Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Permit
CITY OF TIGARD PLUMBING PERMIT s • COMMUNITY DEVELOPMENT . .. • Permit#: PLM2011 -00365 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2012 Parcel: 1 S136DB00201 Jurisdiction: Tigard Site address: 11565 SW PACIFIC HWY Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2 Project Description: Interior plumbing for expansion and remodel. 7/23/12, adding (2) Eco -Lab soap dispensers. Add (6) eco -lab soap dispensers "REPRINT 8/20/12" 9/4/12 REPRINT adding (2) backflow preventers and (1) hand sink Contractor: RAY'S PLUMBING DBA PIPER MECHANICAL Owner: FRED MEYER INC PO BOX 685 3800 SE 22ND AVE BRUSH PRAIRIE, WA 98606 PORTLAND, OR 97202 PHONE: 503 - 232 -8844 HONE: 360 - 892 -8700 FAX: 360 - 892 -9644 FEES Quantity Description Date Amount 2 ea Backflow Preventer 05/02/2012 $62.54 Specifics: 3 ea Dishwasher 05/02/2012 $75.06 1 ea Drinking Fountain 05/02/2012 $25.02 Type of Use: COM 188 ea Floor Drain /Floor Sink/Hub 05/02/2012 $4,203.36 Class of Work: ADD 3 ea Garbage Disposal 05/02/2012 $75.06 Type of Const: 17 ea Hose Bib 05/02/2012 $425.34 Occupancy Grp: 2 ea Ice Maker 05/02/2012 $25.02 Stories: 1 ea Interceptor /Grease Trap 05/02/2012 $25.02 10 ea Primer 05/02/2012 $125.10 12 ea Sink 05/02/2012 $300.24 10 ea Lavatories 05/02/2012 $250.20 1 ea Water Closet 05/02/2012 $25.02 3 ea Water Heater 05/02/2012 $112.56 1 12% State Surcharge - 05/02/2012 $687.54 Plumbing 25 Misc Other Fee 07/23/2012 $25.02 Total $6,739.33 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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 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. CITY OF TIGARD PLUMBING PERMIT e COMMUNITY DEVELOPMENT Permit#: PLM2011 -00365 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2012 Parcel: 1S 136DB00201 Jurisdiction: Tigard Site address: 11565 SW PACIFIC HWY Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2 Project Description: Interior plumbing for expansion and remodel. 7/23/12, adding (2) Eco -Lab soap dispensers.. Contractor: RAY'S PLUMBING DBA PIPER MECHANICAL Owner: FRED MEYER INC PO BOX 685 3800 SE 22ND AVE BRUSH PRAIRIE, WA 98606 PORTLAND, OR 97202 P PHONE: 503 - 232 -8844 HONE: 360 - 892 -8700 FAX: 360 - 892 -9644 FEES Quantity Description Date Amount 2 ea Backflow Preventer 05/02/2012 $62.54 Specifics: 3 ea Dishwasher 05/02/2012 $75.06 1 ea Drinking Fountain 05/02/2012 $25.02 Type of Use: COM 168 ea Floor Drain /Floor Sink/Hub 05/02/2012 $4,203.36 Class of Work: ADD 3 ea Garbage Disposal 05/02/2012 $75.06 Type of Const: 17 ea Hose Bib 05/02/2012 $425.34 Occupancy Grp: 2 ea Ice Maker 05/02/2012 $25.02 Stories: 1 ea Interceptor /Grease Trap 05/02/2012 $25.02 10 ea Primer 05/02/2012 $125.10 12 ea Sink 05/02/2012 $300.24 10 ea Lavatories 05/02/2012 $250.20 1 ea Water Closet 05/02/2012 $25.02 3 ea Water Heater 05/02/2012 $112.56 1 12% State Surcharge - 05/02/2012 $687.54 Plumbing 25 Misc Other Fee 07/23/2012 $25.02 Total $6,473.13 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 No -..; - ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or d' ct questions to OU ` • by calling 503.232.1987 or 1.800.332.2344. I � \ Iss ed By: / ' / Permittee Sign ure: /J o Call 503.639.4175 by 7:00 a.m. for the next available inspe • n date. 