Permit (133) AGF
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT � ' ''- `' Permit#: PLM2018-00085
13125 SW Hall Blvd.,Tigard /� Date Issued: 03/06/2018
T I '' kt ' OR 97223 503.718.2439 Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Relocate all plumbing fixtures for the relocation of the floral department and fresh cut room,and replace bathroom
fixtures. 5/3/2018: REPRINT permit to add exterior grease interceptor.
Contractor: EVOLUTION PLUMBING LLC Owner: ROIC OREGON LLC
7715 NE 33RD DR SUITE D ATTN: SCHOEBEL, RICHARD
PORTLAND, OR 97211 8905 TOWN CENTRE DR, STE 108
SAN DIEGO, CA 92122
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
13 ea Floor Drain/Floor Sink/Hub 03/06/2018 $325.26
Specifics: 1 ea Sink 03/06/2018 $25.02
6 ea Lavatories 03/06/2018 $150.12
Type of Use: COM 2 ea Urinal 03/06/2018 $50.04
Class of Work: ALT 6 ea Water Closet 03/06/2018 $150.12
Type of Const: 1 12%State Surcharge- 03/06/2018 $84.07
Occupancy Grp: Plumbing
Stories: 1 ea Interceptor/Grease Trap 05/03/2018 $25.02
0 12%State Surcharge- 05/03/2018 $3.00
Plumbing
6 Plan Review-Plumbing 05/03/2018 $6.26
Total $818.91
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
IssuedBy: Permittee Signature: 1 /1/7 /4..1e077eri
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
f -
Plumbing Permit Application
Building Fixtures I ECEIVE FOR o1:11(T I SF 011.1
City of Tigard p Received
u 13125 SW Hall Blvd.,Tigard OR 972291 P R 3 0 2 018 Date/By: 3 /$ ..1-_---2sPermit N�G�.,?may/f MO�i�
Phone: 503.718.2439 Fax: 503. 60 Plan Review �`v �Z
Date/By: _�..'��®(� �� Other Permit No.:
1 i G \it i_, Inspection Line: 503.639.4175 OF TIGARD Date Read/B
Internet: www.hgard or gov 8 y y' Jura 10 See Page 2 for
i \ ii a , Nottfied/Method Supplemental Information
,
0 New construction 0 Demolition For special information use checklist
16 Description Qty I Es. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath
312.70( t h�
El1-and 2-family dwelling 11 Commercial/industrial SFR(2)bath 437.78
ElAccessory building ElMulti-familySFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other
Fire sprinkler
�, . ' o e . a sq.ft.) Page 2
1- .,, Site utilities:
Job site address: I �® sIN ?A Ll. ,kl Catch basin or area drain 18.76
City/State/ZIP: I I/�/�l/J� m1� w�lC�� �I IVB Drywell,leachline,ortrenchdrain 18.76
Its 1t vI 012- Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: `1 1 Project name: SolG t a,( I �Q_
T t �V_""J �"l�J Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_J 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
0 Backwater valve` c :€ >t "
12.51, ' r '� '
Clothes washer
SVI 1 -€X o- �1 yp�p 25.02
L( �� vl lYR1L/^ `���C��Y' Dishwasher
�r� C },-, �J �p���,� (1, /� 25.02
` °'"�\\� Q> i J 1 ` f I 1 7 j V L 2 b t 9 -000 U3 Drinking fountain 25.02
lJ ` Ejectors/sump 25.02
3t m ~5»
� Expansion tank 12.51 odt a; cg 5 � AI' aM3 ,,.;
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) i Fax ( ) Ice maker
12.51
r
V : tx " .* Interceptor/grease trap I 25.02 dJ•na
Business name: t,\"\r` \ �kuyy\\9,^9 I Lir, Medical gas(value:$ ) Page 2
Contact name: i'n� f)�A p� Y/�tt 1vJ Primer 12.51
' v l {{{���(/l.d 1 Roof drain(commercial) 12.51
Address: 11( Nt c12Vt�/11 S
JI�� "kn1 Sink/basin/lavatory 25.02
City/State/ZIP: \ l y'\r'11 , o1Q` Orm O-ml Solar units(potable water) 62.54
Phone:(S1)9)) Un-. 2 Q Fax::(S -j S-,9)95-i 3 Tub/shower/shower pan 12.51
E-mail:S Mit J Urinal 25.02
CQNt13ACOlt Water closet 25.02
Water heater 37.52
Business name: 1JCU,\ `--u 1. _` 1 Waterpiping/DWV
�2(71 (�-' YJl56.29
Address: `1'1 E TJlQ Y• �75Ul , Other: 25.02
