Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2009 -00064
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/28/2009
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 160
Subdivision: Lot: 0
Project: Biscuits Cafe
Project Description: Install (2) backflow previenters, (1) dishwasher, (8) floor drains
Owner: FEES
SN PROPERTIES PARTNERSHIP Quantity Description Date Amount
1121 SW SALMON ST 2 ea Backfiow Prevention - 04/16/2009 $92.80
PORTLAND, OR 97205 COM
PHONE: 1 ea Dishwasher 04 /16/2009 $16.60
8 ea Floor Drain/Floor Sink/Hub 04 /16/2009 $132.80
Contractor: 1 ea Ice Maker 04 /16/2009 $16.60
NEWBERRY ENTERPRISES INC 3 ea Primer 04/16/2009 $49.80
40110 SE MEADOWSONG RD 7 ea Sink 04/16/2009 $116.20
SANDY, OR 97055 2 ea Lavatories 04 /16/2009 $33.20
PHONE: 503-668-0375 2 ea Water Closet 04 /16/2009 $33.20
FAX: 503- 668 -0375 1 ea Water Heater 04 /16/2009 $16.60
1 12% State Surcharge - 04/16/2009 $62.93
Plumbing
17 da Additional Permit 04 /16/2009 $16.60
Type of Use: COM
Class of Work: NEW Type of Const:
Occupancy Grp:
Stories:
Total $587.33
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 -0100. You may obtain a copy of the rules
Issued By: i Ca l4 4 I Permittee Signature.
r
Call 503.639.4175 by 7:00 a.m. for an inspection that buss ess 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.
• 03/20/2009 16:25 FAX 5036680375 NORTHWEST WATER WORKS 00 - fI 001 .
' Pl __ nii Per mit A Iic CEIVED M M ;bedoD9...
Building Fixtures • �-ZO� • O y i l
MAR 2`0 2009 1.(..,1; Ol l t( 1
a ' 20 • �4 : 1:s1: ()NI, •� City of Tigard Received �
13125 SW Hall Blvd, Tigard, OR 97 Y OF TIGARD DatrJB Permit Na.: PI _ - o
_ Phone: 503.639,4171 Fax: 503, Ploy
1 ! ri i .; inspection Line: 503.639.4I 75 Bat DIN G DN .. ISION Date/ay: Other Pamiit No e - • ,
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�.:Vp .. !.r i Notified/Method:
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,�...... „�.....;• LL`' " "; :.. �� I,.:.:+.. r L � ! � °:.iiF Gin .ii. .!' +yam " -' -
,. NotifitxNbr
New com'trttction J-- . ........... ..._... .. - :;:-:�:.;�; <'.::1 s;: °
❑ Demolition . For special information mse chericlizi
❑ Addition /alteretiodn:placement 0 Other: D�ption I QM 1 Ea Total
' hl: ,��I ,: .t, r �crc . New I. 2-family dwellings (includes 100 8 for
. •+l.l.:: ..: ... ,, :,G•� C . r,r: °: �, -• each ualiry connection )
❑ 1 -and 2 -fwnil :�- '�_...,,,� ; ��,L':;� •' 1 L. : ..'s� SFR ---• (1) bath 249.20
y dwelling XCommercia rmdustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family i SFR (3) balb- 399.00
Each additional bath/kitchen 45,00
❑ Master builder ❑ Other:
. ,... .