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. • CITY OF TIGARD PLUMBING PERMIT g COMMUNITY DEVELOPMENT Permit #: PLM2011 -00365 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2012 Parcel: 1S136DB00201 Jurisdiction: Tigard Site address: 11565 SW PACIFIC HWY Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2 Project Description: Interior plumbing for expansion and remodel Contractor: RAY'S PLUMBING DBA PIPER MECHANICAL Owner: FRED MEYER INC PO BOX 685 3800 SE 22ND AVE BRUSH PRAIRIE, WA 98606 PORTLAND, OR 97202 PHONE: 503 - 232 -8844 HONE: 360 - 892 -8700 FAX: 360 - 892 -9644 FEES Quantity Description Date Amount 2 ea Backflow Preventer 05/02/2012 $62.54 Specifics: 3 ea Dishwasher 05/02/2012 $75.06 1 ea Drinking Fountain 05/02/2012 $25.02 Type of Use: COM 188 ea Floor Drain/Floor Sink/Hub 05/02/2012 $4,203.36 Class of Work: ADD 3 ea Garbage Disposal 05/02/2012 $75.06 Type of Const: 17 ea Hose Bib 05/02/2012 $425.34 Occupancy Grp: 2 ea Ice Maker 05/02/2012 $25.02 Stories: 1 ea Interceptor /Grease Trap 05/02/2012 $25.02 10 ea Primer 05/02/2012 $125.10 12 ea Sink 05/02/2012 $300.24 10 ea Lavatories 05/02/2012 $250.20 1 ea Water Closet 05/02/2012 $25.02 3 ea Water Heater 05/02/2012 $112.56 1 12% State Surcharge - 05/02/2012 $687.54 Plumbing Total $6,417.08 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 Notif • Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direc • uestions to ' UNC • calling 503.232.1987 or 1.800.332.2344. Issued =y: I ')4(01A4A, Permlttee Signat e: ; ! ' mss_ :� Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 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. CITY OF TIGARD PLUMBING PERMIT I I COMMUNITY DEVELOPMENT Permit A: PLM2011 -00365 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2012 Parcel: 1 S136DB00201 Jurisdiction: Tigard Site address: 11565 SW PACIFIC HWY Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2 Project Description: Interior plumbing for expansion and remodel. 7/23/12. adding (2) Eco -Lab soap dispensers. Add (6) eco -lab soap dispensers **REPRINT 8/20/12** Contractor: RAY'S PLUMBING DBA PIPER MECHANICAL Owner: FRED MEYER INC PO BOX 685 3800 SE 22ND AVE BRUSH PRAIRIE, WA 98606 PORTLAND, OR 97202 PHONE: 360-892-8700 PHONE: 503 - 232 -8844 FAX: 360 - 892 -9644 FEES Quantity Description Date Amount 2 ea Backflow Preventer 05/02/2012 $62.54 Specifics: 3 ea Dishwasher 05/02/2012 $75.06 1 ea Drinking Fountain 05/02/2012 $25.02 Type of Use: COM 168 ea Floor Drain /Floor Sink/Hub 05/02/2012 $4,203.36 Class of Work: ADD 3 ea Garbage Disposal 05/02/2012 $75.06 Type of Const: 17 ea Hose Bib 05/02/2012 $425.34 Occupancy Grp: 2 ea Ice Maker 05/02/2012 $25.02 Stories: 1 ea Interceptor /Grease Trap 05/02/2012 $25.02 10 ea Primer 05/02/2012 $125.10 12 ea Sink 05/02/2012 $300.24 10 ea Lavatories 05/02/2012 $250.20 1 ea Water Closet 05/02/2012 $25.02 3 ea Water / Heater 05/02/2012 $112.56 1 12% Slate Surcharge - 05/02/2012 $687.54 Plumbing 25 Misc Other Fee 07/23/2012 $25.02 Total $6,641.26 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: , Permittee Signature: Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. MAY- 01- 2012(TUE) 01:03 Rays Plumbing (FAX)3608929614 P.002/002 Plumbing Permit A p li Y r E VE D f`1 M b olb/ 'OG� /3 Building Fixtures ,� rOR OFFICE USE ONLY City of Tigard MAY - 1 20 Received /1i�©l /„ �, Permit No.: ' Cede/ /-e03b j a 13125 SW Hull Blvd.. Tigard. OR 97223 t IN e Spiral P O l st m t R� Phone: 503.71 K 2439 Fax: TIGAi yD uwerltr: / Other pe++nh w 2 J /g No.; - � T 1 G A RD Inspection Line: 503.639.4175 w DIVISION Doe Reudymr: ,,L lul gee hose 3 rut Internet ww+v.dgatd•or.gov BUILDING i�dilmUMethud: - - fe - l a)` I�- x RI larnttnulna r$'' tt" : .- •- . .*P • 0 -M!OR1 :t. �� Y �5.. 9 t 1T .' ET- - . . _ '--. +_. a5+ C 15 _.- .....