Permit q
11111 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2014-00352
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/05/2014
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 17
Project: Mizumi Buffet Subdivision: FREWING'S ORCHARD TRACTS Lot: 15
Project Description: Remodel existing restaurant.Adding(1)3"floor drain/sink,(2)non-food sinks&(1)food sink.Replacing/relocating
(1)dishwasher&(5)3"floor drains/sinks.
Contractor: FAR WEST PLUMBING Owner: ROIC OREGON LLC
PO BOX 597 8905 TOWNE CENTRE DR, STE 108
ESTACADA, OR 97023 SAN DIEGO,CA 92122
PHONE: 503-318-5148 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 11/05/2014 $25.02
Specifics: 6 ea Floor Drain/Floor Sink/Hub 11/05/2014 $150.12
1 12%State Surcharge- 11/05/2014 $34.53
Type of Use: COM Plumbing
Class of Work: ALT 3 ea Sink 11/05/2014 $75.06
Type of Const:
Occupancy Grp:
Stories:
Total $284.73
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 N. - ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or di t questions to OU`. .y 503.232.1987 or 1.800.332.2344.
I--ued By: Permittee Signature:
V �t Lu `LL
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.
tPlu in Permit A lica CEIVEI�
Building Fixtures FOR OFFICE USE ONLI
II Ty Received /�' �I ._ �- - `,t / �O3 J
CI of Tigard ��J, Permit No.: [,J'TyL�
13125 SW Hall Blvd.,Tigard,OR 9N31 2 9 2014 Plan Review
to
• Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No. 22.z:,/4-C(1!/y
TIGARD Inspection Line: 503.639.4175 CITY�c,�r,,�„�� Date Ready/By: h„rn: la See Page 2 for
Internet: www.tigard-or.gov �• 1 I !(J K Notified/Method: Supplemental Information
TYPE oguldliiN. DIVISION FEES SCHEDULE
❑New construction ❑Demolition For special information use checklist.
s '.tion I Qty. I Ea. I Total ( s
®Addition/alteration/replacement ❑Other: New 1- ndly dwellings(includes 100 ft.for each utility c. ection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.71 .,
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 78
SFR(3)bath 500.32 ■
❑Accessory building ❑Multi-family fi
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: 13500 SW Pacific Hwy Catch basin or area drain 8.76
Drywell,leach line,or trenc I i rain 18. .
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear '.: ) Page 2
Suite/bldg./apt.no.: Project name:Mizumi Buffet Pk Manufactured home tlities 50.03 ■
Cross street/directions to job sic:McDonald Brit) 1 Manholes 18.76 IM
I l Rain drain co nector ■ 18.76
Sanitary••wer(no.linear ft.:_) Page 2
p Jd' - v� ` - Sto • sewer(no.linear ft.: ) Page 2
G•` •,_ t W.ter service(no.linear ft.: ) Page 2
Subdivision: I. Lot no.: Fixture or item:
Tax map/parcel no.: ..:2 /o g ice.oc 5 OQ Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Remodel Existing Resturant
Dishwasher i 25.02 ,2S•0.1
Add a hood Drinking fountain 25.02
Relocate a interior door and coke dispensor Ejectors/sump 25.02
❑ PROPERTY OWNER I ® TENANT Expansion tank 12.51
Name:David Chen Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02 /5-6. L2-
Address: 1119 SE 163rd Place
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98683 Hose bib
(!J�it t 25.02
Phone:(541)441-0178 Fax:( ) Ice maker .# '_1 • 4ii � i
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 1 I SI1� 25.02
Business name:Convergent Pacific
Medical gas(value:$ )jt� • Page 2
. Primer , • 12.51
• Contact name: Hardy Li �Z
Roof drain(commercial) t1'S' 12.51
Address:8975 Sw Center St Sink/basin/lavatory :
City/State/ZIP:Tigadr,OR 97223 Solar units(potable water) 62.54
Phone:(503)747-3569 Fax::(503)747-3579 Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name;-Fs-Bt,bid Aels2. j -)'f JL /f.-1 j/ _ ,
ater piping/DWV 56.29
Address: PC) �� ' Other: 25.02
City/State/ZIP: E67-,10A-Doc) t ��j Subtotal •
I j , Minimum permit fee: $72.50
E
it inl' 6z3) 3_i . 5/4 Fax:( )
r ti. --< f Plan review (25%of permit fee)
C: Li .. 7 1`� Plumbing Lic.no.: g 3 a
/ State surcharge(12%of permit fee) ).°
/�-' rali
� ilhori�Ced signatu f f F� TOTAL PERMIT FEE
This permit application expires If a permit is not obtained within 180 ys
Print name:Hardy Li Date: 10/27/14 after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Boa taro
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
I
'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
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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
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 i 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate 9 y g
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thni ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 1 ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
• Eye Wash
. Fipor Drain/sink -2" Submit 2 sets of plans with any of the above.
