Permit (174) CITY OF TIGARD PLUMBING PERMIT
V
• COMMUNITY DEVELOPMENT Permit#: PLM2016-00018
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/19/2016
Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Food Court Subdivision: PALMER ACRES Lot: 3
Project Description: Plumbing fixtures for tenant improvement of food court: Relocate(1)2"floor drain,replace(3)sink fixtures.
Contractor: ROCK CONSTRUCTION INC Owner: COSTCO WHOLESALE CORPORATION
PO BOX 2118 PROPERTY TAX DEPT 111
WILSONVILLE, OR 97070 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 503-568-4043 PHONE:
FAX
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 01/19/2016 $25.02
Specifics: 3 ea Sink 01/19/2016 $75.06
1 12%State Surcharge- 01/19/2016 $12.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 503.639.4175 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.
PlumbinE Permit ApplicationRECE1 V E B
Building Fixtures
City of Tigard JAN 19 2016 7fifid,Meth.Yd:
ermit N„�z-ya13125 SW Hall Blvd.,Tigard,OR 97223, 4fVM11GsuVPhone: 503.718.2439 Fax: 503.598. :-l[� Other Permit�T/�f� e (�Inspection Line: 503.639.4175 ��JrLD�I�i '�FI^��Sll/ y: Jurs: ® See Page 2[or
Internet: www.tigard-or.gov r ' tod: Supplemental Information
AF WORK' >� . ;at^*", l+EE• SCaED�I� s
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 R.for each utility connection)
" GAT # OF'COf�STR,,, SFR(I)bath 312.70
a=
❑ I-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
❑Accessory g buildin Multi-family SFR(3)bath 500.32
❑
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: 5-b SW Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: I tt Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: +Co 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.:
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
'DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
iirlr Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
[] PROPERTY 1OWNE111L ❑ TENANT Expansion tank 12.51
Name:
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
'CANT : - ❑ CONTACT PERSON Interceptor/grease trap 25A2
Business name: Medical gas(value:$ ) Page 2
w
Prima Int-4 12.51
Contact name: 62,
Roofdrain(commercial) jP f^ V1 12.51
Address:
(3 Sink ?S'0(6
, J
City/State/ZIP: � l 0'n I O O Solar units(potable wa 62.54
Phone:(ST3) 5-6 H DY Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
. .� CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: 3^r-. Water piping/DW V 56.29
Address: 10,O it Other 25.02
City/Siete"': GJ� 4l Q '7p-7 D Subtotal
Phone:(903 ) 15'68.If 0 q Fax:( ) Minimum permit fee: $72.50 foo in
CCB Lie.: /2 7 70 Plumbing Lic.no.: Irq 10Plan review (25%of permit fee)
State surcharge(12%of permit fee) 1;2.01
Authorized signature: TOTAL PERMIT FEE 1112, 011
Print name: L Date: 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.
1:Building Permlts PLMU-PermilApp--doe 100100 440-4616T(1002 COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
`Site Utilities , Rty, Fee(to) oud Squire Footage. I Permit Fee
Footing drain- I" 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: tee:
Storm&Rain Drain-I st 100' 62.54 S1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to SI0,000.00 $72.50 for the first$5,000.00 and$1.52 for
V Wer k$... (. .QfS.' �LO�ie�} a 1 each additional$100.00 or fraction thereof,to
WlL 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 90.004ir 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 5379.50 for the first$25,000.00 and 51.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including 550,000.00.
Additional plan review for revisions 90.00/hr $50,001 AO 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
uand by Fixture Type Plan review is required for any of the following.
Fixture Typefor Replace/ Please check all that apply.
Work Performed: Capped Added le ❑ Anv new commercial building with water service 2'-and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacum/Whirl ool engineer.
ElCar Wash: -Fath Stall New exterior plumbing site utilities for any complex structure
rive Tltm as defined in OAR918-780-0040.
-D
Ctrs idor/Water
-Drive
T ElMedical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
-Domestic ElAny complex structure as defined in OAR918-780-0040.
Di inking Fountain
Eve wash Submit 2 sets of plans with any of the above.
FloorDrain/s'ink: -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/Refri .Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Sery/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
011ier Fixtures:
l:ABuildingvPennitsVPLMF_PennitApp.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
7850 SW DARTMOUTH ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00018
Don Sylvester
1. Corrections are complete - plumb. final approved
Violation Summary:
Inspector Contractor