Permit CITY TIGARD PLUMBING PERMIT
4. DEVELOPMENT SERVICES PERMIT #: PLM2006 -00140
1.1 DATE ISSUED: 4/17/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S136DA -00700
SITE ADDRESS: 11530 SW PACIFIC HWY • ZONING: C - G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: CORRECTIONS: Sink in basement indirect receptor. Other fixtures: backflow preventer for ice
maker, boiler RP device and consensate in basement indirect receptor.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
HI HAT INC
11530 SW BARBUR BLVD Description Date Amount
PORTLAND, OR 97219 [PLUMB] Permit Fee 4/17/2006 $72.50
[TAX] 8% State Surcha 4/17/2006 $5.80
Phone : Total $78.30
Contractor:
ASSOCIATED PLUMBING CO
P O BOX 301362
PORTLAND, OR 97230 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -331 -0582
FAX 503 -331 -0581
Reg #: LIC 57890
PLM 26 -412PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature.
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
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Plumbing Permit Application; E CI
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t" kt4 Nr^ Received p
� � f , City of Tigard Date/By 1 fil Ob Y,t Permit N ' i, & -GO/ yQ
� n 13125 SW Hall Blvd., Tigard, OR 97223 A 1 7 2006 Plan Review
k +, ® Phone: 503.639.4171 Fax: 503.598.1960 D aX eI B y . Other Permit No.:
, r ,' Inspection Line: 503.639.4175 p
f I G n R Da CITY B • Date Ready/By: Jurs 0 See Page 2 for
e , sg tawatkd8 Internet: www.tigard or.gov nFj 'J'1 i j j f-' Notified/Method: 4 Supplemental Information
TYPE OF "�YO RK�I� � ; r rC,' . vrN , FEE* SCHEDULE •
❑ New construction ❑ Demolition For special information use checklist.
_ Description 1 Qty. 1 Ea. 1 Total
❑ Addition /alteration/replacement Er Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION. • SFR (1) bath 249.20
❑ 1- and 2- family dwelling [Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / l / / 5 3 0 5 c--,..., p..,(.._ p..,(.._ p..,(.._ j 7- C / / '-7 Catch basin or area drain 16.60
7 , G �
City /State /ZIP: /4,n Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: / I Project name: /4/ - WAI"- G,,�
Vt -/t,/_ Footing drain (no. linear ft.: ) Page 2
z ' Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Back flow preventer Page 2 4
C crLfL7.-47 4 ' (_.. c., in... 4. 1 ft 5 GLi �/ e 5'24', Backwater valve 16.60
3 `7 G / 7 ,-,..."/- •/ /6.- o Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
®"PROPERTY OWNER I: ❑ TENANT
Ejectors/sump 16.60
Name: ./ (/( - (_v v / i
./4.1., TZ Expansion tank 16.60
Address: 7/ S ) o ,5 c. r"L__ - H' c/ Fixture /sewer cap 16.60
City /State /ZIP: "'j"/ Ml U Floor drain /floor sink/hub 16.60
Phone: (3) 2_4,46 - (. s- Fax: ( ) Garbage disposal 16.60
J Hose bib 16.60
❑ APPLICANT , ❑ CONTACT PERSON '
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone:( ) I Fax::( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
. CONTRACTOR -
Water closet 16.60
Business name: ` �1._ / Water heater 16.60
Address: , O 6o ' y 3o L ?5 Co Other:
City /State /ZIP: O 9_6
11 Subtotal
Minimum permit fee: $72.50
Phone: (S, S 331 •- O 5 'a- Fax: (5 1 ..O $$ J Residential backflow minimum permit fee: $36.25
CCB Lic.: 7$9O Plumbing Lic. no.r5“."..4 /)-Pli Plan review (25 %ofpermit fee)
State surcharge (8% of permit fee)
Authorized signature: p , - 1 - I'O b 7� J �,�
J r ,(� TOTAL PERMIT FEE I ` ��
Print name: ��", - / Date: . , - _ 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 \Pernits\PLMF- PernitApp.doc 04 /06/06 440- 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 - I' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00
7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 "
Storm &Rain Drain - 1st 100' 55.00 Valuation:. Permit' Fee:.
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total
additional $100.00 or fraction thereof to and
1 including $10,000.00.
Commercial Back Flow Prevention Device 46.40 �1. 0D $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 , $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Fixture Work: Plan Review for Com - Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
-4
Car Wash Drain Isometric or Riser Diagram ,
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley .
• - Commercial
- Service
Swimming Pool Filter •
Washer - Clothes
Water Extractor *Note: If the fixture work under this permit - results in an
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued. ,
i:\ Building \Permits\PLM- PermitApp.doc 07/06/05
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Name:HI HAT INC Updated: 4/17/2006 BLD General I j
Address:11530 SW PACIFIC HWY Jur: IG
Fixtures �
Description: Master # IPLM2006- 00140 � Project: {HI HAT � i,
CORRECTIONS: Sink in basement indirect receptor. Other fixtures: backflow preventer ■
for ice maker, boiler RP device and consensate in basement indirect receptor. ! Misc:
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T i u Cc Description ; Disp 1 Date3 Done By Notes
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1030 Check for parcel tags DONE 4/17)2006 BB • 1 •
Number 1280 Issue permit DONE 4M 712006 BB ;Cancel j; '{
� ' 1815 Backflow Test DONE 4M 712006 BLD ; ;
1310 Issue PLM signature form DONE 4/17)2006 BB ,
1020 Permit created DONE 4/172006 BB 4 !
11010 Application received RECD 4/17/2006 BB
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Name:HI HAT INC I 9' ° —5)FearefGgag? 1 0
BLD General , ,
Address:11530 SW PACIFIC HVVY Jur: ITIG
Description: Master #.IPLM2006-00140 , Project: 1111 FIAT i Fixtures ,
CORRECTIONS: Sink in basement indirect receptor. Other fixtures: backflow preventer
for ice maker, boiler RP device and consensate in basement indirect receptor. , . Misc.
imineli. _ .
