Loading...
Permit CITY TIGARD PLUMBING PERMIT I DEVELOPMENT SERVICES PERMIT #: PL 15120% -00099 .�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/15/2005 PARCEL: 1S136CD-00100 SITE ADDRESS: 11705 SW PACIFIC HWY J ZONING: C -G SUBDIVISION: LOT: JURISDICTION: TIG Project Description: Plumbing TI, create new bathroom and cap 5 fixtures. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 3 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: 3 LAP flFfS/ frP TUB /SHOWERS: SEWER LINE: /ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES PACIFIC CROSSROADS PROPERTIES, I Description Date Amount BY WYSE INVESTMENT SERVICES CO 200 SW MARKET ST STE 345 [PLUMB] Permit Fee 3/15/2005 $116.20 PORTLAND, OR 97201 [TAX] 8% State Surcharl 3/15/2005 $9.30 Phone : Total $125.50 Contractor: EXPRESS PLUMBING 1420 SE EASTWOOD REQUIRED ITEMS AND REPORTS PORTLAND, OR 97222 Phone : 503- 380 -6323 Reg #: LIC 75865 PLM 3 -258PB 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 9 01 -00 • . rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC b f alling 503 - 246 -66' • t -• • 0- 332 - 2344... I sued By: / i'va-0/Loaef Permittee Signature: A 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. .L04., de o r' /M4 -77/ --- /D f i a i- - 0 ` 1 � - � e,o"/ Plumbing Permit Application FOR OFFICE USE ON.,Y City of Tigard ®�� Permit No.: fill ' 13125 SW Hall Blvd., Tigard, OR 97223 Date Recei B ved y : �f / L i //�► Plan Review Phone: 503.639.4171 Fax: 503.598.1960 / /ti���t ?,, I \ DateBy: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 -.% �� ) aria Internet www cr trgard or us ..a Date ed /Me y S See Page 2 for Notified/Method ) 1 Supplemental Information . . 7 r . T ryPE WORK _. :: FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checkl Description Qty. Ea. Total EA Addition/alteration /replacement ❑ Other: New 1- 2 - family dwellings (includes 100 ft. for each utility connection) l';'.:`:,,::, s r . , 7 CATEOOR C'Q1 ?'� d .% t r SFR (1) bath 249.20 ❑ 1- and 2- family dwelling iii 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: Fire sprinkler ( sq. ft) Page 2 � h� . � � _ Si utilities Job site address: , 17 as- S Ct) " f ` C t �-; C Hwy cab - - Catch basin or area drain 16.60 T�C9a.r C�� rt`74z 3 City/State /ZIP: 1 " Drywell, leach line, or trench drain 16.60 d Suite/bldg. /apt. no.: $ - Project name: 5 L ,.. . 00` Footing drain (no. linear ft.: _) Page 2 �`'�'�i Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 r 1 nr 19 ri W y AVX - i" To ') \e pc 1 c o pe* Sho . Rain drain connector 16.60 v 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 Fixture or item Tax map /parcel no Absorption valve 16.60 , t 4 � �„ ,' °'�e : ,. . , , . ., Backflow preventer Page 2 kie(rCc. • Ss A K fl ocir sNpla Backwater valve 16.60 Clothes washer 16.60 Dishwasher 1 6.60 „ ; x Drinking fountain 16.60 - 1,...4 .. - Ejectors /sump 16.60 Name: 'sv.5f to L - Expansion 16.60 Address: Fixtur sewer cap 5 16.60 City/State/ZIP: Floor drain /floor sink/hub , 16.60 Phone: j6) •) 7 l Z, c 10 Fax: ( ) Garbage disposal 16.60 g �, Hose bib 16.60 �a � " "� � Ice maker 16.60 Business name: 'C Q I Interceptor /grease trap 16.60 Contact name: K, G, CHoi Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 Phone: Tel-) 9a-tf - i�� c I Fax: : ( ) Sink/b lavatory + 7 16.60 Tub /shower /shower pan 16.60 E-mail: Urinal 16.60 _l erg . 11 . . g -i , tit .E.. . , . _ _. . Water closet 16.60 Business name: Ex ) e5S` p) (!-M,1 p t V� Water heater 16.60 Address: It.,.p sc as+ G,Jad o Other: . E City/State/ZIP: yv); I LOW" iG e h 112 1 & 9 �1( td I LA Subtotal i Minimum permit fee: $72.50 XD Phone: (10,3) ,380 6 32-3 Fax: ( ) Res tial backflow minimum permit fee: $36.25 il`� CCB Lic.: 75815 Plumbing Lic. no.: 3 Plan review (25% of permit fee) 2 �� State surcharge (8% of permit fee) 9. 3CC i Authorized signature: i ce,, y� "'r TOTAL PERMIT FEE i , 5b Print name: ,T es u `D)1 bar Date: 3 - j 0� j _ - This permit application expires if a permit is not obtained within V 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i:\ Building \Permits\PLM- PemutApp.doc 12/03 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard • • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: tfiit>tes ,.. w.. , ete lntal £ Squar0ootage:: Permit Fee.: Footing drain - l' 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 .. Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $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 and • including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 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 $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . a ors sw,'. ' o � Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" 1 - 3" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang 4 -Stall Sink -Bar/Lavatory I y Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity - Commercial -Service ' total is >9. Swinunipg Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i: \Building\Permits\PLM- PermitApp.doc 3/03 C ITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: P 15/200 5 -00099 ' 11-- 1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/15/2005 PARCEL: 1S136CD-00100 SITE ADDRESS: 11705 SW PACIFIC HWY J ZONING: C -G SUBDIVISION: PACIFIC CROSSROADS LOT: JURISDICTION: TIG Project Description: Plumbing TI, create new bathroom and cap 3 fixtures, 1 Ice maker, 1 RP Device CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 0 OCCUPANCY GRP: B FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: 1 LAVATORIES: 1 OTHER FIXTURES: 5 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Owner: FEES PACIFIC CROSSROADS PROPERTIES, I Description Date Amount BY WYSE INVESTMENT SERVICES CO 200 SW MARKET ST STE 345 [PLUMB] Addl Permit 6/28/2005 $66.40 PORTLAND, OR 97201 [TAX] 8% State Surchari 6/28/2005 $5.31 Phone : [PLUMB] Permit