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Permit CITY OF TIGARD PLUMBING PERMIT s COMMUNITY DEVELOPMENT Permit#: PLM2014-00114 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2014 TI C;.1 R I? 9 Parcel: 1 S 126CA01000 Jurisdiction: Tigard Site address: 9009 SW HALL BLVD 145 Project: Bambuza Vietnam Kitchen Subdivision: FAIRVIEW PLACE CONDO Lot: 20 Project Description: Interior plumbing for TI:Adding(1)domestic dishwasher,(7)2"floor drains,(1)Ice maker,(1)grease trap,and(6) sinks. Contractor: HILDEBRAND PLUMBING Owner: CAFARO NORTHWEST PARTNERSHIP 4480 SW 96TH AVE UNIT#10 PO BOX 422 BEAVERTON, OR 97005 FLORHAM PARK, NJ 07932 PHONE: 503-686-0854 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Dishwasher 04/15/2014 $25.02 Specifics: 7 ea Floor Drain/Floor Sink/Hub 04/15/2014 $175.14 1 ea Ice Maker 04/15/2014 $12.51 Type of Use: COM 1 ea Interceptor/Grease Trap 04/15/2014 $25.02 Class of Work: ALT 6 ea Sink 04/15/2014 $150.12 Type of Const: 1 12%State Surcharge- 04/15/2014 $46.54 Occupancy Grp: Plumbing Stories: Total $434.35 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: ` ■A1111111APIPIFIr 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 of the project. Approved plans are required on the job site at the time of each inspection. CITY OF TIGARD SEWER CONNECTION PERMIT a COMMUNITY DEVELOPMENT Permit#: SWR2014-00033 T[G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2014 Parcel: 1 S126CA01000 Jurisdiction: Tigard Site address: 9009 SW HALL BLVD 145 Project: Bambuza Vietnam Kitchen Subdivision: FAIRVIEW PLACE CONDO Lot: 20 Project Description: 1.88 EDU increase. Contractor: Owner: CAFARO NORTHWEST PARTNERSHIP PO BOX 422 FLORHAM PARK, NJ 07932 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 04/15/2014 $1.824.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: 1.88 Total $1,824.00 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: =,_ _ _� Permittee Signature: Call 503.63'.4 by 7:00 a.m.for the next available inspection . This permit card shall be kept in a conspicuous place on the job site until completion of the proj t. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application ' 420 ,5' l Ai,/,4- 101'00 Building Fixtures �j i ()R OFFICE USE ONLY City of Tigard ti Received �I �r Date/By: 41 /S I1 6.�` YermitNo.: �ma(�y-t�Ily 711 • 13125 SW Hall Blvd.,Tigard,OR 97223 A Plan Review u ■ Phone: 503.718.2439 Fax: 503.598.19 Other Permit No.: /3 '/o2O H_0000t Date/By: Inspection Line: 503.639.4175 1N Date Ready/By: Luria: la See Page 2 for T I C,A R D Internet: www.ti ardor. ov (U y y ..f , g g g 1 'J_. Notified/Method: '_L Supplemental Ioformatiou TYPE OF WORK 7�1G0 FEE* SCHEDULE ❑Ne construction ❑De af�t1 v1 Fors ecial in ormation use checklist �� v Y� Descri tion iT Ea. Total Addition/alteration/replacement ❑o .1%�1 New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTR:Oil ON SFR(1)bath 312.70 1:1 I-and 2-family dwelling /: Commercial/industrial SFR(2)bath 437.78 ❑Accessory building SFR(3)bath 500.32 ry g ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder El Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: G7GD 9 L-'� �4/ /YS"' Catch basin or area drain 18.76 City/State/ZIP: ' 4 G," ��23 F otin drain line,or trench drain age 2 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: y�5`- I Project name: ;�e3/P1 ef(/.7/47 'arY` Manufactured home utilities 50.03 Cross street/directions to job site: gi-e^/ 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.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 �N // A9 'SCr40 7/ � F� Ay / Clothes washer 25.02 Cv / / U Dishwasher / 25.02 /2$ Lid 444/47/ 4/i �4ve9'52 /�f� �/1 6fs�s�r/t�j-=fie'��f`''�'y Drinking fountain 25.02 3 C&......77,67 c.57/n,•<- Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor siric/hub ? 