Permit CITY OF TIGARD • PLUMBING PERMIT
I • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00358
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 ®�� ® Date Issued: 12/10/2012
Parcel: 2S110AB00200
Jurisdiction: Tigard
Site address: 14345 SW PACIFIC HWY
Project: Desserts of Distinction Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1 -4
Project Description: (2) grease interceptors. Reprinted 12/27/12, to add (2) floor drains, replumb (1) existing 3 -comp sink and add
DWV.
Contractor: PRO DRAIN & ROOTER SERVICE, INC Owner: KOLVE, G C
3300 NW 185TH AVE #213 14389 SW PACIFIC HWY
PORTLAND, OR 97229 TIGARD, OR 97224
PHONE: 503 - 533 -0430 PHONE:
FAX: 503 - 296 -2419
FEES
Quantity Description Date Amount
2 ea Floor Drain /Floor Sink/Hub 12/27/2012 $50.04
Specifics: 2 ea Interceptor /Grease Trap 12/10/2012 $50.04
1 ea Sink 12/27/2012 $25.02
Type of Use: COM 1 ea Water Piping /DWV 12/27/2012 $56.29
Class of Work: ALT 1 12% State Surcharge - 12/27/2012 $24.46
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $205.85
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 i ation Cente& Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire questions to OUNC •y calf • r 32.1987 or 1.800.332.2344.
Issu ad By: / A. 7/ Perm ittee Signatu •
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.
Plumbing Permit Application
Building Fixtures RECEIVED I (112 OFFICE USE ONI.I
City of Tigard Received I L NO`
'r 131 SW W Hall Blvd., Tigard, OR F ' r .r 3� 7 2012 Date/By: : /A.. 'i / J\ .9a/ �p� Permit No.: 4.04a•� 3
Phone: 503.718.2439 Fax: 503.' ` :. 9 Plan Review
nn Date /By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 V OF TIGARD Date Ready/By: tuns ® See Page 2 for
Internet: www.tigard- or.gov p�i
C � l rr l 1l c Notified/Method: Supplemental Information
TYPE ODlwOf 1 G 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 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
JO SITE INFORMATION AND LOCATION Site utilities:
Job site address: / MM y Catch basin or area drain 18.76
� � �� r7C.1 ~ I C / Drywell, leach line, or trench drain 18.76
City /State /ZIP:
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 1 8.76
Rain drain connector 1 8.76
Sanitary sewer (no. linear ft.: _ ) Page 2 X I--'
l ( r r Storm sewer (no. linear ft.: ) Page 2
V Water service (no. linear ft.: ) Page 2
bdivision: l Lot no.: Fixture or item:
Tax map /parcel no Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
11 G 4 Clothes washer 25.02
Ayr, C ?/ [ t-�2 ( ) �M P v l / O Dishwasher 25.02
- 77t_ 2..t_ plr j c �, 7� / / tgnri !)to Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.5 l
Name: Fixture /sewer cap 25.02
Floor drain floor sink/hub 47\ 25.02 56.
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 A-5,6).
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
n r \ Water heater 37.52
Business name: N.) Water piping/DWV / 56.29 6-6, .2.1
Address: Other: 25.02
City /State /ZIP:
Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized sign.. ' l h/ ,Ar j TOTAL PERMIT FEE ' , , '
Print name: :•al ( 1 ,r/ 7 "'""" Da e. 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 - 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 ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non -food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: - Lav/Bar non -food related
- Bradley
- Com/Serv/Util food related j
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I: \Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
ill Accumulative Sewer Tally
v
0 • Tenant Nano: Desserts of Distincticin***CREDITS*** SWR# N/A
Site Address: 14345 SW Pacific Hwy P1,�1#,2013-00358
TIGARD .
•
Parcel#: 2S110AB00200
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptistry/Font 4 0 0 0 0 0
Bath: -'fub/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
li ye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 2 4 2 4
-3 inch 5 0 0 0 0 0
-4inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 I-IP) 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:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 0 0 0
-Cum/Serv/Util-Food Related 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 0 0 0
Urinal 6 0 0 0 0 0
Previous 1•DU Count 0 0
Capped EDU Credit 2.5 40
TOTALS 0 0 0 0 2 _ 4 2 -36
Current Fixture Value -36 divided by 16= -2.250 Current EDU 1 EDU= $4,665.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -36 divided by 16= -2.250 over (under) S (10,49625)
Enter EDU Change Here r -2.250
Notes: 44 CRLDI'I S**42.5 Credits from PLA12012-00349 applied to this pemiit.
Authorized Name/Signature: Debbie Adamski Date:{ 12/27/2012, .
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.
I:\Building\Sewer Tally\Sewcr'I'allyShect-4165.xls 07/01/12
p CITY OF TIGARD REVISED PLUMBING PERMIT
' -
r
s COMMUNITY DEVELOPMENT I /dN (3-07-1 Permit #: PLM2012 00358
T 1G AR. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2012
R
Parcel: 2S 110AB00200
Jurisdiction: Tigard
Site address: 14345 SW PACIFIC HWY
Project: Desserts of Distinction Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1 -4
Project Description: (2) grease interceptors .