City/State/ZIP: $3,,
Y t�f�, ) O� t fl v1 ( Subtotal d5r,0A
Phone:(SD3) U%--- Q Fax:(S1)90)90t).5.02,^12 Minimum permit fee: $72.50
CCB Lic.: 1 95-1 y Plumbing Lic.no.:?` ,c.3?Jl_k Plan review (25%of permit fee) ,„.A6,
�- State surcharge(12%of permit fee) 3,uc a
Authorized signature: TOTAL PERMIT FEE 3e ftCr�
Print name: iv /a s Date: 91 This permit application expires if a permit is not obtained within 180 days
-' L( v t4.19.0/1 [ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\BuildingTernits\PLMU-PemnitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su' s ression S stems:
fit.
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 a eater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52
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
each additional$100.00 or fraction thereof,to
e andincludin• $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 char•e-1/2 hour and includin• $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 char_•e-2 hours each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and includin:$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 char_•e-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 ;"
7 '' re r _ Plan review is required for anyof the following.
� ��
OwiAlg
ee''t`ype'EorPlease check all that apply.
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior 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
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"
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the s ualifications 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
FOR OFFICE USE ONLY—SITE ADDRESS: /SS /b ,cGci 4/4\6-
Gam/
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
IN Transmittal Letter
r c,;\E.n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: /(71J DATE RECEIVED:
DEPT: BUILDING DIVISION
RECEIVED
FROM: .6C1\ IU-, /V llr\AV APR 3 0 2018
COMPANY: di iI k) \ `J\ \j1, L�� CITY D
OF GaRD
BUILDING DIV
PHONE: \M 3c(1). By:52>
RE: Ick D Svc VcAx\h� T1-W1.Z i7- 0 15s"
(Site Ad ess) (Permit Number)
- 14--)q
(Pro ect name or s division name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s)of plans. `2v- Revisions: u,M,I, `TL IAC
Cross section(s) and details. Wall bracing and/or lateraRnalysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: 0,1/1G k Vt k l Ot(- e)v•-- 4— e7<-k-Ylor2 a&S2�
I k�
c
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: s/3/f Initials: S
Fees Due: ❑Yes ❑No Fee Description: Amount Due:
i' -.� - ,12.-s7/774) $ 6 , a--(,
$
$
$
Special
Instructions:
Reprint Permit(per PE): es ❑No r sone
Applicant Notified�S*i ' Date: c.573 /ce Initials:
7e-,i______
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc
CITY OF TIGARD PLUMBING PERMIT
Permit#: PLM2018-00085
COMMUNITY DEVELOPMENT
Date Issued: 03/06/2018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Relocate all plumbing fixtures for the relocation of the floral department and fresh cut room,and replace bathroom
fixtures.
Contractor: EVOLUTION PLUMBING LLC Owner: ROIC OREGON LLC
7715 NE 33RD DR SUITE D ATTN: SCHOEBEL, RICHARD
PORTLAND, OR 97211 8905 TOWN CENTRE DR, STE 108
SAN DIEGO, CA 92122
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
13 ea Floor Drain/Floor Sink/Hub 03/06/2018 $325.26
Specifics: 1 ea Sink 03/06/2018 $25.02
6 ea Lavatories 03/06/2018 $150.12
Type of Use: COM 2 ea Urinal 03/06/2018 $50.04
Class of Work: ALT 6 ea Water Closet 03/06/2018 $150.12
Type of Const: 1 12%State Surcharge- 03/06/2018 $84.07
Occupancy Grp: Plumbing
Stories:
Total $784.63
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.
