Permit (73) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00530
TI[;,k R n 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19/2016
Parcel: 1 S 136DB02400
Jurisdiction: Tigard
Site address: 11640 SW PACIFIC HWY
Project: Tacos&More Subdivision: None Lot: None
Project Description: Interior plumbing:Replacing(1)dishwasher,(2)floor drains,(1)ice maker,(1)grease trap,and(6)sinks.
Contractor: AFFORDABLE RESTAURANT HOODS SALES&INSTA Owner: CHAMPION, RONALD V&ROBERTA E
2121 SE OCHOCO ST 16449 LEXINGTON CT
PORTLAND, OR 97222 LAKE OSWEGO, OR 97034
PHONE: 503-805-1463 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 10/19/2016 $25.02
Specifics: 2 ea Floor Drain/Floor Sink/Hub 10/19/2016 $50.04
1 ea Ice Maker 10/19/2016 $12.51
Type of Use: COM 1 ea Interceptor/Grease Trap 10/19/2016 $25.02
Class of Work: ALT
6 ea Sink 10/19/2016 $150.12
Type of Const: 1 12%State Surcharge- 10/19/2016 $31.53
Occupancy Grp: Plumbing
Stories:
Total $294.24
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 is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Util" - Notification Cen- Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
direct questions to OUNC a ' g 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.
Plumbing Permit Application
Building Fixtures c11410)
City of Tigard Received
`J gPermit No.: `/"
11111 ll a 13125 SW Hall Blvd.,Tigard,OR 972 G PlDan Reviewte/By: C r,/ia/u,
err
' �L�, f tl!` �S
Phone: 503.718.2439 Fax: 503.598.1960 (� 201U Other Permit No.:
t DateBy:
Inspection Line: 503.639.4175 t t` 1
C I G n R D pp1,�Date Ready/By: loris: El See Page 2 for
Internet: www.tigard-or.gov v ,fit; 1ii�A Cf Notified/Method: 7-- ,, Supplemental Information
TYPE OF WORK aC l rav S% FEE* SCHEDULE
❑New construction 0 1 t i For special information use checklist
�/ Description �� Qty. Ea. Total
LTJ Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-and 2-family dwelling E3Commercial/i•
ndustrial
• SFR(2)bath 437.78
0 Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION.AND LOCATION Site utilities:
Job site address: LI WO 51).) QA11 i Olijr Catch basin or area drain 18.76
Drywe. „_^ /,
Footing
1,leach line,or trench drain 18.76
City/State/ZIP: (ylrt wgl L, "� Z2{�,��� Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: `t r a: 4 004. Manufactured home utilities 50.03
Cross street/directions to job site: C?W Pte(F` fi-tA !' 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 ff.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
M0 la `,�,L 1. n 76 r 4,N Clothes washer 25.02
Qtt ��V &02 - j`K•1A'�/ Dishwasher ' 25.02 AS-,c9,
i w�'• 0 Know 7. Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 1 [WTENANT Expansion tank 12.51
Name: (jI ,PONT 6M. Fixture/sewer cap 25.02
Address: tt tj A �, Floor drain/floor sink/hub ?/ 25.02 5()„Oil
Garbage disposal 25.02
City/State/ZIP: L-K•041,44,0 DV.. 41-40134• Hose bib 25.02
Phone:60 ) Zj(-{-04.$1 Fax:( )) Ice maker 1 12.51 ,i_,..,
❑ APPLICANT L1eCONTACT PERSON Interceptor/grease trap 1 25.02 ,L')...
Business name: RD 4 f% L4 L(Ty 0.44iNi IA ti Medical gas(value:$ ) Page 2
Contact name: 1� �
' I _. Primer 12.51
V
Roof drain(commercial) 12.51
Address: ?j N a C ()* '„_ Sink/basin/lavatory (f 25.02 56)r j,,,
City/State/ZIP: osalThUli7 4... q 1-7,.)1' Solar units(potable water) 62.54
Phone:Orb; ) ill-. 4.2friI Fax::( ) Tub/shower/shower pan 12.51
E-mail: F Q� L,.LT'(P(�iet4447 a �JVU4iL.. cfry4 Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
i L1r
Business name: AIk 9404:4-44141* Water piping/DWV 56.29
Address: 'i•I 14 47t. 4060-ow s'r • Other: 25.02
City/State/ZIP: PQM ,(7 2 ZV ,Subtotal 7
Phone:(y714) 5'.• �� Fax:( ) \l l Minimum permit fee: $72.50
CCB Lic.: l 9 A___ Plumbing Lic.nok i 7f t, 1�`411 Plan review (25%of permit fee)
11
State surcharge(12%of permit fee)
Authorized signal A
i.19, TOTAL PERMIT FEE it A
Print name: k�0.d�NTa` V This permit application expires if a permit is not obtained within 180 days
� Date: ��• 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' 62.54Medical 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
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*.
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
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greeter,except systems designed and stamped by licensed
Car Wash -Each Stall engineer. •
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspiratoras defined in OAR918-780-0040. -
Dishwasher -Commercial I ..,./-- 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918.780-0040.
Eye Wash
Floor Drain/sink -2" ?i ✓ Submit 2 sets of plans with any of the above.
3"
4,, Isometric«Ρor Riser Diagram
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains .
Oil Separator(Gas Station) CommentS'regarding fixture Work: '
Rec.Vehicle Dump Station
Shower -Gang F
-Stall
Sink/Lav -Non-food related 1) z..,----
-Bradley
-Commercial-food related 1 ,
-Service
Swimming Pool Filter ' *Note: If the fixture work under this permjt results in an
Washer-Clothes
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:
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