- tE ': ' d New construction ❑ Demolition For spedal information use rhec*Prt Description [ qty. [ I - taut ea Addition /ullerutiun/replacement ❑ Other, New 1.24am1ly dwell (Inclu 100 R. far each utility connection) z x aiteciR3:'olr`CGNS ii it iN" .S- , n'-: SFR(I)bath 312.70 © 1 - and 2- family dwelling [$[ Commercial/industrial SFR (2) bath 437.78 SFR 0 Accessory building ❑ Multi - family Ea ch E l (3) tenth 500 0 2 Each additional bath/kitchen 25.02 Q Master builder 0 Other _ Dire sprinkler ( sq. IL) Page 2 i . i; . :: -WW � :I1VMbltio:46NNNlia OC 110Nr4 :10,7f _Siteutllide,.. - zr Job site or/dress: 11565 SW Pacific HWY Catch basin or urea drain 18.76 Drywell, leach line. or trench drain 18,76 Cityl5mtr1LlP:Tlgardl0ltN7223 _ - - Footing drain (no. linear it.:_) _ Page2 Suite/bldgJapt. no.: I Project name: Fred Meycr•Tlgard Munufuctuted home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 - _ Sanitary sewer' (no. linear il.: ,_ Page Storm sewer (no. linear tt.: _) Page 2 v Water service (no, linear IL: ___, Page 2 Subdivision: I Lot no.: Fixture or Item: Tax map /parcel no.: Buckflow preventer A 31.27 l0.?, 5y '; .7 : . a. , } r L L CWPrtON OF . WOI&I g ; : L . s . • -4° : _ Backwate valve 12.51 Clothes washer 25.02 Remodel of ezlsdng - Dishwasher 3 25.02 76. Drinking fountain / 25.02 As .o P. Ejectors/sump 25.02 ' " RO 11• x.M6311' g 1 1 - � Expunsion lank 12.51 •3.iF.i�r1 : P 2 Name: Fred Meyers Fixture/sewer cap 35,02 Floordrain /( 25.02 f; Address : 11565 SW Padre HWY Carhage disposal 3 25.02 75.00 City/State/ZIP:Tlgard/ORI9fl23 )dose bib - / 25.02 VAS 39 Phone: ( ) Fax: ( ) ice maker a 12,51 A5'..9.1 ®i , , Gpry"tAd gj ? intcrecptod / 25.02 g 5-0A lusineus name: Piper Meebaaletil Med1cni gas (value: S ) Page 2 Con Wet nu: Peter Levanen Primes - -- - Jd 12,51 /715 mc -- - Roof dreln (commercial) 12.51 Addr - sir: POB 685 Sink/basin/lavatory 02A 25,02 65D 49 Cily/State/LiP: Brush Pralrle/WA/911606 Solar units (potable water) 62.54 Phone: (360) 892 -8700 l Fax; : (360) 892-9644 Tublshower /shower pun 12,51 E -mail: peter.levnnen a@pipermecbanlcaLeom Urinal 25.02 ., - w„ '- - elope 2 ,2 e IITA - h3K:.m4. ,� • G�'O � > ' .. ' . -..:-. ` Water I .2 Wata hurts 3 37. 1/ . S! I3tu+inertsnumm Piper Mechanical Wnterpiping/DWV _ 56.29 Address: POB 685 Other. 21.02 City/Stute/ZIP: Brush Prelde/WA/98606 ,__.r.. Subtotal 5 7a9.6Y . Phone: (360) 892 -8700 Fax: (360) 892 -9644 Minimum permit rem $72.50 Plan review (23% or permit fee) Cal Lie.: 33217 Plumbing Lie. no.: 37•149PB \ ik I State surcharge (12% of permit fa) 4 g7. • Aulllurized signatur TOTAL PERMIT FEE 6417.08 I Print Hume: 4d�� Z �l� u , : , b I Date•,�� T� p° It application espies If • permit L not obtained within 180 days � - Aber It Us been accepted w complete:. "Fee methodoloi ' act by 114-Cwmty Building Industry Service tkvurtl. • 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 - 1 100' 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' 1 62.54 7,201 and greater $327.54 Sewer - each additional 100' 7 37.52 Water Service - 1st 100' 1 62.54 Medical Gas Systems: Water Service - each additional 100' 5 37.52 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 1 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", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by Fixture Type Plan Review for Plumbing Installations . Fixture Type for Replace/ Plan review is an required for of the following. Work Performed: Capped Added Relocate q any g' Baptistry/Font Please check all that apply. Bath - Tub /Shower ❑ Any new commercial building with water service 2" and - Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918 -780 -0040. Dishwasher - Commercial 1 • I ❑ Medical gas and vacuum systems for health care facilities. - Domestic I ❑ Any multipurpose fire sprinkler system. Drinking Fountain • . I ❑ Any complex structure as defined in OAR918- 780 -0040. Eye Wash 2 Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. 