Class' 1111W02) Li Edit a
Typ _ _ __ _ _ . __ _ _ __ _ _ _ _ ___. _ .: Ed
1 1 Activity: 730 Desc: Case update (see note) Updated: 4/21/2006 AMS
Occupanci; Y
Disposition:IDONE ,- Hold Level: No hold I 0 ff .
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Number of 11
1 Calendar Tag:i 414eNikii,
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.1 Report Tag:IADMN
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Assigned To: ; 1
DATE DONE 1 4 t 21 / 2006 '
. Done Ely:1AMS
11 ' Notes: X-Coordinated
s I T 90-00029 _
' 1 This permit covers corrections required under PLM2003-130010. -- - - -- ------ '
te: j
, 11 Please final and close that one when this one receives final Y-Coordina
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i! i approval. Thanks, Albert. )\/R Confirmation Number
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Albert Shields - PARCEL TAG Re: Hi Hat -- 11530 SW Pacific Hwy -- new PLM needed for corrections. Page 1
P\ , � • Co IY6
From: Albert Shields
To: #Counter
Date: 3/21/2006 11:19:43 AM
Subject: PARCEL TAG Re: Hi Hat -- 11530 SW Pacific Hwy -- new PLM needed for corrections.
This is a substitute parcel tag so that counter staff can know what to do with a permit application I expect
well receive within a day or two. Its also a file note and FYI to everyone else.
RE Hi Hat restaurant, 11530 SW Pacific Hwy -- property owner or plumbing contractor will be applying for
a new PLM. It should include the following:
1. Install approved backflow protection device on ice machine supply.
2. Install soaking sink on basement level including an approved indirect waste receptor.
3. Extend cooling unit waste line to approved location.
4. Install required RP backflow device on water supply boiler.
If there are any questions regarding issuing this permit please check with Mike, Hap, or Albert.
END OF PARCEL TAG.
For the file ... I spoke today with Dennis from Wolcott Plumbing and Norm Dowty, brother -in -law of Hi Hat
owner Melvin Louie.
Per Norm, Hi Hat will engage Associated Plumbing and will take out a new PLM to cover the outstanding
correction items, none of which fall within the scope of work under the original 2003 Wolcott permits.
After that permit is issued well move the correction items off of the 2003 permits and over to it. When we
do our first inspection under the new permit well also do a final inspection under the old permits,
expecting to pass and final them out.
I'll put a hard copy of this in the address file and will clip it to the existing PLM card for PLM2003- 00010.
(The card for PLM2003 -00017 is missing.)
Questions? Call me please.
»> Albert Shields 03/20 4:55 PM »>
Mike, this note is for you and for the file on this job so that we all know what is going on and can explain it
to the owners if need be.
I spoke with Bill Cooper of Associated Plumbing, 503 - 799 -4910, at some length about this job and the
corrections we've required. The Hi Hat owners apparently asked him to look over the corrections list but
have not yet hired him. (Wolcott was the contractor on the original two PLMs, PLM2003 -00010 and
PLM2003- 00017, both of which were reinstated for final inspection last month, and a new permit,
BUP2006 -10013 has been issued for the ADA bathroom upgrade.)
John Williams' 3/8/06 inspection report picks up on your 1/17/03 report. All of these 3/8/06 corrections
appear to be carry-overs from your earlier one and they all pertain to kitchen - related items (as opposed to
bathroom items.)
If there are no corrections to the bathroom permit, PLM2003- 00017, and if John agrees, it looks to me like
we can give that permit a final pass and close it out.
On the other hand, none of these remaining correction items were covered by the 2003 kitchen permit,
PLM2003- 00010, and they need to be covered by permit -- installation of the soaking sink and indirect
waste receptor, RP Backflow device installation on boiler, backflow device on ice machine, etc. The old
permit is too old to be added to so a new permit is required. It doesn't matter to us whether Hi Hat has
their former plumber, Wolcott, or Associated take out the new permit.
Albert Shields - PARCEL TAG Re: Hi Hat -- 11530 SW Pacific Hwy -- new PLM needed for corrections. Page 2
• P I t 21. ( X ) I
If we have no corrections on the original kitchen work, which was simply the installation of two 2" floor
drains, we can final out that permit, as soon as a new permit is issued to cover these correction items.
When you speak with John please find out and let me know whether the previously permitted bathroom
and kitchen work can be passed and finalled once we get a permit for the new work.
Thanks, Albert.
Albert Shields
Housing Inspector, Building Codes Enforcement Officer
City of Tigard
503 - 718 -2426
Albert a(�tigard- or.gov
Don't be misled by the fact that my EMail address has changed
twice this year already. It is now, as above, Albert(c�tigard- or.qov.
Please make sure your Frequent Contacts or Address Book lists
me this way. Thanks, Albert.
CC: Dianna Howse; Hap Watkins; Jeanne Temple; Mike Sheehan