
Building Fixtures FOR OFFICE USE ONLY - '
- 2 2009 Received
City of Tigard APR oateB i- 2 09 V,I per*1+i1 No.: PL t'!'1 - ` i5
13125 SW Hall Blvd., Tigard, O 97
.: F OF TI GARD �±�,.�
Phone: 503.639.4171 Fax: 503.5 Plan Review c
Daid$y: Other Permit No.:' 700 I --COO J3
Inspection Line: 503.639.4175 BUILDING DIVISION
Internet www.ti ard -or. ov } Nou Ready/By: /M tho S See Pen Z Information
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❑ New construction ❑ Demolition For special informalian use checklist
Addition /alteration/replacemcnt 0 Other: am dwellings (includes
...... , , r e �...:,_ ti ; .c�W' ° �-: �, x t'1 r r � r r uS °i: � y !'+ ( s 100 ft. for each utility connection)
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Description Es, To _
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`� �� 1 it d � ins in c ec�
s�, Y)�_ 'i tlt4p'' i � E1;3 . SI . to - e. , i y, Yta I' (F = (��: SF I) bath 24 20
9 !f ! 1 ,zrca.- -:n =:= i. P'! e9PrV' rr! 10iiis_:5::2E�': 11441 P11tdRifi ( 9�
❑ 1- and 2 - family dwelling ,Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
�] Other:
y „ � a , ,,.,:.� E Firc sprinkler ( _ sq. ft.) Pag 2
r * 1r..=.T )k ;. ,t f ; ( a i : ¢ lu' P 4tr ', . i1 1 Q- i 1 N 41, ! irk' Site utilities
Job site address; 1 S� n )ar ou,kL Si-. Cat ch basin or area drain 16.60
City /Strz ZIP: , ,-- t. cAra Gp Q17 ,,7.3 Drywell, leach line, or trench drain % 16.60 M G
Footing drain (no. linear ft.:
/apt, no.: ; Project name: �i , s ) Page 2
C
Manufactured home utilities 110 00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no, linear ft.: ) Page 2
Subdivision: J Lot no.: Water service (no. linear ft.: _ ) Page 2
Tax map/parcel n Ilk Fixture or item .
map /rl o..
Tax gt cra .. pa r c e € p,: , ..ms .. t :,«:: a � Absorption valve . 16.60
, r
_�'k! :.-'- +irv r - -z. .l ,: 1 7. �,
.; � •,:' • :1+!lr:Pc_::::r -! _.' '1
al, _:::::_ " cle_ ` , •a ... =_ =ir• w _� :: :: { °t 11 > .�_::� Backflow preventer Page 2
Cal IiVenrlt�t Backwater valve 16.60
1 Clothes washer 16.60
Dishwasher 16.60
{'1@41 -'!2 ', ®' „ . ir4`T ` t 71 1;,' 1 , kid --° s l': l °1 { �pp t Drinking fountain 16.60
I• ..) � Ejectors /sump 16.60
11
Name: t o Co t_c_ico A s Expansion tank 16.60
Address: ' ( Fixture /sewer cap 16.60
City/State /ZIP O'. 9 7 3 Floor drain /floor sink /hub 2 . .45._
16,60 r j
Phone: (5,) Li4. 3I3 Fax; ( ) Garbage disposal 16,60
$ � =_i, ��k! s �,. � P p , i e �
I "r__:_ l I tit :Y` . =1�i jl;? i ; r a ri !i1t ' 4;1001 Hose bib 16.60
Business ;, narp Diu, l 4�e r.;?n lee maker 16.60
- - 1..1_ 't t�. -?'' ,
interceptor /grease trap 16.60
Con name: -
`Q� 1n v . \ , 56'1/1 Medical gas (value: S ) Page 2
Address: , _Q t 1 ,11 G • A, tO , Primer / 16.60 /(
City /State /ZIP: j ' I ° r C a, 6 . v ,' Roof drain (commercial) 16.60
Phone: (5C-) - �t A 3'1 3 55 Fax:: (50-4)) -7 1..•, `tom -/ I . Sink/basin/lavatory 16.60 / {0 ' G Q
`r -- Tub /shower /shower pan 16.60
E-mail: • r t a.Smc.L c?k ' • C_p(Vl,
.Yr " :
1 ' r. : tt r^�ii-- {ii °a. 'it' : n„ :, :rc �s;i� •� 99 z - - _ - ! ! Urinal 16.60
- 1 .. ; �!°1 P i b, �- _ 1t'' l 8 o � ;4,1i C �e " ' ::31 ¢ 1 ' 5, ii a' ' g" :dl'�.4 ;
f�t a+ ...........•�a .d.6 „ !sra „ _ �1,.�`?? PG � P, 1, PS, 1! � .: d::;:,-'- c.r,,[!vdern ^ti ,,, , Posp:1- :- ::: -!, � "1 ,: # - 8�, W a t er closet 16.60
Business name: ,rr
`jT ;�G `r, ( C _ ( 1 Water heater 16.60
Address; U3i4�a•ln 0 , e , Other:
City /Start /ZIP: ,�i � Subt • 'QC{
I � � C. 1, M inimum permit fee: $72.50
Phone: ( ) U6( Fax: ( - c - 7 , - 45/ 'r' Residential backtlow minimum permit fee: 536.25
-
ry CCB Lie,; 414 , t4 .. • 9 '.1 . 9 Plumbing Lic. no.: ,- j r 4 s v Plan review (25% of permit fee)
r ' / State surcharge (12% of permit fee) 11 . -1 J I.
