Permit (209) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENTti
Permit#: PLM2016-00609
T f ReD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/19/2016
a.
Parcel: 2S102CC09100
Jurisdiction: Tigard
Site address: 13553 SW PACIFIC HWY
Project: DDHK,LLC Marijuana Facility Subdivision: 2008-058 PARTITION PLAT Lot: 2
Project Description: Interior plumbing for a new 2,997 sq.ft.retail building:Adding(3)sinks,(2)water closets,(2)hose bibs,and(1)
water heater.
Contractor: MALMEDAL ENTERPRISES INC Owner: DDHK VENTURES LLC
PO BOX 207 12604 SW 60TH CT
BANKS, OR 97106 PORTLAND, OR 97219
PHONE: 503-324-0759 PHONE:
FAX: 503-324-0580
FEES
Quantity Description Date Amount
2 ea Hose Bib 12/19/2016 $50.04
Specifics: 3 ea Sink 12/19/2016 $75.06
2 ea Water Closet 12/19/2016 $50.04
Type of Use: COM 1 ea Water Heater 12/19/2016 $37.52
Class of Work: ALT 1 12%State Surcharge- 12/19/2016 $25.52
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $238.18
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: ....fleet-- Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available ins.-: ••• -_ -.
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 `_ t. {. 1 v
Building Fixtures FOR OFFICE LSF ONLI
Cl of Ti andVReceived
tY g �d2 (� p�.�-�- Permit No.: (� / _�
Date/By: f /1)6l 6"GaCa�7L7ly
13125 SW Hall Blvd.,Tigard,OR 9722311114
rl Q'\�
L Plan Review
Phone: 503.718.2439 Fax: 503.598.19�(y Other Permit
tC{ �, Date/By: (I
T I G A P.D Inspection Line: 503.639.4175 a ( NATO Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov � C, s' I otified/Method: Supplemental Information
TYPE OF WOR1[..r 4 veal) FEE* SCHEDULE
(2New construction b} tpn For special in ormation use checklist
Description Qty. Ea. Total
1dition/alteration/replacement 0 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
❑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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
�3s 5-3 s� P4«��c Aiw '')
Drywell,leach line,or trench drain 18.76
City/State/ZIP: '77.-5..,r_/ (
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: DRii( L.tc, /Yry,,,+,`1,.,,ev tIc FF Jt manufactured home utilities 50.03
Cross street/directions to job site: l Z 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
DESCRH'r1ON OF WORK rm . '1 Backwater valve 12.51
Clothes washer 25.02
/AhleArt t'Y'� 1 M LJ 4.. 7ç 7----.2-... Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY,OWNER 1 3. <TENANT: Expansion tank 12.51
Name: m T 44_ / Fixture/sewer cap 25.02
Address: Pd 2_16-1b ,( L L Floor drain/floor sink/hub 25.02
p I k
Garbage disposal 25.02
City/State/ZIP: ) 0 l2 ( 74_8Hose bib 2 25.02 yZi cl-(
Phone:(w3) GSC 6s--yq Fax:( ) Ice maker 12.51
0
APPLICANT 0 CONTACT pgRsoN Interceptor/grease trap 25.02
Business name: y\4.Z-- ` (G4 , at c(l t, q S G- Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: /I M �� Roof drain(commercial) 12.51
Address: ()c1 3 2 O lb k-/ Sink/basin/lavatory 3 25.02 74--Lt-"
City/State/ZIP: 7-,--4 0Y` i -7/-5( Solar units(potable water) 62.54
6o
Phone:(S$2 ) d _ 0 s.--- v Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02'5 S
( U ( r" lLI
Water closet rl. 25.02 5-0,0-1
CONTRACTO
Water heater I37.52 j_7e�,)..
Business name: r1 t f• eJ P rt,.-d t d 7 Water piping/DW V 56.29
Address: (>0 k ?A�7 t Other: 25.02
City/State/ZIP: (� l C (L. 9 7/0, Subtotal
Phone:(n)) 3 2 _ O 7c, Fax:( ) Minimum permit fee: $72.50 ( GJ
Plan review (25%of permit fee)
CCB Lic.: l U ..5-35- Plumbing Lic.no.:
State surcharge(12%of permit fee) d...5'5 ,
Authorized signature: ,.-- ) "(',,Z 7 -8 TOTAL PERMIT FEE j, , 1 ET
Print name: 7�/t i Date:/2 _/9--/C 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.
S�'l S7s1 .t.-
1:\Buildisg\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) I 1
/i(,,)-; -7 d'
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-15'100' 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 Feet
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
Qty, Fee(ea) Total" each additional$100.00 or fraction thereof,to
Other Inspections or Feesand 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*. an Review for Plumbing Installations
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
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.
Cuspidor/Water
-Commercialirator ❑ Any multipurpose fire sprinkler system.
D -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', ,Isometric or°Miser Diagram
4"
0 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
-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 3 _
-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:
13553 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2016-00609
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Corrections are complete, plumbing final - approved
Violation Summary:
Inspector Contractor