•
Contractor: PRO DRAIN :8; ROOTER SERVICE, INC Owner: KOLVE, G C
3300 NW 185TH AVE #213 14389 SW PACIFIC HWY
PORTLAND, OR 97229 TIGARD, OR 97224
•
PHONE: 503 - 533 -0430 PHONE: .___ _
FAX: 503 - 296 -2419
FEES
Quantity . Description . Date Amount
• 2 ea Interceptor /Grease Trap 12/10/2012 $50.04
Specifics: 1 12% State Surcharge - 12/10/2012 $8.70
Plumbing
Type of Use: COM 22 ea Minimum Fee Adjustment - 12/10/2012 $22.46
Plumbing
• Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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:
Ab 6r4 Permittee Signature: oil An epL n 11 0 6
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
• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00358
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2012
Parcel: 2S110AB00200
Jurisdiction: Tigard
Site address: 14345 SW PACIFIC HWY
Project: Bakery Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1 -
Project Description: (2) grease interceptors
Contractor: PRO DRAIN & ROOTER SERVICE, INC Owner: KOLVE, G C
3300 NW 185TH AVE #213 14389 SW PACIFIC HWY
PORTLAND, OR 97229 TIGARD, OR 97224
PHONE: 503 - 533 -0430 PHONE:
FAX: 503 - 296 -2419
FEES
Quantity Description Date Amount
2 ea Interceptor /Grease Trap 12/10/2012 $50.04
Specifics: 1 12% State Surcharge - 12/10/2012 $8.70
Plumbing
Type of Use: COM 22 ea Minimum Fee Adjustment - 12/10/2012 $22.46
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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: I , �` - , �t Permittee Signature: O`' Pitt CAWIJ
/�J�l�! Call 5 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.
To permit dept Pege 2 of 3 2012- 12 -07 00:23:24 (GMT) From: 000rge Rlsenmay
12- 06- 12;12 :35PM; From: ProDrai t ry To:5032962419 ;5035339376 # 1/ 2
Plumbing Permit Application I . 1
Site Utilities FOR OFFICE USE ONI,1'
DEC 0 6 2012
City Received
Tigard Datealy: (p1.' ID // a - S( Pcnn;t No.: PC Let o7V 0 - (gyp 3 S
• 13125 SW Hall Blvd., Tigard. OR 97223' r rTIG6pn Plan Renew
o Phone: 503.718.2439 Fax: 503.598.1 c9 a 11.3 1LJ Daley Other Permit No.:
T I c n It n Inspection Line; 503.639 BUILDING DIVISION Dale Retdy/ay: A h'1 Sec Page 2 for
Internet: www.tigard- or.gov Nolitied/Mclhod: r
1 � Supplemental Information
TYPE :OFF: WORK;:': ::::: : > :'::: ;:s:; .: FEE• SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. L Ea. I Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includct 100 R. tore each utility connection)
• I
CATEGORY OF CONSTRUCTION : ..- " :: " $FR .:. ( ) bath 312.70
❑ I- and 2- family dwelling EI Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ AeeeMe
ry g ❑ Multi- family
Each additional lath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. n.) Page 2
JOB SITE . INFORMATION :.AND:;LOCATION; ; : :; ;: °° Site utilities:
Job site address: 14345 SW Pacific Hwy Catch basin or area drain - 18.76
City / State/ZIP: Tigard. OR 97224 Drywe11, leach Iu1e, or trench drain 18.76
Footing drain (no. linear IL; ) Page 2
Suite/bldg. /apt. no.: , Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear R.: ) Page 2
Storm sewer (no. linear ft.: _ ,,J Page 2
Water service (no, linear It,: - ) Page 2
Subdivision: l Lot no.: Fixture or Item:
Tax map /parcel no.: Backflow prcvcnter 31.27
ReckwIItCr vulva
. DEstawnoi, : OF • WORRK ::::•; ::.:: :::.:;':::; ;' ::i;: ' ` � • ".
Clothes washer 25.02
InstailV grease interceptors
Dishwasher 25.02
A Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ; . •::I :: : ':: i:❑ .xg$ANT ?: >: ; :: > :: 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:( ) la: maker 12.51
❑. �y-
Interceptor/ ety_{
:APPLICANT ❑7;CONTACTSPERSON:;;zi: �A 25 .02
Business name: Medical gas (value: S ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51 ;
Address: Sink/bneln/lavatory _ 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub/>irowar /shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR .. >. •. Water closet 25.02
Water heater 37.52
Business name: ProDrain & Rooter Service Water piping/DWV 56.29
Address: 3300 NW 185 #213 Other: 25.02
City/ State/ZIP: Portland, OR 97229 Subtotal 50. 0 t '
Phone: (503) 533-0430 Fax; (503) 296 -2419 Minimum permit fee: $72.50 1 Z. SO
CCB Lie,: 108504 j 51(4 Plumbing Lic. no.: 26 -776PS Plan review (25% of permit fee)
State surcharge (12% of permit fee) TJi'1 0
Authorized signature: I j V / TOTAL PERMIT FEE e ( ,D
I Print name: Lisa Bolkc ` "j Date: 1214 /12 This permit application expires if a permit le not obtained within 180 days
after It has been accepted as complete.
*Pea methodology Rot by Tri- County Building Industry Service Board.
1:\ naildlla \Paroit974MU- PamitApp.d°c 10/01109 440.4616T(10/02/COM/Wat)
To: pormit dept Pogo 1 oT 3 2012- 12 -07 00:23:24 (O MT) From: Oaorga Rlaon may
FAX COVER SHEET
TO permit dept
COMPANY city of tigard
FAX NUMBER 15035981960
FROM George Risenmay
DATE 2012 -12 -07 00:25:27 GMT
RE
COVER MESSAGE
www.efax.com