Permit CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit #: PLM2013 -00094
TIGARDI 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/25/2013
Parcel: 2S102AB05800
Jurisdiction: Tigard
Site address: 12345 SW MAIN ST
Project: Symposium Coffee Subdivision: 1996 -026 PARTITION PLAT Lot:
Project Description: Cap (1) garbage disposal, (1) dishwasher and (1) sink, add (1) dishwasher, (3) 2" floor drains /sinks, (1) bar sink
and (4) food prep sinks.
Contractor: H & W MECHANICAL INC Owner: TIGARD AREA CHAMBER OF COMMERCE
14194 SW BARROWS RD #1 12345 SW MAIN ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 860 -1011 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 03/25/2013 $25.02 •
•
Specifics: 3 ea Fixture /Sewer Cap 03/25/2013 $75.06
3 ea Floor Drain/Floor Sink/Hub 03/25/2013 $75.06
Type of Use: COM 1 ea Ice Maker 03/25/2013 $12.51
Class of Work: ALT 5 ea Sink 03/25/2013 $125.10
Type of Const: 1 12% State Surcharge - 03/25/2013 $37.53
Occupancy Grp: Plumbing
Stories:
Total $350.28
•
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 obtainaopy of the rules
or direct q : • NC by -fling 503.232.1987 or 1.800.332.2344. ■
Issued = / Permittee Sign. ure:
MEM
Call 503.639.4175 by 7:00 a.m. for the next avail. ble insp• '• • • e.
This permit card shall be kept in a conspicuous place on the job - ite until co • pletion of the project.
Approved plans are required on the job site at the tim = • _ . - inspection.
Accumulative Sewer Tally
p Tenant Name: Symposium Coffee "CRI ?DI'1'S" SWR # N /,\
TIGARD Site Address: 12345 S \1' Main St PI,N1 # 2013 -00094
Parcel #: 2S102AB05800
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: - 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 /\Vater Aspirator 1 0 0 0 0 0
Dishwasher: - Commercial 4 0 0 0 0 0
- Domestic 2 0 1 2 1 2 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 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 1 -IP) 16 0 1 16 0 -1 -16
- Commercial (to 5 I IP) 32 0 0 0 0 0
- Industrial (over 5 I IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 1 1 1 1
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:
- l..av /Bar - Non -Food Related 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Com /Scrv/Util - Food Related 3 0 1 3 4 12 3 9
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 EDU Count 0 0
Capped EDU Credit 0
'1'0'1'A LS 0 0 3 21 8 19 5 -2
Current Fixture Value -2 divided by 16 = -0.125 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -2 divided by 16 = -0.125 over (under) 5 (606.45)
Enter EDU Change Here -0.130
Notes: * * *CRI:DI'1'S ** *Installing (1) 2" floor drain and (2) 2" floor sinks. Because the floor sinks are indirect waste for the food prep sinks,
only the sinks are assessed for EDU's.
Authorized Name /Signature: Debbie . \damski Date: 3/20/2013
Building Division
. Note: The property owner shall retain the ORIGINAL sewer rally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
l:\ Building \Sewer Tally \Sewer I'allvShect- 4665.xls 07/01/12
Plumbing Permit Application
'Mudding Fixtures R EEIV E FOR OFFICE USE ONLY
Rece ived
City of Tigard 2 Permit No.: Pa-001 , - 000 1
III g Date/By: / 3 ✓ F
I I 13125 SW Hall Blvd., Tigard, OR 97223 MAR 2 0 Z013 Plan Review t�,¢
0 Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit No.
T I G A R D Inspection Line: 503.639.4175 CITY
0F TG Da te Ready/By: !1'a I ' ' 3 / , 1 p Sufis: ® See Page 2 for n �
Internet: www.tigard-or.gov v' 1 to N otified/Method:'! ll L� Supplemental Information
BUILDING DIV ISION FEE* SCHEDULE F
❑ New construction i$ Demolition For special information use checklist
Description I Qty. I Ea. I Total C
I X Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 W
❑ 1- and 2- family dwelling tg Commercial/industrial SFR (2) bath 437.78 1
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family 01
Each additional bath/kitchen 25.02
0
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: N
Job site address: /23. s .. , (.t tom . Catch basin or area drain 18.76
G Drywell, leach line, or trench drain 18.76
City /State /ZIP: ...
T.y6 b ) OR., ) 1 Z'Z�j Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: ' ‘ . „ ,I 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.: _ 6 1 62 �Q §-$ QC7 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
teC.
_ _ -_- ` .� Clothes washer 25.02
ex4e-. 1 ( C \ G 14+2 Dishwasher / 25.02 Aco 9 "
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I C4 TENANT Expansion tank 12.51
' Fixture /sewer cap 25.02 75.
