Permit (200) CITY OF TIGARD PLUMBING PERMIT
: • COMMUNITY DEVELOPMENT Permit#: PLM2018-00440
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2018
T f A I<.f7 9 Parcel: 2S102CB00200
Jurisdiction: Tigard
Site address: 13115 SW PACIFIC HWY
Project: Natural Grocers Subdivision: None Lot: None
Project Description: Backflow preventer for landscape irrigation.
Contractor: DESANTIS LANDSCAPES INC Owner: TIGARD PACIFIC RE LLC
7907 SW STATE ST C/O LEADERSHIP CIRCLE LLC
SALEM, OR 97317 1521 OXBOW DR STE 210
MONTROSE, CO 81401
PHONE: 503-364-8376 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/24/2018 $31.27
Specifics: 1 12%State Surcharge- 09/24/2018 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 09/24/2018 $41.23
Type of Use: COM Plumbing
Class of Work: OTR
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 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. 2.1987 or 1.800.332.2344.
Issued By: / ` Permittee Signature: `�j�
ice. i �,' —s� �il�/ ge-- -. �7 !/��fl/
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 Apnlicatio
Building Fixtures FIVE. l'oR OFF1( 1 I SI (1'\1.\
Received
City of Tigard SEP 24 2018 Reeve/Bv w Pe iiii,
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
�r Phone: 503.718.2439 Fac: 50+.593, Other Permit No
Inspection Line: 503.639.1175 ` Y I- I R'IL Date,By
AGI? BUILDING Date Ready By; JIM F: B See Page 2 for
Internet: wtivw,tigard-or.gov i IVISION Notifed(Ivtethort Cain'Information
® l r>r s1+ec+nl rnJotnsm'ion use checklist.
New construction 0 Demolition
Descriptionj Qty. I_ Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwrlfngs(includes 100 ft.for each utility uonn ctien)
..t s °;a
+a a� art - sa to arta -04',� � SPR(1)bath 312,70
°`., � ; -.. _.. ,
0 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0
\,initi-family
Each additional bativkitchen 25,02
❑Master builder
0 Other: Firesprinkler sq. Page 2
t §! e �- �r t' -3 3 r„...,..! Site win bsins:
Catch basin or area drain18.76
§,
Job site address: SW Pacific Hwy
City/State'ZIP: Tigard, OR 97223 Drvwell,leach line,or trench drain ® 18,76
Footing drain(no.linear 11.:_ ) Page
Suite/bldg./apt.no.: I Project name:
Natural Grocers Manufactured home utilities 50.03
Cross street/directions to job site: SW School St Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft,:_) Page 2
Storm sewer(no.linear 11,: Page 2
Water service(no,linear ft,:_) Page 2
Subdivision: Lot no,: Fixture or item:
Tax tllap/parcel no.: Backflow prey enter 1 31.27 31.27
I...!!".-3;-"",, , Backwater valve 12,51
' Clothes washer 1 25.02
Dishwasher
Drinking fountain 75.02
Ejcctorslsump5 02
(� a d 0 � 614' �, Expansion tank
Name: 1. Fixture sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State+'ZIP: Hose bib 25.02
Phone:
hone ( ) Fax:( ) Ice maker 12.51
bnlerce tor! reale lira 25.02
{�,hPPLICAI+IT u CONTACT PERSON ,, P g i
Medical gas(value:S_) Page 2
Business name:
Primer 12,51
Contact name:
Roof drain(commercial) 12.51
Address:
Sink basin;lavatory 25.02
City:State:Z1P: 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: DeSantis LandscapesInc
Water piping Dib"\' 56.29
Address: 7907 State St Other: 25.02
City Stale YIP: Salem, OR 97317 Subtotal
Phone:(503)364-8376 Fax:( 503)364-8064 Minimum permit foe: 572,50 $7250
Plan ret iett (25°o of permit Cue)
CCB Lie.: 146197 Plural'tg Tic,no,:5876
State surcharge(12"o of permit fee)
Authorised si�pnahn�: L101.AL PER\IIT FEE $72.50
Print name: �j i1/ VV I)ale: f{ I k1/6 This permit application expires if a permit is no(obtained within 180 dabs
�lQ� P A I ` alter it has been accepted as complete.
111 *Fee meihodologv set by Fr-Counl) Bu IId]nb Industry Service Board
I Bail I e Tennus PL.AIt'Pa r A doe IS nl!i'; ..1O- rU O U' r r41'H II
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Su ,ression S stems:
ro • T
., `.-s '., eel. :.`ii •
..*.. ..: .!.i +s "� i`. . ... ''
50,03 MR 0 to 2,000 $121.90
_ 37 52 mg 2,001 to 3.600 5169,69
3.601 to 7,200 $233,20
Sewer-1st 100' 11.111 62.54 7.201 and greater $32734
Sewer-each additional 100' .1111 37.52
M.
Water Service-let 100' Medical Gas S stems:
Water Service-each additional 100'
Storm&Rain Drain-1st 100' 62,54 MI $1.00 to$5,000,00 Minimum fee$72.50 ..
Storm&Rain Drain-each additional 100' IIIIII 37.52 MI $5,001,00 to$10,000.00 $72.50 for the first$5,000.00 and$1,52 for
f> ; $ s �y ; each additional$100.00 or fraction thereof,to
'•''} - ',�' '�1 and including$10.000.00.
Inspection of existing plumbing or for II $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 traction thereof,to
minimum charoe-1,2 hour and including$25,000.00.
Inspections outside of normal business 1111190,00,hr MI $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 traction 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$50.00000 and$1.20 for
each additional$100.00 or fraction thereof.
minimum ohs ie-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
t or' + t f
accurately report fixtures could result in increased sewer fees f t�� .' i m: i .. M
44ex by,Flthwe :. Plan review is required for any of the following.
Ft*turte •$" !;-f' . Please check all that apply.
Y•
Wart P. armed-i ,t • 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
Drive Thru as defined in OAR918-780-0040,
Cuspidor/Water Aspietor 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system,
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eva Wash Submit 2 sets of plans with any of the above.
Floor Dtainisink: -2"
-3 I d le 011'Rser- ,..'
4..
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\Tach.Refiig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rea.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Las Oar non-food related
-Bradley
-Com,Sery('til food related
-Service *Note: if the fixture work under this permit results in an
Su immine Pool Filter increase of sewer EDUs,a sewer permit will be issued anti
Washer-Clothes
water Extractorfees assessed for the sewer increase must be paid before the
Water Closet-toilet plumbing permit can be issued.
t onal
Other Futures:
I lhiildint Permits PLMF PermilApp.doe 08-04 2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13115 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00440
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 1 1/2" Febco DC,model 850, serial # 38317 , for irrigation, located by water meter-
approved with test.
Violation Summary:
Inspector Contractor