Fee 3/15/2005 $116.20 [TAX] 8% State Surchari 3/15/2005 $9.30 Contractor: Total $197.21 EXPRESS PLUMBING 1420 SE EASTWOOD REQUIRED ITEMS AND REPORTS PORTLAND, OR 97222 Phone : 503- 380 -6323 Reg #: LIC 75865 PLM 3 -258PB 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 rule - - e o in • 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these ml- • r di -ct que lions to OW C by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: _LL. Permittee Signatu _A 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. . • Building Fixtures , Plumbing Permit ApplieationE I OR 01 H I: I S II ()\I. City of Tigard /By Permit No.: ReceiDateved �p � 1M.,2a5 o X99 13125 SW Hall Blvd., Tigard, OR 97223 q1 Phone: 503.639.4171 Fax: 503.598.1960 JUN 28 2014 Plan Review I f Date/By. Other Permit No.: 24- Hour Inspection Line: 503.639.4175 p CITY OF TI 1 - �i" DateReady/By. J °ns b El See Page 2for Internet: www.ci.tigard.or.us Notified/Method: 1 Xr Supplemental Information TYPE O F W DIVISION FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I 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 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION - AND LOCATION Site utilities Job site address: Catch basin or area drain 16.60 City /State /ZIP: Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 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: I Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher / V 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 3 0 16.60 City /State/ZIP: 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: Interceptor /grease trap / t/ 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 3 ✓ 16.60 Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet / ✓' 16.60 Business name: Water heater 16.60 Address: Other: RP PEA/MC / t/ /4.10 Subtotal City / State/ZIP: Minimum permit fee: $72.50 l z .� " " Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 / CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% 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 Ser • • • is\ Building \Perm its \PLMF- PennitApp.doc 06/05 440-4616T(I0/02/COM/WEB) 7 • / / Plumbin! Permit Application - City of Tigard . • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities fir. Fee (ea) Total Square Footage: Permit Fee: Footing drain - I" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 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 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Back flow Prevention Device each additional $100.00 or &action thereof to (minimum permit fee $36.25) 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 $25,000.00 and $1.45 for each additional $100.00 or fraction thereof to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Complex Structures Are you capping, moving or replacing existing fixtures? If A "complex structure" is defined as an installation of a plumbing "yes", please indicate work performed by fixture. Failure to system that meets any of the following criteria accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: i ❑ Any new exterior plumbing site utilities. New Moved Existing Capped ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service - Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor/Water Aspirator are being installed for the food service area. Dishwasher - Commercial ❑ Any new residential building containing three (3) or more - Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system. Eye Wash Floor Drain /sink 2" Submit 2 sets of plans with any of the above. -3" -4 „ Car Wash Drain Isometric or Riser Diagram Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal - Commercial three (3) or more stories in height. - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer Clothes *Note: If the fixture work under this permit results in an Water Extractor increase of sewer f EDUs, a sewer permit will be issued and Water Closet - Toilet P urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. i :\ Building \Pennits\PLMF- PermitApp.doc 06/05 Accumulative Sewer Tally Parcel # 1S136CD -00100 Tenant Na'ne: Sushi Hana This SWR# N/A Site Address: 11705 SW Pacific Hwy Suite J This PLM# 2005 7 00099 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 Eye 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 1 6 0 -1 -6 - Car Wash Drr 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 HP) 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 1 2 1 2 - Bradley 5 0 0 0 0 0 - Commercial 3 0 4 12 0 -4 -12 - 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 1 6 1 6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 5 18 2 8 - 3 - 10 Current Fixture Value -10 divided by 16 = -0.6 Current EDU 1 EDU = $ 2,500 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -10 divided by 16 = -0.6 over (und $ (1,500.00) Enter EDU Change Here 0.6 ' - . Notes: "'CREDITS" Signature: 11".R��f�Zagl� t!• Date: /i j � i Buildigg'6ivision Note: The property . - - . 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 \SewerTallySheet.xls 7/1/04 CITY OF TIGARD BUILDING DIVISION PERMIT #: PLIVI200& -00099 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/15/3005 Phone: (503) 639 -4171 N Inspection Requests (24 Hrs.): (503) 639 -4175 '__.. INSPECTION WORKSHEET FOR DATE: 6/29/2005 TIME: 7:08AM PAGE: 76 SITE ADDRESS: 11705 SW PACIFIC HWY J CLASS OF WORK: SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE: PROJECT NAME: SUSHI HANA DESCRIPTION: Plumbing TI, create new bathroom and cap 3 fixtures, 1 Ice maker, 1 RP Device OWNER: PACIFIC CROSSROADS PROPERTIES, I, PHONE #: CONTRACTOR: EXPRESS PLUMBING PHONE #: 503.380 -6323 Inspection Request Scheduled For: Date: 6129/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 010393-02 503- 984 -6655 N Corrections /Comments / Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: fib Date: 6/291 Phone #: (503) 718-