25.02 I-1 c. 1 Y Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker / 12.51 a. 5-7 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap ( 25.02 At". O,Z Business name: /��y� /VG A e5jy� Medical gas(value:$ ) Page 2 ',' Primer 12.51 Contact name: C`j,,Coif- , Address: /L/G fjf /� Roof drain(commercial) 12.51 7! OG L5� 9' . L 1/€ Ut"f Sink/basin/lavatory lit‘ 25.02 (S-2), IA City/State/ZIP: (:: il/P/7G/t/ t.V Solar units(potable water) 62.54 Phone:63 )(16-- - SV Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: l_iZ?,77. Water piping/DW V 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal 31r7 E( Phone:( ) Fax:( ) / Minimum permit fee: $72.50 CCB Lic.: �9' , y y>I b/1q Plumbing Lic.no. //��7/I/ilgr Plan review (25%of permit fee) I //! State surcharge(12%of permit fee) 1. i&,Sit Authorized signatur • ' TOTAL PERMIT FE �Lr 3 Print nam /,4er/ /7/4/ ‘/re:;,... c� Date:y/S--/y This permit application expires if a permit is not obtained wit in 180 days after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permita\PLMU-PermitApp.doe I0/01/09 440-4616T(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-lS'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 Re inspection 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 ❑ 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: -Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Stall as defined in OAR918-780-0040. 1:1 Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. -Domestic El 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" S' 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: -LavBar non-food related • 5' -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 WaterCloset-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Accumulative Sewer Tally s Tenant Name: BAMBUZA VIETNAM KITCHEN SWR# SWR2014-00033 TI G 110) Site Address: 9009 SW HALL BLVD#145 PLM# PLM2014-00114 Parcel#: 1S 126CA01000 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values _ Baptisery/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 0 1 2 1 2 Drinking Fountain 1 0 0 0 0 0 lyre 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 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 HP) 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 Living Unit 16 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 -Com/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 EDU Count 0 I 0 Capped EDU Credit 0 TOTALS 0 0 0 _ 0 3 6 _ 3 6 Current Fixture Value 6 divided by 16= 0.375 Current I:DU 1 EDU= $4,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 6 divided by 16= 0.375 over (under) $ 1,824.00 Enter EDU Change Here 0.380 Notes: Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 4/15/2014 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\SewerTallySheet_4800._070113.xlsx III Accumulative Sewer Tally ■ Tenant Name: BAMBUZA VIETNAM KITCHEN SWR# SWR2014-00033 Site Address: 9009 SW HALL BLVD#145 PI.M# PLM2014-00114 TIGARD Parcel#: 1 S 126CA01000 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values _ Baptisery/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 0 1 2 1 2 Drinking Fountain 1 0 0 0 0 0 Eye 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 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 HP) 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 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Station) 6 0 0 0 0 0 Rec.Vehicle Dump station 16 0 0 0 0 1) 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 -Com/Serv/Util-Food Related 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 _ 0 0 (1 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 TOTALS _ 0 0 _ 0 _ 0 3 6 3 6 Current Fixture Value 6 divided by 16= 0.375 Current EDU 1 EDU= $4,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 6 divided by 16= 0.375 over (under) $ 1,824.00 Enter EDU Change Here 0.380 Notes: Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 4/15/2014 Building Division ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges. r 1:\Building\Sewer Tally\SewerTallySheet_4800._070113.xlsx Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9009 SW HALL BLVD 145, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2014-00114 George Heimos 1. Tail piece for front hand sink over maximum distance of 24". 910.5 2. Provide trap on dishwasher indirect drain, over 5'. 803.0 3. Provide trap on food prep sink indirect drain, over 5'. 803.0 4. Provide 3/4 grate on front left ﬂoor sink in front of hand sink. 310.4 5. Vacuum relief valve installed on water heater is required when above ﬁxtures. 608.7 6. Provide a dye test on both sanitary and grease waste, to verify there is no cross connection to storm sewer. 1101.2 7. Recall inspection when corrections have been completed. Re-inspection required. 103.5.6.1 Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9009 SW HALL BLVD 145, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2014-00114 George Heimos NOTE Did dye test on sanitary sewer from tenant toilet and checked at downstream manhole, pass Violation Summary: Inspector Contractor