3" 63 103 2 Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings Garbage - Domestic - non -food - q g Disposal - Domestic -food related that meet the qualifications above. - Commercial -food related I ' I - Industrial -food related Ice Mach./Refrig. Drains 2 Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang • -Stall Sink/Lav - Non -food related 4 6 - Bradley • - Commercial -food related 3 6 - Service I 2 Swimming Pool Filter . Washer Clothes *Note: If the fixture work under this permit results in an • Water Extractor increase of sewer EDUs, a sewer permit will be issued and , Water Closet - Toilet . I fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: P: \Fred Meyer \11 \l 1- 0029 -01 - FM Tigard\ 02Corresp \204Jurisdiction \Buitding\PLMF - PermitApp 11221 I.doc Accumulative Sewer Tally sl : , a Tenant Name: Fred Meyer ** *CREDIT'S * ** SWR # 2011 -00175 - IGnitl� Site Address: 11565 SW Pacific Hwy PLM # 2011 -00365 Parcel #: 1S136DB00201 Fixture Value Previous Previous Credits Capped Fixture Fixture New Ncw • # value count capped #s value count added # added value total #s total 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 1 4 1 4 0 0 - Domestic 2 0 0 1 2 1 2 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 2 2 2 2 •• Floor Drain /Sink: - 2 inch 2 0 0 103 206 103 206 - 3 inch 5 0 63 315 0 -63 -315 - 4 inch 6 0 0 0 . 0 0 - - Car Wash 6 0 0 0 0 0 • Garbage Disposal: - Domestic (to 3/4 HP) 16 0 0 0 0 0 - Commercial (to 5 I -IP) 32 0 0 1 32 1 32 - 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: - Lay/Bar - Non -Food Related 2 0 0 4 8 4 8 - Bradley 5 0 0 0 0 0 - Com /Sery /Util - Food Related 3 0 0 4 12 4 12 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 _ 64 319 117 272 53 -47 Current Fixture Value -47 divided by 16 = -2.9 Current EDU 1 EDU = $4,500.00 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -47 divided by 16 = -2.9 over (under) $ (13,050.00) Enter EDU Change Here -2.9 Notes: 12/23/11, per Kathy at CWS ok to calculate the 103 4 "floor drains at the 2" rate, as these drains are required to be 2" but . Kroger wants them to be 4" for maintenance purposes. . Authorized Name /Signature: Debbie Adamski Date: 12/22/2011 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. 1: \ Building\ Sewer Tally \ SewerTallySheet-4500.xls 07/01/11 Plumbing Permit Application FOR OFFICE USE ONLY City of Tigard Received /2 Permit No.' a 13125 SW Hall Blvd., Tigard,OR 97223 Date/By: L� - 2 0 // 0 0 24 4' Pl II . Phone: 503.718.2439 Fax: 503.598.1960 D an Review ateJBy: Other Permit No.: 'I• I GA R D Inspection Line: 503.639 Date Ready/By: kris: RI See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction 0 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 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: 11565 6 .,, }Pii- -c Fit_ Pt 0✓Y Catch basin or area drain 18.76 City /State /ZIP: Ti 2 Drywell, leach line, or trench drain 18.76 C �b i Q Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: pRi4, ' 4.yEL 4F 375 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 ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 gi,r.oAEl . - 42L (G) 6 ^ L66 SO /fit) Dishwasher 25.02 ..b /.S, &,' /v EIS Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Fixture /s• - ., alb Ill . - Name: - - 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 a APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: S D WA W Medical gas (value: $ ) Page 2 Primer 12.51 f i‘l Contact name: 6 , r,(„AvS Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units (potable water) 62.54 Phone: (5o3) 50‘i - 5757 I Fax :: ( ) Tub /shower /shower pan 12.51 E -mail: DVSv-ps),Ll q u5 /t(c�r ZI [p� , Cer► Urinal I 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: Water piping/DWV 56.29 Address: Other:L ( ECp L66 , , 6 25.02 /SO , /2. City/State /ZIP: SO/9P /SPC SFAS Subtotal ( 50. IL Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) ti. Q 1 Authorized signature -`\..2„ ‘ `..