Alp -7
Authorized signature: • 1
- _ . r��� +�.i Y _ 1 TOTAL PERMIT FEE 1 / 1 t.53
Print name: A, fcrA ,- astn Date: Li a 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 Boar •
I: Bu+! di Permi!App.d0c i2/2 440-4616T( /02/CONVWEB)
95i 775cf
. Apr, 2. 2009 9:49AM No. 4733 P. 3
• i urninng rermat Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su .• i ression S stems:
. . 1 L . y " . . E at �t1 > Yrl°lig ! 1 -� Ii41, i.:�::.. r rx 1 1 • - y , M:Sru..A t .. r 7 §i" : i
�� � t ' , 7 :i. §.__ ?,1 i!!E°t4rr r �. �7 3iW � 1 ut
�y;n ° �_. gf
pp 1..._..- _....n. ,... ,! , o, = „, o. : -... 't `` .l 9Et. .' 1 I . b y y 1!1 2-•
'� ,il °' 1 ' A' .� ...- � irdtt' • `: •: . SNiC -1 -its 1 �r::..,. � :._:..�. ,r � ' � .. .:Y!r . : � E�?� C � f/d �:....: � .
Footing drain - 1" 100' 55.00 0 to 2,000 { °t 5115.00 L
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160,00 _
Sewer- 1st 100' t 55
3,601 to 7,200 5220.00
so and greater $309.00'
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas S 'stews: •
Water Service - each additional 100' 46.40 1 ..,,_. i W ::�. ,:,:
zt oElY''i=t' -S li ;:-= ='� t,:� ; .t:: ;.�t
'y'�rpi'a El} "' xis - -' dg:IN } �
ik tigj ' :° . .li IU ill 7i,.. ,Il # o,� 1 II jF.. r 4 cr lllFr Ef.
Storm St Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain 9 .. Drain - each additional 100' 46.40 55,001,00 to 510,000.00 y $72.50 for the first 55,000,00 and 51.52 for each
'?d•,s =;G o ;t .::Y j jlf!4 t' - l :ye1 f6t _ 4S I
cj1 � .- •4_�_s l;_, , H' 11 `iEa 1 additional $100.00 or fraction thereof, to and
qq _
i i §s::.e111 ' =sse 19r4�1 648'':a including $10,000.00,
Commercial Back Flow Prevention Device 46.40 $10,001,00 to 525,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional 5100.00 or fraction thereof, to
(minimum .ermit fee 536.25) 27.55 and including $25,000.00.
Rain Drain. single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first 525,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour • 72 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $l 20 for
each additional $100.00 or fraction thereof.
•
Commercial Fixture ° °" " '"
Wo1'k: ( iii -. r ! _ ttlilri�,w,_.. g atliiWg l lei ; ;s 1
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurate] report fixtures could result in increased sewer fees *. El Any new commercial building with water service 2" and
d s niir 4 tI ( p" t r1 p ,. eiki ibi , � i lp greater. except systems designed and stamped by licensed
,ss i iil it ppp j 'ls it,, ! i t - 1 0 . ft' "Plot., engineer.
1°c. ` ....t lrwx i:; -: �,;: i L.r?! o s_ :16:41 6; -�° t lip tt",u
;s,, ; ❑ New exterior plumbing site utilities for any complex structure
Bs List /Font as defined in OAR918- 780 -0040.
Bath - Tub / Shower Ill Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool CI Any multipurpose fire sprinkler system. •
-
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 - 0040.
- Drive Thru
Cuspidor /Water Aspirator Submit ? sets of plans with any of the above.
Dishwasher - Commercial
Domestic E, 3?, 6.ft ! ai i ° ,. ,r- Yn ucis:_e 1 t a:< i; t�
- . n ::: 1
;' k , l,,..- _..: t t R . 1 l l '18t8 11 s
Vji
Du
Eye Fountain
__- I ``� ❑ Isometric � .:. a..,,ir?~ ,r......= :,����Rlls °,�:i::::�� �ll +si
e Wash r riser diagram is required for new buildings
Floor Drain /sink - 2" 4 3. that meet the qualifications above.
• 3"
Car Wash Drain
Garbage -Domestic ` Com ments regarr ng fixture wor • Disposal - Commercial is 1
Industrial _ ] l i ', . t,i! &. I ■ W
Ice Mach 7Refrig. Drains
Oil Separator (Gas Station) y_r L
Rec. Vehicle Dump Station
Shower -Gang • ^ t •' gam
-Stall
Sink -Bar/Lavatory
Bradley *Note: If the fixture work under this permit results in an
-Commercial �� increase of sewer EDIJs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the - Swimmmg Pool Filter plumbing permit can be issued.
Washer - Clothes __ '
water Extractor
Water Closet - Toilet
Urinal
Other Fixtures :' a . 1 _ _ _
i:t Buildinrt ➢ermits\PLM- Permi,App.doc !2/27 /0c,