Permit (26) CITY OF TIGARD PLUMBING PERMIT
11 ' COMMUNITY DEVELOPMENT Permit#: PLM2017-00042
R CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/13/2017
Parcel: 1 S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY Z
Project: Papa Murphy's Pizza Subdivision: None Lot: None
Project Description: Interior plumbing for TI: Adding(1)commercial dishwasher,(2)3"floor drains,(1)ice maker,(3)sinks,(2)
commercial sinks,(1)service sink,(1)clothes washer;Capping(3)sinks and(1)service sink;Relocating(1)water
closet; Installing(1)hose bib,(1)grease trap,(1)primer,(1)water heater.
Contractor: RAYBORN'S PLUMBING INC Owner: PACIFIC CROSSROADS PROPERTIES IN
PO BOX 69 BY WYSE INVESTMENT SERVICES CO
19990 SW CIPOLE RD 1501 SW TAYLOR ST STE 100
TUALATIN, OR 97062 PORTLAND, OR 97205
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
1 ea Clothes Washer 02/13/2017 $25.02
Specifics: 1 ea Dishwasher 02/13/2017 $25.02
4 ea Fixture/Sewer Cap 02/13/2017 $100.08
Type of Use: COM 2 ea Floor Drain/Floor Sink/Hub 02/13/2017 $50.04
Class of Work: ALT 1 ea Hose Bib 02/13/2017 $25.02
Type of Const: 1 ea Ice Maker 02/13/2017 $12.51
Occupancy Grp: 1 ea Interceptor/Grease Trap 02/13/2017 $25.02
Stories: 1 ea Primer 02/13/2017 $12.51
6 ea Sink 02/13/2017 $150.12
1 ea Water Closet 02/13/2017 $25.02
1 ea Water Heater 02/13/2017 $37.52
1 12%State Surcharge- 02/13/2017 $58.55
Plumbing
Total $546.43
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 stions o *UNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: 1 _/
-drat
Call
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 ( ) . , i 0 t Siwe`) M_ r,54
Building Fixtures • k ' FOR OFFICr USE OVEN
./:
Cityof Tigard ? Received /7 �%�
Date/By: OL l3 „3.77-- Permit No.: f".7a ,1 2_.cmc r/
114 • 131SW Hall Blvd.,Tigard,OR 97223 t, .t , '! ' V
1! X11 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 to/By: Other Permit No.: t,q 1 T{ ,iri
Inspection Line: 503.639.4175 \- '
l I G A R D to Ready/By: Auris: See Page 2 for
Internet: www.tigard-or.gov ` �,tia �anti/tit/Method: Supplemental Information
• TYPE OF WORK .�> t FEE* SCHEDULE
❑New construction 0 Dem4� s For special information use checklist
Description Qty. Ea. Total
[Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling (Commercial/industrial SFR(2)bath 437.78
o Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION' Site utilities:
Job site address: /( ?05 Catch basin or area drain 18.76
t S l„� �� (-1 W�/ S J t fi t Drywell,leach line,or trench drain 18.76
City/State/ZIP: ( -A n•d 0
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: ?AP,' mt/12Pst S c-taf't.o8-.(3O 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
,DESCRoaTiON OF wpm(' ''':••• ' Backwater valve 12.51
/e I's Clothes washer /� / 25.02 2S1 C)a
WO A9100,61 i/1^ f Utas 4 Sera' Ce S Dishwasher d./'--/ l 25.02 ,g.5-
` ,1 J 5fi9 re- Drinking fountain 25.02
Ejectors/sump 25.02
',IMP,*.OWNER ❑,TENANT ,, Expansion tank 12.51
Name: Fixture/sewer cap c/'' . ii 25.02 /� L e
�I„, Hs ~ - Floor drain/floor sink/hub A 25.02 5"Z►•e.r
Address: 2,i U S£ e,„ (4.,„,,,d- SF : Sc,t..ti (E,0
Garbage disposal 1A,, ,� 25.02
City/State/ZIP: -f k'a�d, e/2,-- '? 7 Li -/ Hose bib ( 25.02 yZ,s',(. ;,
Phone:(...03) C1 7 Q`/00 Fax:(5 3) 2.2 7-,252)7 Ice maker ( 12.51
,: VS.APPLIC� Q CONTACT PERSON Interceptor/grease trap / 25.02 ;..5
Business name: Pi, Medical gas(value:$ ) Page 2
I'i, P,/1-�l,¢� ,Zai• eaQLt F'� 9 h...€ S
l Primer I 12.51 /A 51
Contact name: ,�"e gdo' KCL" t`i
Roof drain(commercial) / 12.51
Address: QLy7t . SIA) 6S'' Ati, - Sink/basin/lavatory (4) V i 25.02 15e.
City/State/ZIP: T!Ll 4_1„,„:„.,.r
ej,,dz 9 7 d 6 ti Solar units(potable water) 62.54
Phone:(To 3 ) ct 7 v ._5-7,00 Fax::(5-d3)q 7-..2 /v Tub/shower/shower pan 12.51
Aw
E-mail: ,'2.7_4 ' L9,,,,./X, !n 24 r c..erY,, Urinal 25.02
^+� CO NIt ACTOR Water closet I 25.02 AS,,c)j
Water heater 37.52 37 52
Business name: RRY.30R/1I:s p(.uMnI/V(t
Water piping/DWV 56.29
Address: tot iq o 5 f..+ C.C-ea LC-% Q-S Other:
25.02
City/State/ZIP: U c.t 4 .i n D a 1 7 0 b Z Subtotal i`6 7.v 0
Phone:(6j-03) (64'L-•C{( 3 e>, r Fax:(TO})(„A(- 2_32...8 Minimum permit fee: $72.50
pPlan review (25%of permit fee)
CCB Lic.: I./3--/ u $Z Plumbing Lic.no.: 3�(- /(o6PB -
State surcharge(12%of permit fee) ,-•55
Authorized signature:V t�
TOTAL PERMIT FEE 57L.k/
r Print name: 4.40,w) w(..Jty ,)„.v Date: Ll4l�(7 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.
I:\Building\Permits\PLMU-PerwitApp.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: ermit 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 Inspections or Fees qty Fee(ea) Total and includingi $10,l$100.00. or fraction thereof,to
I1 and $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 1,
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
P 0 Any new commercial building with water service 2"and
Baptistry/Font
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engine
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exxr.
terior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial I 0 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"
3" 1 W J 7113/i 7 Isometric or Riser Diagram
4„ 11,❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
- that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related (#'ilv.iles }
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains 1 Comments regarding fixture work:
Oil Separator(Gas Station) kr ✓/c,i (ij S.144( ,(t) �ku s-,Aiii
Rec.Vehicle Dump Station C i J-{Uv.1 `d0, S711' r i) .-crt.)
Shower: -Gang
-Stall (1) /'=7' c:v1, lA,A•Ad .c.",,,,k)
i l i) Any s.ivf(.
Sink: -Lav/Bar non-food related 1 3
-Bradley -IvI6d;"r'y T'Z ZW`^ r
-Com/Serv/Util food related � �fve-tz*.rilnllf 4re14,,,.j to 7.1 1 (c " 4.-411.--
-Service
.-411--Service 3 4 *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 1 plumbing permit can be issued.
Urinal
Other Fixtures: /. " S
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2