---- TOTAL PERMIT FEE i (0g. f3 Print name: "y •1 ] Ac s r / hf I Date: 7 Zo /( `L 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 - 1" 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 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $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 ec Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to Inspections 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. Quanti by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previ us 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 Submit 2 sets of plans with any of the above. - Domestic 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 lumbin permit can be issued. Water Extractor p g p Water Closet - Toilet Urinal Other Fixtures: I:\Building\Permits\PLM- PermitApp.doc 2 Plumbing Permit Application Rec eived - Ci of Tigard V1 Pe rmit No.: IN U 131 SW Hall Blvd., Tigard, OR 97223 Plan Re : 003 S R E C EI SEP Q 4 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 2 0 1 2 Date/By: Other Permit No.: TI G n It D Inspection Line: 503.639.4175 CITY ► �I 1 1 OF � Date ReadReady/13y: runs: la See Page 2 for Internet: www.tigard or.gov D Notified/Method: Supplemental Information TYPE OF W011 ILDNCi OfinSION FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use check list 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 (I) bath 312.70 ❑ 1 -and 2- family dwelling g 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: I 1 5 h 5 5,../ eikt Fl (. LiU Y Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: Ti 6 mul, i p (i, 9 7 1.23 Footing drain (no. linear ft.: ) . Page 2 Suite/bldg. /apt. no.: I Project name: c( a (1 t' r & S 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 ft.: ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer . 31.27 62.5y DESCRIPTION OF WORK Backwater valve 12.51 ff // Clothes washer 25.02 e- , ,eloiNcu '' A (2) 6A-Gll,'ri.Dv✓ PP,4 JQ 5 A-1.91;• Dishwasher 25.02 O J H rit S „J j 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 ( 25.02 Z 5. 02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: S,%' co") Water piping/DWV 56.29 Address: I 0/ rW , 6, (, L 4 sAl.) ST Other: 25.02 City/State /ZIP: P Btti6't./AJp r 0 2 17732, Subtotal g7. SI, Phone: (5 03) Soy -5857 Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: °L._- TOTAL PERMIT FEE . Print name: NilS J 6 17.0 l,"'" ;t Dat (� L This permit application expires if a permit is not obtained within 180 days V �� 1 /� 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 - 1s 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 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $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 Tub /Sow ❑ New exterior plumbing site utilities for any complex structure Bath - hower Tub /S erlpool as defined in OAR918- 780 -0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive Thru ❑ 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. Car Wash Drain Garbage - Domestic Disposal - Commercial Industrial Comments regarding fixture work: Ice MachiRefrig. 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\PLM - PermitApp.doc 2 I 15 5 e ,'4C1 P� y R. - / I - 0636 IAPMO RESEARCH AND TESTING, INC. 5001 East Philadelphia Street, Ontario, California 91761 -2816 • (909) 472 -4100 Fax (909) 472 -4244 • www.iapmo.org SCC Accredited C B-P5 ANSI /aP ANSI Au:milted Program OCPS PRODUCT CERTIFICATION Accredltb CCN rM • TN 771111111 CERTIFICATE OF LISTING C IAPMO Research and Testing, Inc. Is a product certification body which tests and Inspects samples taken from the supplier's stock or from the market or a combination of both to verify compliance to the requirements of applicable codes and standards. This activity is coupled with periodic surveillance of tho supplier's factory and warehouses as well as the assessment of the supplier's Quality Assurance System. This listing is subject to the conditions set forth in ® the characteristics