Permit (150) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00574
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/27/2018
['G�"�T�.D Parcel: 1S136DA00700
Jurisdiction: Tigard
Site address: 11530 SW PACIFIC HWY
Project: Lu's Sports Bar&Lounge Subdivision: None Lot: None
Project Description: Repairing 20 ft.of sanitary sewer.
Contractor: B&G EXCAVATION&PLUMBING LLC Owner: LU,XU JIAN
4241 SE 136TH HUANG,WEN HUI
PORTLAND, OR 97236 4798 AUBURN LN
LAKE OSWEGO, OR 97035
PHONE: 503-761-2038 PHONE:
FAX: 503-762-6710
FEES
Quantity Description Date Amount
20 If Sanitary Sewer 12/27/2018 $62.54
Specifics: 1 12%State Surcharge- 12/27/2018 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 12/27/2018 $9.96
Plumbing
Class of Work: ALT 1 ea Investigation Fee 12/27/2018 $90.00
Type of Const: 1 ea Investigation Fee 12/27/2018 $90.00
Occupancy Grp: 11 Investigation Plumbing 12% 12/27/2018 $10.80
Stories: State Surcharge
1 ea Investigation Fee 12/27/2018 $90.00
11 Investigation Plumbing 12% 12/27/2018 $10.80
State Surcharge
Total $372.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.;a e.'
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available' spection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Site Utilities s FOR OFFICE list ()NEN'CI of Tigard A Received y
"J g Date/By: iW)-7/1 t) /927- Permit No.:het/4101.1i
�"
�P�y1 1 i r-- ,6.)$ 7'
11 . 13125 SW Hall Blvd.,Tigard,OR 97223 �y ?o Plan Review
II Phone: 503.718.2439 Fax: 503.598.191 (' ! Date/By: Other Permit No.:
Inspection Line: 503.639.4175
F I G A}t 1) �yp Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov + tki
• t9 Notified/Method: r Supplemental Information
0 New construction 'r1 i eniolition For special information use checklist
Description Qty. Ea. Total
ddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
� � '',: ,,,:, „ ,ai SFR(1)bath 312.70
yA'
0 1-and 2-family dwelling CI Commercial/industrial SFR(2)bath 437.78
CI Accessory buildingSFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
s 'r ,`R 444%414441444444
44% � 44 : Site utilities:
/ l /� /1,,e.)\/
Catch basin or area drain 18.76
Job site address:
//5 30 SIt,U ,7 moi` f
City/State/ZIP: 4_1 Drywell,leach line,or trench drain 18.76
I.. Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
.5; 2/ <j/ Rain drain connector 18.76
7 Sanitary sewer(no.linear ft.: 7�) • ( Page 2 /;,'1-5.4
Storm sewer(no.linear ft.: ) Page 2 �b
Water service(no.linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
iiiNiyiiy y
��, t � � ,�///�/ �4i 4444,4-44W.a.k �ig" " Backwater valve 12.51
t� ,� � t fi Clothes washer 25.02
1�-r'f 1i'l u t e bug r
Dishwasher25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,,1"4.': ::;4i'":"'
iii s x// v p/O/;; "'//y r
,�/ , „, �s � .,���' ;�/ //f 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
AtRA; ,: ',413,04'0,'''11',,,.. icier :ffir41'
�' .i%�,: " `` ,s ' Interceptor/grease trap 25.02
�y Medical gas(value:$ ) Page 2
Business name:
el ` xcA t tion `, pi� 6:ill Primer 12.51
Contact name:
'aii i C cl t/t r) Roof drain(commercial) 12.51
Address: c 1 5¢ 562`11n Sink/basin/lavatory 25.02
City/State/ZIP: r'` in b - Solar units(potable water) 62.54
Phone:(C ) '11v ---2 ( P.1 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: i 't - t ti Urinal 25.02
,y , .� �,f ,y� y���,>��f Water closet 25.02
Water heater 37.52
Business name:,. gCCi9L 4
ti,
�he2f 6 Water piping/DWV 56.29
Address: 92 V't 5i L, 136,'7"fr ii`/p Other: 25.02
City/State/ZIP:/2/tT�i i C)1.L_ Subtotal 6,2\ 531
C ) ��i Fax: Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: /70 27 dumbing Lic.no.: ) i ..(Z-3 State surcharge(12%of permit fee)
Authorized sig p: ure: -c--,,.�__e,/> TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
T-
Print name:., tit' ''/ 0-70 Date: 1 e after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su$ ression S stems:
�;!;/" . royz;; :,:g �,a.H a' ;H
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
3,601 to 7,200 $233.20
Sewer-1st 100' M. 62.54 ME 7,201 and Ireater $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
Wfi
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
� o , ��•�i i i � ;
�� •�� G�� �" 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: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*.
. ,AT �' �a W x { #
r-,, fi :». . Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower 111 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 ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the .ualifications 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/Lay -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\Bobo\AppData\Local\Temp\PLMU_PermitApp.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11530 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00574
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 8" existing San Sewer pipe repair is complete.
2. Inspection by camera to verify tie in.
3. Note: provide plug for 8" clean out located in parking lot under frame cover.
4. Plumbing final- approved
Violation Summary:
Inspector Contractor