Name: PV1tN
`� Floor drain/floor sink/hub 3 25.02 75 PLO
Address: ��77e i S� /t .*t Garbage disposal 25.02
City /State /ZIP: 9 itke t u jonts ( 0 Q 19 7 j y D Hose bib 25.02
Phone: (5D3) f g - 02.( Fax: ( ) Ice maker / 12.51 /A. 51
Cit APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Sy � • - 1 \i - Primer 12.51
Contact name: ` w1 .u� VVV
Roof drain (commercial) 12.51
Address: _4296/ S, j�,. Sink/basin/lavatory 5 25.02 /A a
City /State /ZIP: i , � 0 Solar units (potable water) 62.54
Phone: (5b3) 91S-A2.6 % Fax: : ( ) Tub /shower /shower pan 12.51
E- mail: key 1 Urinal 25.02
KGV ttAl reSO4. GGC . CIAN••• • Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: .A, W MeAl..a. c la PC,. Water piping/DWV 56.29
Address: /!/ /5yy 5 g 3, m Other: 25.02
City/State /ZIP:" -1 �it I 0(24 • 7 z23 Subtotal (2,..7,5- Phone: (50g/ - 1 . 0‘) Fax: ( ) 4 Minimum permit fee: $72.50
CCB Lic.: % - 77, / Plumbing Lic. no.: / bb 13 Plan review (25% of permit fee)
State surcharge (12% of permit fee) 37 .S3
Authorized signature: �� TOTAL PERMIT FEE 36 • a
IA This permit application expires if a permit is not obtained within 180 days
Print name: ...<400,1-, • • te:3 Z-.0 )3 l 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
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 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: t' N► 6 c T�' / rjk5 I' O 11) �i 2 e-cT
Are you capping, adding or replacing fixtures? If "yes ", - Do )367 C'U� �T FLob2 vr- ��iS roe__
please indicate work performed by fixture. Failure to Eco6i2' ;
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
❑ Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Wash: -Each Stall New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
❑ Any multipurpose fire sprinkler system.
Dishwasher: - Commercial
- 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
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 / 9
- 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
Water Extractor fees assessed for the sewer increase must be paid before the
WaterCloset - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I: \Building'Permits\PLMF- PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
Of HI t • Tenant Name: SWR #
Site :Address: 1'I.A1 #
TIGARD
Parcel #:
Fixture Value Previous Previous Credits Capped I:ixture fixture New New
# value count capped #s value count added # added value total #s total values
liaprisery /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 ' IQ, 1 p2. 0 0 0
`�7
Drinking Fountain 1 0 0 0 0 0
Eve Wash 1 0 0 r/ 0 0 0
•- Floor Drain /Sink: - 2 inch 0 0 A( ( � 2 0 0 0
- 3 inch 5 0 0 ` 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 I -II') 16 0 L_ / 0 0 0 0
- Commercial (to 5 I -I P) 32 0 0 0 0 0
- Industrial (over 5 1 -IP) 42 0 0 0 0 0
Ice NI achinc /Refrigerator Drain 1 0 0 / 1 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:
- I.av /Bar - Non -Food Related 2 0 0 0 / 0 0 0
A D.n.ccAr
- Bradley 5 0 Q 0 Z rnrd,4e,e 0 0 0
- Cum /Scn /Util - Food Related 0 i , . 0 H /' 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 EDU Count 0 - I./ 0
Capped [DU Credit 91 0
'I'O"I': \I.S 0 0 0 7 0 _ 0 aq 0 0 0
Current Fixture Value 0 divided by 16 = 0.000 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided be 16 = 0.000 Previous [DU
Change 0 divided by 16 = 0.000 over (under) S -
Enter EDU Change Here 0.000
Notes: -0- /rib, 2.ccT = C , , o1JLV /1i , it PJo,t) r C 7(r
Authorized Name /Signature: Date:
Building Division
Note: The property owner shall retain the ORIGIN Al. sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the Ciry of Tigard Building Division to redeem credits towards future system development charges.
I: \Building \Sewer Tally \Sewerl'allvShect- 4665.xls 07 /01 /12
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12345 SW MAIN ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
05/01/2013 00:00
PLM2013-00094
FAIL
Had conference with plumber regarding flow control access, call for final when ready.
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12345 SW MAIN ST, TIGARD, OR, 97223
Commercial - Plumbing
320 Plumbing rough-in
04/11/2013 00:00
PLM2013-00094
FAIL
1. Provide direct connect for dishwasher drain
2. Provide water heater expansion tank
3. Provide trap on indirect waste for prep sink
4. Provide backflow protection on expresso machine
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12345 SW MAIN ST, TIGARD, OR, 97223
Commercial - Plumbing
320 Plumbing rough-in
04/15/2013 00:00
PLM2013-00094
PART
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12345 SW MAIN ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
05/01/2013 00:00
PLM2013-00094
FAIL
Had conference with plumber regarding flow control access, call for final when ready.
Violation Summary:
Inspector Contractor