d 59
s^,::7 ,: �o ,i'._. �. T4ort.:AP n::.7 , of ft)
Page 2
ob site „ ! ",,. aL•::.. "„�[�,,': _:- , : Site a 'tie
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address: /6.,..;? 3 (i 3.-O i7 C'7 (_. /-7 4 : j
� Catch basin or arm drain 16.60
City /State,zrP: /7/ G e ,�,/ /-)2_. Dr tine, or d l, leach ti t
16.60
Suite/bldg ✓apt, n i G�0 Project narne: / . _ .:
• � / � . A • / ; � (; .;,� Footing drain (no linearft
� -`_) Page 2
Cross street/directions cons to job site: Manufac tined home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sew (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 /port ci no.: " - _ Fixture or Item
-"' h � -�w " �L ,�..� Absorption v
In 1 �. � wietk• __:7�"L7 w�. I' ..:` ' Wrn9 irla,N� i�� - = 1 �:ia° - ^ieini n 81Ve 16.60 j
�• '� �I1�C' ".i`± . .r,i � ,,,,_. .d: .F '11b* . Y, ' ii, .,: :ij i.` i:.. _,., I 1
` � . •. C ,., . ....,, ._ : � .. .. .. .,1��:: =''' ;,ati�. °> = 13ac1�ow prevenfer � � Pngc ( d�
A16..%i r7 / G• C . ' /?r ;G ! .l 0 co ..g2
/ - Backwate valve 16.60
_Clothes washer 16.60 //_
i kr .:-,. :!'1 -
4044 ,.... _ fffff--�fff ----"„••••
y.: uO WjY ._ r= �h ;i,
,
Drinking foemtgen
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_ „a'.'.....: ( .d__..,.. • :,L:: •,.,,... N41�<� _ - :��.,• a a' � :�.�I'.- '1�N�APR-- -,.: _ 16,60
Name: - jectors/sump 16.60
Address:
Expansion lank 16.60
Fixture/sewer cap 16.60
City/State/21P: Floor drain/floor sink/hub / S` 16.60 ' r"1
Phone: ( r ��' , j 7� ,.der
:.+.�,,,.. � G arbage disposal
A UcAlpl _
s .
aFS; „ w�i t +cii - ° P; ii Hose bib
� „ ...4�� X 21, _ _ : "5�:
..I.._ � : ��D'iG'EINR'. aF�p)l',,, 1 16, 60
,! 1
name. l r '' ;f, f f- ^ �� t/,1 r57/i`' S Ice maker c f 16.60 /�.,, 64'; B
' hrocreeptor /gams trap 16.60
Contact name: 6-1 Ii'; �:� ?r?� /, �% r Medical $
'' edical gas (value ) Page 2
Address:
/7`7 - ( . :�(.•v l %: ^ 2'/ ✓ : ;(, '2i°•. YGq Pr 111 = j 16.60 41 ",5(. `
City/State/ZIP: ;' Z /� L! % . � 4f. Roof drain (commercial) 16.60
Phone: ( ` J r� (� - -, E. % (,!C Fax; : ( ) Sink/basutJlavaiory 1;1 1;,. G 16.60 %�f !�, �;`G
E -mail: Ta /showedshowcr pan 16.60
u'4 i.. , _ . �, i �A 11 :�vlwll.: .. mu,. -. ; iIIYY'' ,.JVL 7:=114.11. _ Urinal
_..�.... :1 :; .. I, .i R • . : :'7' � is ::iM` '.: tin 111 16.60
I
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:...._:. _. . T � „!_e!: :::'R.1..:: , r ,. : :iii a. .., : 1 6 . 60
''•„'. : :,_�. Water closet t t n
� Du.cincss mate. a � .. /.,fit � ' „ r ...... - ....._. _,,.�..,.. rl r 2_, M
Address: r /� / % %, ! :r i,t i/ I / <
_ .S Water heater / 1 j 16.60 /&. L. 0
/G // . , �- /�' //�G7 /�i.').r cc D . i ! _ Otbu: I o e- ir' :.. irLr. � l r J, • /_,(. n, i&-4^0
tv City/stat�L1P: ;,_ , ..) /..t .//! ; (A_ q
Subtotal �i?c�. 4c Phone: (;:7�) ji 7 F ` �) ,, Minimum permit fee: $1250
kl (<74 „ .� - z ► G G , S'' ("J_7 /5S Residential baeldlow minimum permit fee: $36.25
CCB Lic.: .. i ` 47 7 Plumbing Lic. no.:,?)--.3...-5,3 p8 Plan review (25% of permit fee)
Authorized sib/} - �� . �%, - State surcharge (12°% o f p eamit fee ) �j2
Print name: • "� J_ .� : � elti L6/_ :'7 / v .- TOTAL PeRMft
1 5 81.33
1./ i S S ' :;i !. :,: 11)atc:: _
L:../ � �G'. hr ' �'�`� � .��. � a% This permit
_ permit application expires if a permit is not obtained within
•_.J 180 days atter it has been accepted as complete.
