Permit (32) CITY OF TIGARD PLUMBING PERMIT
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2: . COMMUNITY DEVELOPMENT Permit#: PLM2017 00226
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/08/2017
T E n aR• Parcel: 2S 102AA00600
Jurisdiction: Tigard
Site address: 12045 SW HALL BLVD
Project: 7-Eleven Subdivision: TIGARD HIGHWAY TRACTS Lot: 12
Project Description: Replace/relocate 2"floor sink with new floor sink.
Contractor: S&S SEARS INC Owner: ALPROP LLC
PO BOX 446 4905 SW GRIFFITH DR STE 205
GLADSTONE, OR 97027 BEAVERTON, OR 97005
PHONE: 503-650-8200 PHONE:
FAX: 5023-650-8203
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 06/08/2017 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 06/08/2017 $25.02
1 12%State Surcharge- 06/08/2017 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 06/08/2017 $22.46
Plumbing
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 Noti - •-• enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yo may obtain a copy of the rules
or dire, questions to ••NC b calling 503.232.1987 or 1.800.332.2344.
By: Permittee Signature:
Issu•d B 9
0
i� � i „/��_ tit /
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 RECEIVEP FOI2 OFFICE USE OtiLI'Received i
City of Tigard Date/By: LC $ /I Permit No.: P1,/9,,,f7-OC a 2i/
- ' 13125 SW Hall Blvd.,Tigard,OR 97223
q6t1 Plan Review
Phone: 503.718.2439 Fax: 503.598'1 t`I 8 201 j Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read/B runs: ® See Page 2 for
TIGARD Ready/By:
Internet: www.tigard-or.gov
_tri Of a fIGAR Notified Method: Supplemental Information
TYPE OF . emo�,h
For
FEE* SCHEDULE
❑New construction i , '"tionvspecial information use checklist.
�°� Description Qty. Ea. Total
r^--� dition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath r 312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
0 Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
7--C� / Catch basin or area drain 18.76
Job site address: i J� � I i /�L
',�T'�\ /� Drywell,leach line,or trench drain 18.76
City/State/ZIP. �1 4_ < <61' . 6>'7zz3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: 7-// 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
> 1 Backwater valve 12.51
16',' DESCRIPTION OF'WORK „
Clothes washer 25.02
fgep1 RC e-/ a td 7L( *d"^� - `-� k"
' 7 ' 1'5 ishwasher 25.02
/t�i t� SCAt- ^
i4-(5, G ,..1".,..1"..2._ C�v�1". H Dratng fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
�` 0 PROPR�I , �?WNER �v� 1 �� ElTE1I,�1NT P
Name: Fixture/sewer cap i 25.02
Floor drain/floor sink/hub \ 1 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 LICANT ,4.` i ❑ CO a . 'RSON - .y: ' Interceptor/grease trap 25.02
Business name: -Y
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
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
a ,;CTOR '. ':;:
Water heater 37.52
Business names �S , '} /S a -c Water piping/DWV 56.29
Address: /Z Yom' 6 L Other: 25.02
City/State/ZIP: 7 f �7 7 Subtotal
Phone:( ) �j �Z,�
Fax:( ) C�5-7),-i) zo3 Minimum permit fee: $72.50 7a1
CCB Lie.: /5( ��� Plumbing Lic.no.: 7 G
Plan review (25%of permit fee) �-
` s 3 State surcharge(12%of permit fee) O ,76
Authorized signature: TOTAL PERMIT FEE
Print name: � n e cam - Date:-g_ /7 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-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-1a 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
l? 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 es*. Plan review foj I lumbing Ii.stallations
Quantity by Fixture Plan review is required for any of the following.
Fixture Type for •eplaee/ / Please check all that apply.
Work Performed: Capped Added toes f
Baptistry/Font ❑ Any new commercial building with water servicer and
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 ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic 0 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» � tr1C Q is Diagra i
0 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: -Lav/Bar non-food related
-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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12045 SW HALL BLVD, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00226
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor