Permit (118) CITY OF TIGARD PLUMBING PERMIT
11111
'11 COMMUNITY DEVELOPMENT Permit#: PLM2017-00071
Date Issued: 03/07/2017
TI A I<.t) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126CB00500
Jurisdiction: Tigard
Site address: 9300 SW WASHINGTON SQUARE RD
Project: LensCrafters Subdivision: None Lot: None
Project Description: Add(2)new hand sinks
Contractor: D&F PLUMBING Owner: MACY'S DEPARTMENT STORES INC
4636 N ALBINA AVE ATTN: TAX DEPARTMENT
PORTLAND, OR 97217 7 WEST SEVENTH ST
CINCINNATI, OH 45202
PHONE: 503-282-0993 PHONE:
FAX: 503-288-0604
FEES
Quantity Description Date Amount
2 ea Sink 03/07/2017 $50.04
Specifics: 1 12%State Surcharge- 03/07/2017 $8.70
Plumbing
Type of Use: COM 22 ea Minimum Fee Adjustment- 03/07/2017 $22.46
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 1, - ' _. ''a 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.irect questions to s. C b calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: y.
XY)
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.
PlumbingtPernpit Appli t f , ,
Site Utilities FOR OFFICE USE ONLY
Cityof Tigard 7 Received 7 �) ,
g1 . Permit No.: n,, 77
iII . 13125 SW Hall Blvd.,Tigard,OR 3 Date/By: 7 (� o?O!7 aGD<�
Plan Review
Phone: 503.718.2439 Fax: 503 598.1960 g c
Date/By'
Other Permit No.'A,01(2,(90/7-6� 7
Inspection Line: 503.639.4175 ib ..)rvzSai ,.
TIGARD
Date Ready/By: Jurism See Page 2 for
Internet: www.tigard-or.gov r Notified/Method: Supplemental Information
- u .41.I -
TYPE FEE* SCHEDULE
For special information use checklist.
0 New construction ❑Demolition
- Description I Qty. Ea. Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
''4!'1,,;1',,:'''''',';';':' CATEGORY OF iC?NSTRUCTiOYV SFR(1)bath 312.70 1 t
1-and 2-famil dwellin SFR(2)bath 437.78 'C
Ely g ®Commercial/industrial
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
7- JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address,]730 S'W WASHINGTON SQUARE RD Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:97223 N
Footing drain(no,linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: LENSCRAFTERS/MACYS 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:
-6
Tax map/parcel no.: /5/016' Q5'
6 'Q Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
ADD 2 HAND SINKS Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY-OWNER 1 �❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
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
°'AYI'LI '471- [ CfJI t Yi'"PI RSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 2 25.02 d
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:D&F PLUMBING Waterpip g/i in DWV 56.29
Address:4636 N ALBINA AVE Other: 25.02
City/State/ZIP:97217 Subtotal
Phone:(503)282-0993 Fax:(503)288-0604 Minimum permit fee: $72.50 7A.5t)
Plan review (25%of permit fee) ------
CCB Lie.:465 Plumbing Lic.no.:26-23PB
55-70
// State surcharge(12%of permit fee)
'A Authorized signature: , I L /I TOTAL PERMIT FEE g j,a o
This permit application expires if a permit is not obtained within 180 days
Print name:SANDI WA' 'E Date: after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Perhit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site.Utilit es Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-151 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
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
Val anon: .
Storm&Rain Drain-1st 100' 62.54 PermitFee:
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 InSpeetions or Fees tY• 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ " Plan review is required for anyof the following.
Work Performed: Capped Added Relocate 9
Baptistry/Font Please check all that apply.
Bath Tub/Shower
0 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 Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ 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 OAR918-280-0040.-
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
4 Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food 0 Isometric or riser diagram is required for new buildings
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
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit 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:
C:\Users\randy\AppData\Local\Temp\PLMU_PermitApp.doc 2
.11 Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map & tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS -Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
-
r c la _ ._ , . cleanoutst eaclr uppe
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Permits\PLMF-PermitApp.doc 12/30/05
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9300 SW WASHINGTON SQUARE RD, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00071
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor