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Permit CITY TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2006 - 00601 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/29/2006 PARCEL: 2S 110DC -02200 SITE ADDRESS: 15570 SW PACIFIC HWY ZONING: C -G SUBDIVISION: TIGARD PROMENADE LOT: 011 JURISDICTION: TIG Project Description: SAFEWAY. Adjust case drain at fish case. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS; 1 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES TIGARD CENTER 9777 WILSHIRE BLVD. Description Date Amount #609 [PLUMB] Permit Fee 12/29/200E $72.50 BEVERLY HILLS, CA 90212 [TAX] 8% State Surcha 12/29/200E $5.80 Phone : Total $78.30 Contractor: GRIDLINE PLUMBING & HEATING 4343 SE 37TH AVE PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS Contact # : PRI 503 -771 -8790 FAX 503- 771 -1083 Reg #: LIC 74105 PLM 26 -449PB • 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 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. • Issued By:� �j Permittee Signature: Lal 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 Plumbin • Permit A lication belt OFFICE Plumbing USE ONLY R eceived Plumb-� Date/By: / /_ 0/4 V ( • ' emut No � M ea 6 a b A ( 1 I , Cit CI of Tigard Planning Approval Sewer y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 QEC 2 9 200 Ahoo Post - y: Permit No.: Phone: 503- 639 -4171 Fax: 503 - 8 -1960 Post - Review Land Use _ Uar� �,,)�� �i� DateBy: N o.: Internet: www.ci.tigard.or.0 11, ^ � + :� Contact Juris.: Case 183 See Page 2 for • , _ 1 a- 24 -hour Inspection Reque s i ' 1 Twin- Name/Method: _ Supplemental Information. TYPE OF WORK FEE* SCHEDULE (for special information use checklist) ❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total E] Addition/alteration /replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF CONSTRUCTION (includes 100 it. for each utility connection) 1 & 2-Family dwelling © Co mmercial/Industrial SFR () bath 249.20 ❑ Y g SFR (2) bath 350.00 DAccessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2 Job site address: 1 5570 SW Pacific Hwy Site Utilities Suite #: I Bldg. /Apt. #: +,;• Catch basin/area drain 16.60 Drywell/leach line/trench drain 16.60 Project Name:Safeway store ii 1478 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2 . Tax map /parcel #: Water service (no. linear ft.) - - Page 2 Fixture or Item DESCRIPTION OF WORK Absorption valve 16.60 Adjust rasp rlra iri for new case Backflow preventer Page 2 move foreward approx 1 foot at Backwater valve 16.60 Fish case. Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ❑,PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 Name: Expansion tank 16.60 Address: Fixture/sewer cap 16.60 City /State /Zip: Floor drain/floor sink/hub 1 16.60 1640 40 Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 ❑APPLICANT ❑ CONTACT PERSON Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: Roof drain (commercial) 16.60 Phone: Fax: Sink/basin/lavatory 16.60 E -mail: • - •Tub /shower /shower pan 16.60 CONTRACTOR Urinal 16.60 Business Name: Gridline Plbg Duncan & Water closet 16.60 9 Water heater 16.60 Address: 4343 Se 37th av_ Duncan inc Other: City /State /Zip: Portland Or. 97202 Other: Phone:5037718790 Fax: 5037711083 Plumbing Permit Fees* Subtotal $ CCB Lic. #: 7- 1 0 5 Plumb. Lic. #: 2 6 4 4 9 pb Minimum Permit Fee $72.50 $ 72.50 Authorized ` j 1 2 Residential Backflow Minimum Fee $36.25 Signature: ,64.d. /. , % Date: Plan Review (25% of Permit Fee) $ • ' te n Duncan State Surcharge (8% of Permit Fee) $ 5.80 (Please print name) TOTAL PERMIT FEE $ 7 8 _30 Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. i:\Dsts\Permit Forms\PlrnPermitApp.doc 01/03 t 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' 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 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 $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: 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 *. Quantity by (Fixture) Work Performed Comments regarding fixture work: Fixture Type: Replace New Moved Existing Capped 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" -3" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: rQSe i),eQw i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM200500601 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/29/2006 Phone: (503) 639- 4171 apy'�l • Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 1/3/2007 TIME: 7 :07AM PAGE: 31 SITE ADDRESS: 15570 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: TIGARD PROMENADE LOT #: 011 TYPE OF USE: PROJECT NAME: SAFEWAY DESCRIPTION: SAFEWAY. Adjust case drain at fish case. • OWNER: TIGARD CENTER, ER PHONE #: D ENT , CONTRACTOR: GRIDLINE PLUMBING & HEATING PHONE #: 503 -771 -8790 Inspection Request Scheduled For: Date: 1/3/2007 Pour Time: Code # Inspection Description Confirm # Con Message 305 Plumbing underslab 041730-01 971- 2756'167 Y Corrections /Comments /Instructions: ec _p l•h , A d I 4 . / _ , f - for,-- w • T z'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: r 1 Date: //...3 i -7 Phone #: (503) 718- D " 2