Permit CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit#: PLM2014-00186
T f G A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/05/2014
Parcel: 2S 102AA00490
Jurisdiction: Tigard
Site address: 12085 SW HALL BLVD 130
Project: Arellano's Bar Subdivision: TIGARD HIGHWAY TRACTS Lot: 13
Project Description: Interior plumbing for bar:Adding(1)grease trap,(2)primers,(3)sinks,(1)water closet,(1)DWV,and capping(2)
3"floor sinks.
Contractor: MODERN PLUMBING Owner: HALL STREET CROSSING LLC
11120 SW INDUSTRIAL WAY BY MR&MRS ROGER W TOM
TUALATIN, OR 97062 8067 SW RIGERT COURT
BEAVERTON, OR 97007
PHONE: 503-691-6166 PHONE:
FAX: 503-691-6771
FEES
Quantity Description Date Amount
2 ea Fixture/Sewer Cap 06/05/2014 $50.04
Specifics: 1 ea Interceptor/Grease Trap 06/05/2014 $25.02
2 ea Primer 06/05/2014 $25.02
Type of Use: COM 3 ea Sink 06/05/2014 $75.06
Class of Work: ALT 1 ea Water Piping/DWV 06/05/2014 $56.29
Type of Const: 1 ea Water Closet 06/05/2014 $25.02
Occupancy Grp: 1 12%State Surcharge- 06/05/2014 $30.77
Stories: Plumbing
Total $287.22
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: 'ermittee 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.
Plumbing Permit Application a q 4r t tiq/ • , ,Q. k_
Building Fixtures FOR OFFICE USE oNl.l
City of Tigard n" 4.► t''f _ Received i Permit Nu.:
iiii
'I 13125 SW Hall Blvd.,Tigard,OR 9 _ Date/By:
S(/�( ,� P ��y-���
= Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No.:f,42,V U
Date/By: (t'(- U rl
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: f-un•�s� ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: / rV Supplemental Information
TYPE OF WORK 11.( 'JI ,q';4';�'i, FEE* SCHEDULE
:ANA!. .' .
New construction [g,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 correction)_
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling y 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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: t a 0 c s s w 1-1c.11 a(u J S V i,{r ISO Catch basin or area drain 18.76
City/State/ZIP: _ Drywell,leach line,or trench drain 18.76
d c r Or r7 7 I L 3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: n r Li(c n o a R a r 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: l Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
,P/(Ml p l)15 1-0 v- eq\)°‘-. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I P TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02 5w:oY
- -- _-
Address:
Floor drain/floor sink/hub
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 ZS. 0 Z
I Medical gas(value:$ ) Page 2
Business name:
nrella r,vs Ma;kef LCC
Contact name: Primer 12.51 c.o�
G M a r far e/(rs n o Roof drain(commercial) 12.51
Address: / 208 5 S 111 /a c 11 13 J Uri Sink/basin/lavatory 25.02
City/State/ZIP: '7 1•66 rd G r Solar units(potable water) 62.54 S�Q
Phone:(q a I ) 6 y s .. 68 2s Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
r� Water closet / 25.02
2S a
a CONTRACTOR Water heater 37.52
Business name: i .001 Water piping/DWV / 56.29
Address: `/f S tj -.V\,-,'ts* / L J:& , Other: 25.02
City/State/ZIP: -12, 4:4 6:4 0 '7U j 031%.,.i.i5
t Minimum permit fee: $72.5
Phone:( ) ti 1 -62./476 Fax:( _ ,)
• Plan review (25%of permit fee)
CCB Lic.: j a a o 3, Plumbing Lic.no.:81 966
State surcharge(12%of permit fee) X 172_
Authorized signature: , w---- TOTAL PERMIT FEE
r1 This permit application expires if a permit is not obtained wit I n 180 days
Print name: U TY1G r I I r c(i[>n d Date: (�_5_ / after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46161'(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 ect
Ins ions or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Inspections 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 Thru 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
4 ❑ 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
-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 aid before the
Water Extractor p
WaterCloset-Toilet - plumbing permit can be issued.
Urinal
Other Fixtures:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
■ . Tenant Name:ARELLANOS MARKET SWR#N/A
Ti t;n it i s Site Address: 12085 SW ITALI,BLVD SUITE 130 PI,M# 2014-00186
Parcel#: 2S102AA00490
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count (tipped#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 0 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 0 0 0
-3 inch 5 0 2 10 0 -2 -10
-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 1 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 0 3 6 3 6
-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 0
Capped EDU Credit 0
TOTALS 0 0 2 10 3 6 _ 1 -4
Current Fixture Value -4 divided by 16= -0.250 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -4 divided by 16= -0.250 over (under) $ (1,200.00)
Enter EDU Change Here -0.250
Notes: ***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 6/5/2014
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.
I:\Building\Sewer Tally\SewerTallySheet_4800._070113.xlsx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12085 SW HALL BLVD 130, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
FAIL
PLM2014-00186
George Heimos
1. Raise both soda machines drains and provide minimum 1" gap to sink.
2. Hand sink hard capped and not installed. Provide new permit when sink is installed
3. Recall inspection when corrections have been completed.
arellanos.contractor@gmail.com
503-367-7118
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12085 SW HALL BLVD 130, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00186
George Heimos
Violation Summary:
Inspector Contractor