*Fec methodology set by Tni-County Building Industry Service Board
I: -doe 12/27a16
440
•
•
''' 03/20/2009 16:26 FAX 5036680375 NORTHWEST WATER WORKS Z1002
. e Plumbin Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee le
Schedu• .
Schedule: � • r.., ; : , Residential Fire
. .. r ile § :�� ' ., . , • ....I h (es 7�. i
I�. ...L�., � � ": KI .,. .. : O�1 !� I 4: a� �nul•. , � t" Systems:
:: Suppression
Footing dram . 1'4100' 55.00 2 . 0 00 Foli a -F _..._I - Ivre tft iN,i: :,, i L
; n
... .. ,..�,: - ..,,., 1.:: ";.:
oto z,oao $125.00
Footing drain - each additional 100' 46.40 2.001 to 3,600 $160.00
r
Sewer - 1st 100' 55.00 _3,601 to 7,200 _$220.00
S r 7201 and der $309.00
Sewer -each additional 100'
46.40
Water Service - 1st 100' 55.00
water Service . each adaitioaal 100 46.40 Medical Gas Systems:
te
St orm & ,r.: ,
I tlaasc . .. . : . ..
_ train Drain ls 100' ;i?aiDr ^I ' :,+ ipe I
55.00 � :�':" 1: rli'1lf� „t;mnrs- ;,;w1- • . ••M1 �� ,.-77.12:
S1.00 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,
;� :., < - �, i s ^ $ 0 actio and eo 1 for each
; tRFi /riltellll : : •'IE ; ' < _ ". 010' x " - ee ' Cai) : ' : ItTatU1 r additional $100.00 or fraction thereo to and
Commercial Back Row Prevention Device 46 40 2 including $10,000.00.
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----- . • , (,�i $10,001.00 to 515,000.00 for the first o and for
Residential Backflow Prevention Device each additional ditional $100.. 00 0 fraction or fraction thea reoeo f to
(minimum permit fhe $3625) 27.55
Rain Drain. single family awn and iacludirtg $2
_ �B 65.25 $25.001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and Including $50,000.00,
Sab[otsl: l� � ` $50,001.00 and up $742.00 for the first $50,000.00 and $120 for •
-- ) each additional $100.00 or &action thereof
(cn- lij
Commercial Fixture Work: _r
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.
accurately report fixtures could result in increased sewer f- - *. 0 A ny new commercial building with wafer
.. , ,,. .. service
- ..'Nsll q . I � . r
g sery 2" and
r : ;1� ; ''•` ;. i4� u :� ;; �1� , - ? I�I�Qtinofl by `{FAittate)Wou k Pr i foripieiid ... greater, except systems designed and stamped by licensed
1-i ypc, ; ;:,t u ; ` :: :;;` ∎; , :i I'd" " i engineer.
1:.... ravlar�.. Cif'
P _ Badtrliak, ❑ New exterior plumbing site utilities for any complex structure •
Baptistry/Font as claimed in OAR918- 780 •0040. • Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler
Car Wash - F.ac]i Stall system.
-Drive Thru ❑Y complex structure as defined in OAR9l 8-780-0040.
Cuspidor/Water Aspirator Submit nets of plans with any of the above.
Dishwasher - Commercial /
-Domestic
Drinking Fountain t ._- .- . .... .........:_ . 11(��/iA� , ,.�� f_ 9y
Eye Wash Isometric or riser diagram is required for _.. _ ,.. �° W_..
— V .
in new buildings
Floor Drain/sink -2" 44, / : tha meet the qualifications above.
- 3" t ..
- 4"
Car Wash Chain - _ ' ,
Garbage - Domestic
Disposal -Commercial
Comments regarding fixture work:
-Industrial
Ice MachJRefrig, Drains 1-
Oil Separator (Gas Station) _
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
- Bradley - *Note. Lithe fixture work under this permit results in an
'Commercial « increase of sewer EDUs, a sewer permit will be issued and
Service 0 fees assessed for the sewer increase must be paid before the
_ Swimming Pool Fluter r
Washer - Clothes -- plumbing permit can be issued.
Water Extractor
Water Closet - Toilet .-
urinal '^
Other Fixtures: ;-k- q 1 r,;
1 :1 Building \PermilstF 1M-Pu App.doc (?127/06