. -3" I 6j
Lae Isometric or Riser Diagram
Car Wash Drain Domestic-non-food
❑ Isometric or riser diagram is required for new buildings
$poi;al -Domestic-food related that meet the qualifications above.
hl•k''1'i !' -Commercial--food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) -.4-y1 Comments regarding fixture work:
Rec.Vehicle Dump Station L)(t* r e Shower -Gang (`•o"'
-Stall 1.° c')
Sink/Lav -Non-food related 1, ' p-,� . 2
-Bradley I_ P ,Lad
-Commercial-food related' LrQ
-Service
Swimming Pool Filter ii/5 *Note: If the fixture work under this permit results in an
Washer-Clothes 4.,1 '
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
\\WIN2008\Projects\200I2-Mizumi Buffet\PLMF-PermitApp.doc 2
PlumbinE Permit Application
Building Fixtures FOR OFFI('F. USE nNl.l
RECIuFD Received // �/�,�/ -06 City of Tigard _ /2 /1 . Permit No.: N(U vl s
r� 13125 SW Hall Blvd.,Tigard,OR 9723 Plan Review:
Eril
'i Plan Re
Phone: 503.718.2439 Fax: 503.59 -1919 8 '',, 4 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 CITY 01-f Date Ready/By: luris ® See Page 2 for
Internet: www.tigard-or.gov i Notified/Method: Supplemental Information
TYPE OF 1 ' 1 FEE* SCHEDULE
❑New c nstruction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
ddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCT! N SFR(1)bath 312.70
El m
1-and 2-family dwelling omercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family ,C.
Each additional bath/kitchen 25.02
1:1 Master builder 12 Other: t
Fire sprinkler( sq.ft.) Page 2 C.
JOB SITE INF,RMATION AND LOCATION Site utilities: O
Job site address: / 3'50 5w' ', ej t.c_ , Catch basin or area drain 18.76
City/State/ZIP: 'rr au Ye( B Drywell,leach line,or trench drain 18.76 0)
J Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: /7 I Project n: :'Ill e t fr WL J 63 ez i'r>✓4-- 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.: Backflow preventer 31.27
DESCR ' ION OF WORK Backwater valve 12.51
d 1 3 ! , J,< s'� '..I/d Clothes washer 25.02
fY ,,`` Dishwasher I 25.02
`TGv D //( Cl S ' f /. f po- P142101 Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPER OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 4 . 25.02
Address:
Garbage disposal 25.02•Q../City/State/ZIP A Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT l i ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer
Contact name: `Zf
Roof drain(commercial) 12.51
Address: O Sink/basin/lavatory Z 12.51
02
City/State/ZI : V Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail:
Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: fit iv Q az in "i4- Water piping/DWV 56.29
Address: 1> 0 (j&..( A--97 Other: 25.02
City/State/ZIP: L--'6'...ka"!� 6,4 9 70 2_3 ,Ik I �i _ Subtotal
Phone:(5j03) 3/i''.rl z Fax:( ) p8 3-.0(44, Minimum permit fee: $72.50
CCB Lie.: ?g �9 �� t6 Plumbing ,�f 3 3.fi
Plan review (25%of permit fee)
( Plumb' Lic.no.
State surcharge(12%of permit fee)
Authorized signature: qtr_____7 q TOTAL PERMIT FEE
Print name: 0 C v G,,. 'L k R- Date: Z )..../1 /l Cif This permit application expires if a permit is not obtained within 180 days
L after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
L\Building\Pennits\PLMU-PermitApp.doc 1 0/01/09 440-4616T(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-In 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
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
uantiy by Fixture Tee-) Plan review is required for any of the following.
Fixture Type for acd Please check all that apply.
Work Performed: kelocat ❑ Any new commercial building with water service 2"and
Baptistry/Font 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
-Drive ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial CI 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: -LavBar non-food related 2.
-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 p
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
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
13500 SW PACIFIC HWY 17, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00352
George Heimos
Violation Summary:
Inspector Contractor