Permit CITY OF TIGARD PLUMBING PERMIT
III 2 COMMUNITY DEVELOPMENT Permit#: PLM2013-00267
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2013
Parcel: 2S 113AB00600
Jurisdiction: Tigard
Site address: 16165 SW 72ND AVE
Project: CCK Restaurants LLC Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Install(1)laundry tray,(1)hose bib&(1)water heater.
Contractor: DEAN WARREN PLUMBING& REMODELING INC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 14701 ATTN: N PIVEN
PORTLAND, OR 97293 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-236-4152 PHONE:
FAX: 503-296-2218
FEES
Quantity Description Date Amount
1 ea Hose Bib 08/05/2013 $25.02
Specifics:, 1 ea Laundry Tray 08/05/2013 $25.02
1 ea Water Heater 08/05/2013 $37.52
Type of Use: COM 1 12%State Surcharge- 08/05/2013 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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 B
IC
06...0 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�f the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applic:4,'1,,
i EIVED
Building Fixtures ioi OFrlcl'; USE ONLY
City of Tigard AUG 5 2013 Received ? 6_ /3 PermitNo.: pLM�/3-Odo7
IIIII I: U 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: EIWO OTIGARD Plan Review Other Permit No.: ,2 2
Inspection Line: 503.639.41 Date/By: tvQ�1 7'OOt 7y
T I G A R D $UILDING DIVISION Date Ready/By: lads: 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
. TYPE OF WORK ,. ., • '.. , . FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total W.,
liCI Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) Ud
CATEGORY OF CONSTRUCTION' • ' SFR(I)bath 312.70 l
❑ 1-and 2-family dwelling '�Commercial/industrial SFR(2)bath 437.78 O
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02 ''
❑Master builder ❑Other: v
Fire sprinkler( sq.ft.) Page 2
. JOB SITE INFORMATION•AND LOCATION Site utilities:
•Job site address: (e.�1C S 5tz 9•Z u Catch basin or area drain 1 8.76
City/State/ZIP: -rib� re_ 91-Z7.-� Drywell,leach line,or trench drain 18.76
n! Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: CL.._k_11.1Z0.3.17 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: O`S!/ 31.-0 0c4 Backflow preventer 31.27
DESCRIPTION OF.WORK K . Backwater valve 12.51
1 ij Leki lOkDe l Clothes washer 25.02
' ,, Dishwasher 25.02
``,^,--
k t xOJ'E Q I bb Drinking fountain 25.02
• c(6,k.)Trr`(2-ti•- 0A (z.- Kt fgTf Ejectors/sump 25.02
❑ PROPERTY,OWNER ' • l . ' . ❑,TENANT Expansion tank 12.51
Name: Pao T 61- Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 153 S oime - Garbage disposal 25.02
City/State/ZIP: `l 2-Z--NA 1 Hose bib I 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT , ❑ CONTACT'PERSON Interceptor/grease trap 25.02
Business name: ,D«0 W'AR�E� Medical gas(value:$ ) Page 2
n A Primer 12.51
Contact name: �p 1� ej
Roof drain(commercial) 12.51
Address: Pb 60,1, Qj Lilo i Sink/basin/lavatory , 25.02
City/State/ZIP: IRO a:I-LA A D 0 a C� 7P13. Solar units(potable water) 62.54
Phone:(5t6 ) lC{StP Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
'CONTRACTOR Water closet 25.02
' " Water heater 1 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal U
Phone:( ) Fax:( ) D 7'
Plan review (25%of permit fee)
CCB Lie.: 6C-` kl. Plumbing Lic.no.: Z. 'b
State surcharge(12%of permit fee) /O S/
Authorized signature
�r TOTAL PERMIT FEE �g.o7
Print name:Cb $�� � Dater S- 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 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 ,1
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the ualifications above.
Garbage -Domestic non-food qualifications
-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: -LavBar non-food related
-Bradley
-Com/Serv/Util food related
-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:
1:\Building\Permits\PLMF-PermitApp.doc 08/04/2011 2