Plumbing Permit Applicati l 1� `` ¢ `
Building Fixtures FOR OFFICE LSE ONE)
Ci of Ti and M A R ^r� Q
41 Received
g LV)Q f\ �1 `' Date/By: '� /de--1Permit No� M
` �he !/QQ
13125 SW Hall Blvd.,Tigard,OR 972233 Plan Review
iliPill-1- Phone: 503.718.2439 Fax: 503.5 1 i' Date By: Other Permit Z �� //100y
Inspection Line: 503.639.4175 1 V -1 �°
I C \RD Date Ready/By: Rats: BI See Page 2 for
Internet www.tigard-or.gov 1 i l� a4 3 Notified/Method:
Supplement, . ''',rmation
❑New construction ❑Demolition For special information use checklist
Description
..,., Additi
on/alteration/rplacem, nercia 0 Other: New 1-2-family
dwellings(i(includes 1 00 Qftt.yf.oreachEuatity onnTeocta'o
l
n)
� f v SFR(1)bath 312.70 a . '' fitf .,-- ;, '''''4----'-t'-- -
❑ 1-and 2-family dwelling pp Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
El Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
M e_. ,,^„e"1 't,1 , ' '' ' r sn
� t"° t � , '���, ; Site ati6ties:
Job site address: 15570 SW Pacific Hwy Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Safeway 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
r a l.a 12.51
p !r; 1r ,, Backwater valve
i R ' "' Clothes washer 25.02
Relocate Floral department, install new fresh cut room, replace Dishwasher 25.02
bathroom fixtures. Drinking fountain 25.02
(Building Permit#B2018-00003 Ejectors/sump 25.02
1P i w
'•t 4ho-', 1 € K 17wz ` Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: - Floor drain/floor sink/hub 13 25.02 325.26
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
. . . .� :"4-7''. a r, Interceptorgrease trap 25.02, . . '7;: m .$:';' , w 77 '7
, ' . ';'.'4'''''''!"-
� .�! .,
Business name: Evolution Plumbing LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Shaina Pasi
Roof drain(commercial) 12.51
Address: 7715 NE 33rd Dr. Suite I _ Sink/basin/lavatory 7 25.02 175.14
City/State/ZIP: Portland, OR 97211 Solar units(potable water) 62.54
Phone:(503 ) 655-3388 Fax::( 503) 305-8373 Tub/shower/shower pan 12.51
E-mail: shaina.pasi@evoplumbing.net Urinal 2 25.02 50.04
3 , - ro r ,i Water closet 25.02
6.1 '' 6 150.12
¢ _' Water heater 37.52
Business name: Evolution PlumbingLLC
Water piping/DWV 56.29
Address: 7715 NE 33rd Dr. Suite I Other: 25.02
City/State/ZIP: Portland, OR 97211 Subtotal 700.56
Phone:(503) 655-3388 Fax:( 503)305-8373 M� permit fee: $72.50
)fee
(25%of permit
CCB Lic.: 189876 Plumbing Lic.no.: PB834 Plan review _ _
-
® State surcharge(12%of permit fee) �'y 07
Authorized signature: ��/ CLQG TOTAL PERMIT FEE J t/.63
Print name: Shaina Pasi Date: This permit application expires if a permit is not obtained within 180 day
3/6/18 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
440-4616T(10/02/COM/WEB)
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su pression S stems:
'144-.V......"..-:- e11 may. L,L
[ F
mom.-s.f.. ,. ., ; ,, ..,.a. ., ,.„,.,v....144,14,..!-. ,t, r :,K r
Footing dram-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 S stems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-I st 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
... `Y 4,. ri 7-477--7,-,';'-'''.-- 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 char l e-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 char:e-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 char_•e-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*.
, Yri .-::G Y--d- i :.A4'::,' "�il% w+ .,..1-4 ice,.
Fiats T for :. . a h i _. i x ' t: 4 a t t 1 e i',p 't
gam`
Mork" ., , ' i F Plan review is required for any of the following.