below and Is not to be construed as any recommendation, assurance or guarantee by IAPMO Research and Testing, Inc. of the product acceptance by Authorities Having Jurisdiction. Effective Date: June 2011 -Rev. 8/3/2011- Void After: June 2012 Product: Grease Interceptors File No. 4296 Issued To: Oldcastle Precast, Inc. P.o. Box 323 Wilsonville, OR 97070 IDENTIFICATION: Grease interceptors shall be permanently and legibly marked with the manufacturer's name and /or trademark, model number, liquid retention capacity, month and year of manufacture, load limits and maximum recommended depth of earth cover in feet and inlet & outlet . Marking { shall appear on a plate that has been permanently attached, molded, cast, or wetset onto the interceptor located on the left hand side of the inlet or on top of the interceptor near the inlet. Permanent markings shall be adequately protected from corrosion so as to remain permanent and readable over the life of the interceptor. Unit'shall also bear the UPC® certification mark. Chairman, Product Certification Committee CEO, The IAPMO Group 1 For the most accurate and updated Information please visit http: / /pld.iapmo.org/4296 y ^. •' "f This listing is for the period indicated herein and is void after the date shown above. Any change in material, manufacturing process, marking or design without having first obtained the approval of the Product Certification Committee, or any evidence of non - compliance with applicable codes ' ^ �,:� :" . . and standards or of inferior workmanship, may be deemed sufficient cause for revocation of this listing. Reproduction of or reference to this form for `: - - advertising purposes may be made only by specific written permission of IAPMO Research and Testing, Inc. Any alteration of this certificate could be grounds for revocation of the listing. DOC#08 I A IAPMO RESEARCH AND TESTING, INC. CERTIFICATE OF LISTING Page 2 -Rev. 8/3/2011- Void After: June 2012 Product: Grease Interceptors File No. 4296 Issued To: Oldcastle Precast, Inc. CHARACTERISTICS: Grease interceptors with two (2) compartments designed to remove •grease from effluent and to retain grease until accumulations can be removed by pumping the interceptor. Grease interceptors shall have a minimum size of 20 inches of manhole over the inlet and outlet compartments. It is recommended that a sample box be located at the outlet end of all grease interceptors so that the administrative authorities can periodically sample effluent quality. May be manufactured in concrete, steel, fiberglass reinforced polyester or polyethylene material. To be installed in accordance with the manufacturer's instructions and the requirements of the latest edition of the Uniform Plumbing Code. Products comply with the applicable sections of the latest edition of the Uniform Plumbing Code °. Manufactured in compliance with IAPMO /ANSI Z1001 -2007. Products listed on this certificate have been tested by an IAPMO R &T recognized laboratory. This recognition has been granted based upon the laboratory's compliance to the applicable requirements of ISO /IEC 17025. • DOC #08 A • 4 �ti - IAPMO RESEARCH AND TESTING, INC. • CERTIFICATE OF LISTING Page 3 -Rev. 8/3/2011- Void After: June 2012 Product: Grease Interceptors File No. 4296 Issued To: Oldcastle Precast, Inc. MODELS: Note: Models with "," indicate compliance with the National Plumbing Code of Canada. Grease Interceptors: UV Designation 576 -GA 576 -GA -CWS c 612 -2 -GA 712 -GA 712 -GA -CWS 816 -GA 816 -GA -CWS 4686 -GA 5106 -2 -GA 5106 -GA -CWS DOC #081 A 4 IAPMO RESEARCH AND TESTING, INC. CERTIFICATE OF LISTING Page 4 • -Rev. 8/3/2011- Void After: June 2012 Product: Grease Interceptors File No. 4296 Issued To: Oldcastle Precast, Inc. ADDITIONAL COMPANY INFO: i • i DOC #081A