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 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" 13 Submit 2 sets of plans with any of the above.
-3"
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 All fixtures to be relocated:(13)Floor Sinks(6)Lay Sinks(1)Dump Sink
Shower -Gang
-Stall (61 ater Closet 121 Urinals
Sink/Lav -Non-food related 7 (L l-U c C/) S E-i2-1/i cif✓
-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 R fees assessed for the sewer increase must be paid before the
Urinal 2 plumbing permit can be issued.
Other Fixtures:
http://www.tigard-or.gov/document center/Building/PLMF PermitApp.d1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15570 SW PACIFIC HWY, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2018-00085
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
CITY OF TIGARD PLUMBING PERMIT
i.
COMMUNITY DEVELOPMENT F Permit#: PLM2018-00085
T IG A p.f)i 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 3�� 41,:i., Date Issued: 03/06/2018
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Relocate all plumbing fixtures for the relocation of the floral department and fresh cut room,and replace bathroom
fixtures. 5/3/2018: REPRINT permit to add exterior grease interceptor.
Contractor: EVOLUTION PLUMBING LLC Owner: ROIC OREGON LLC
7715 NE 33RD DR SUITE D ATTN: SCHOEBEL, RICHARD
PORTLAND, OR 97211 8905 TOWN CENTRE DR, STE 108
SAN DIEGO, CA 92122
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
13 ea Floor Drain/Floor Sink/Hub 03/06/2018 $325.26
Specifics: 1 ea Sink 03/06/2018 $25.02
6 ea Lavatories 03/06/2018 $150.12
Type of Use: COM 2 ea Urinal 03/06/2018
Class of Work: ALT $50.04
6 ea Water Closet 03/06/2018 $150.12
Type of Const:
1 12%State Surcharge- 03/06/2018 $84.07
Occupancy Grp: Plumbing
Stories: 1 ea Interceptor/Grease Trap 05/03/2018 $25.02
0 12%State Surcharge- 05/03/2018 $3.00
Plumbing
6 Plan Review-Plumbing 05/03/2018 $6.26
Total $818.91
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.
Aft
Issued By: - �m 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.
9 '
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE (SF 011.1
City of Tigard qq Received
1111 II 13125 SW Hall Blvd.,Tigard,OR 9722f31PR 3 0 2018 DateBy: - !, , I PennitNcy0 , t_2r.,`f_-er �i�
Phone: 503.718.2439 Fax: 503. 60 Plan Review ^ " `'
Inspection Line: 503.639.4175 y 4 Date/By: _ ..a(g( i t c/� Other Permit No.:
TR,C \I:17 OF 1 1 GARD Date Ready/By: Jur s: See Page 2 for
Internet www hgazd or gov pQ
8 • ► 2 a , Notified/Method
+ �y 4 �, , y Supplemental Information
0 New construction ❑Demolition For special information use checklist
IS6 Addition/alteration/replacementDescription Qty. I Ea. I Total
0 Other:
New 1-2-family dwellings(includes 100 ft.for each utility connection)
' SFR(1)bath
312.70
❑ I-and 2-family dwelling VI Commercial/industrial SFR(2) 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder ❑OEach additional bath/kitchen 25.02
Other:
wz t e e Fire sprinkler( sq.ft.) Page 2
i s ,a-� . ,.r ' 1'r ,.° ct � Site utilities: g
I�� / ® v
Job site address: 1n I �j�r�� p1„,� Catch basin or area drain 18.76
City/State/ZIP: 'r��v/II�J mI�V �vIV�114
'[ IVq Drywell,leachline,ortrenchdrain 18.76
Suite/bldg./apt.no.: VJ 't!/i Project name: II� Footing drain(no.linear ft.: Page 2
• 1 �"1�J 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
Subdivision: Water service(no.linear ft.:_) Page 2
Lot no.: Fixture or item:
Tax map/parcel no Backflow preventer 31.27
Backwater valve
* 5 ` .4 s`�° 4,* . ,." ' . rte'; , �� , . 12.51
I ( @y p o Clothes washer 25.02
�*_' b 1.oce \ v(Viy' Dishwasher
`5 IiYJ\\� Q is'h00 i"� *p��/�r� 25.02
j \ Vl l l/iD i co -0D0g5 Drinking fountain 25.02
Ejectors/sump 25.02
" iii „ {i: t � " q ftwl Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
Hose bib 25.02
Phone:( ) Fax ( )
i.77,-)eq y
Ice maker 12.51
i 't ,' `:%:141;11e%''' t Interceptor/grease trap 1 25.02
Business name: '�..V,l, ' \u \\9'w-Ag L n Medical gas(value:$ ) Page 2
-')-� ' V l t 1.��
Contact name: i r V l 1111 Prime 12.51
Address: lit t I e Roof drain(commercial) 12.51
' `�' �i"" Sink/basin/lavatory 25.02
City/State/ZIP: Ytai/V A ) 0(2_, °21 I Solar units(potable water)
Phone: 2 USS--. 2� ��1 1 62.54
�9-) J� I Fax::( S•93�'� Tub/shower/shower pan 12.51
E-mail S Urinal
o, p NJQ t" ' _y' ` ' ',,.'�'t 25.02
� � � Water closet 25.02
Business name: I 1tA ,µ Water heater
vC L1 ' u XY12- ILL
I n 37.52
`(v1Tt i'J'l ) LtJ�. Waterpiping/DWV 56.29
Address: -)-1tiNEJ
�JJ Dry.• S�� \ Other: 25.02
City/State/ZIP: ('tl rLn> Or. (x-10 1
(l K-� t v, Subtotal 05,0
Phone:(SIP)) UZ• ' Q�Q� Fax:( '79)' S',9)2-,12) Minimum permit fee: $72.50
CCB Lic.: �l ✓�Uu u Plumbing Lic.no.: !' Plan review (25%of permit fee) �-AG
��� State surcharge of
Authorized signature: `mss _ (12% permit fee) 3,cn
TOTAL PERMIT FEE 31,2F
Print name: Ivla_'s- I Date: 4,/,...0/1 QUI This permit application expires if a permit is not obtained within 180 days
'' "l LS 1 // after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PertnitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su s ression S stems:
'Zif
,� � � � �'.� �� 50.03 � to 2,000���� ���� �� � � �
Footingdrain-1'100' $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 1.eater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52
Storm&Ram 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
�r s . : `9= each additional$100.00 or fraction thereof,to
� '. . and includin• $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 chaz:e-1/2 hour and includin• $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 char.e-2 hours each additional$100.00 or fractionn thereof,to
Reinspection Fees _ 90.00/hr and includinl$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 char•e-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 sereport fixtures could result in increased sewer
,�. ,.
r Plan review is required for any of the following.
Please check all that apply.
WQrIcI'eitlCutrltti * .'
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 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"
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
FOR OFFICE USE ONLY-SITE ADDRESS: /53 16 S4.>
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
NI Transmittal s ittal Letter
i n E.n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: 7 )12't DATE RECEIVED:
DEPT: BUILDING DIVISION
RECEIVED
FROM: .6c K \\k . UiVA APR 3 0 2018
COMPANY: &A.V1, U�VW);1, �.LC� CITY MSI
BUILDING
DG DI O�—
PHONE: lQ S93cC> By:,
RE: I "� D Svcs TUI246I7' 0
(Site Address) (Permit Number)
&kt
(Pro ect name ors ivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. `2,- Revisions: ‘k,M, Inc
Cross section(s) and details. Wall bracing and/or latera alysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: TO,Vii l VveiVa Ot.H e:Ws-- c Ylb�
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: -5/3 if Initials: S
Fees Due: ❑Yes ❑No Fee Description: Amount Due:
" o 'f.&zJ $ 6 , ?-4.,
$
$
Special
Instructions:
Reprint Permit(per PE): es ❑No _4, one
Applicant Notified
:SMq,nf Date: ,573 /c' Initials:
I:\Building\Fonns\TransmittalLetter-Revisions 061316.doc