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Permit C ITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00287 r►Ga 3 : 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/7/2008 PARCEL: 2S 102CC -00500 SITE ADDRESS: 13600 SW PACIFIC HWY ZONING: C -G SUBDIVISION: TIGARD MARKETPLACE LOT: JURISDICTION: TIG PROJECT: H MART Project Description: Installation of (2) sinks and (1) 2" floor sink. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS; 1 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES 13500 PACIFIC CORP BY CAP ADVISORS Description Date Amount 38345 W TEN MILE RD, STE 170 [PLUMB] Permit Fee 7/7/2008 $72.50 FARMINGTON HILLS, MI 48335 [TAX] 12% State Surch 7/7/2008 $8.70 Phone : Total $81.20 Contractor: FAR WEST PLUMBING PO BOX 597 ESTACADA, OR 97023 REQUIRED ITEMS AND REPORTS Contact # : Reg #: LIC 78959 PLM 3 -246PB 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 rule • •ire questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issu =d By: ,k _0 ` ` , 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. CITY OF TIGARD BUILDING DIVISION PERMIT #: P &M 2.00T CO 257 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 kiv - 7 � 7/ 2 o O7. Inspection Requests (24 Hrs.): (503) 639 -4175 n1l. INSPECTION WORKSHEET FOR DATE: 7 (z 1 0 T. TIME: Pi)/ PAGE: SITE ADDRESS:13 (7OO_9L) PAc;t c: ` I-t'(. j. CLASS OF WORK: SUBDIVISION: 11 Ag ,, -„I rs/N a ,Tet 4 LOT #: TYPE OF USE: PROJECT NAME: 14 .r 0.4 DESCRIPTION: OWNER: PHONE #: CONTRACTOR: ea✓ t„,„IzrertAA,..Jo., PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 1 F►tea DQvA5 317 S7 C IS Corrections /Comments /Instructions: Caft- c Lc/( 4—A ii,- K PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: r►'1tl`— \f\"-4.' Date: - 7 1 ZA \,D t Phone #: (503) 718- CITY ����~�^ ��������� .'/' � ��m w m ��n m m����xm�� =� �'� ` ` ` BUILDING DIVISION PERMIT #: 002D . 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: . ///2808 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 .4. , 1.1!. INSPECTION WORKSHEET FOR DATE: 7/11/2008 TIME: 7:OOAM RAGE: ` 8 SITE ADDRESS 13GOV0YV PACIFIC HVVY CLASS OF WORK: SUBDIVISION: ll@ARDKAARKE|PLAC[ LOT #: TYPE OF USE: PROJECT NAME: 11 MART DESCRIPTION: Installation of (2) sinks and U 2" floor sink. 7Y9/08. ALTERING PERh4|T, 2'`FLOOR SINK TAKEN OFF PERh&|T, CAPPING 3-COMPARTMENT SINK. OWNER: 135OD PACIFIC CORP, PHONE #: CONTRACTOR: FAR VVEF..;T PLUMBING PHONE #: Inspection Request Scheduled For: Date: 7/11/2000 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough-in 072534'01 503888-8498 Y �� �� .�� �� � ��,„� � ��° `~' � Corrections/Comments/Instructions: `' | 1 PARTIAL APPROVAL 111 CANCEL | | NO ACCESS ri FAIL Ei CALL FOR INSPECTION || ADDITIONAL FEES ASSESSED Inspector: \y\~~' Date: -) i / I 1 0 7 ' , Phone #: (503) 718- ` ` Plumbing Permit Application Building Fixtures _ FOR QF USE O � r<r • rte, ;f' Rece ived ,: City of Tigard r 1 t/ a Permi No.: � tY g C E V IV Date/By �I "r' r '� g c_.C./ �8 0 13125 SW Hall Blvd., Tigard, • 97223 Plan Review /1 �/ r ` C . Phone: 503.639.4171 Fax: 503. 19 o• Other Permit No.g ��' t ( A I t. ' D ate / By: =h`' Inspection Line: 503.639.4175 1 G /Y RD U ■ Date Ready /By: lur' See Page 2 for .`,i lt►4a.*'u Notified /Method: www.tigard - or.gov _�� ��// ��°°``��, �+ Noti/Method: /f (4o Supplemental Info TYPE {{NVORKr TIGAR� FEE* SCHEDULE ❑ New construction 6� ` Q D v S, ®�l For s, ecia/ information use checklist Description 1 Qty. 1 Ea. 1 Total ❑ Addition/alteration/replacement ❑ 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: 1 ?, t 0 0 . SL'&) t9oc:, -CI' c- N W Catch basin or area drain 16.60 City /State /ZIP: T , hd og" ci 7a Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: , / rnarl- Footing drain (no. linear ft.: _ Page 2 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: 1 Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK • Backflow preventer Page 2 yo UvT D SHc , A•;de q ) 1 ma y-r -- Backwater valve 16.60 Q Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: t _ Oho ‘ Expansion tank 16.60 Address: I /)kio .. (,) J 0•-R} -Cyr TI--" Fixture / sewer cap 16.60 City /State /ZIP: "TUN c 1 - t 1 6 ,R 1' 10-6 t- Floor drain/floor sink/hub / 16.60 Phone: (9) ) 1(.(:- 6(C5 Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 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: Rdrain (commercial) 16.60 r CS in#Eirillavatory a- 16.60 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR . Water closet 16.60 Business name: 1 ' kV 1 y p1 a (4 �‘ Water heater 16.60 Address: ?,0 1 3 )( c-q/) Other: City /State /ZIP: �5t (' . ( \ 0 C"7 io Subtotal f- Minimum permit fee: $72.50 5C) Phone: (150 ) 3\x_ S 1 I f 8' _ Fax: ( ) Residential backflow minimum permit fee: $36.25 1e CCB Lic.: C r., 8 I� Plumbing Lic �: . -( 0 U - Plan review (25 % of permit fee) r State surcharge (12% of permit fee) 5, 70 Authorized signature: \ TOTAL PERMIT FEE 61 PO Print name: ( .)(, k L Date: 1) TT 6 g 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 \Permits\PLMF- PermitApp.doc 12/27/06 440- 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 - In 100' 55.00 0 to 2,000 $I 15.00 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 - l st 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 including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $I.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 and including $50,000.00. specially requested inspections - per hour 72.50 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 Plumbing Installations Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: • • . Replace engineer. . Previous Capped •Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain • Isometric Or Riser Diagram . Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink 2" that meet the qualifications above. - 3" - 4" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial 3-- increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\ Building \Permits\PLM- PermitApp.doc 12/27/06 Accumulative Sewer Tally Parcel # 2S102CC -00500 Tenant Name: 1H Mart This SWR# 2008 -00107 Site Address: 13600 SW Pacific Hwy This PLM# 2008 -00287 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off #s count # value #s values Baptisery /Font 4 0 0 0 0 0 Bath - Tub /Shower 4 0 0 0 0 0 - Jacuzzi /Whirlpool 4 0 0 0 0 0 Car Wash - Each Stall 6 0 0 0 0 0 - Drive through 16 0 0 0 0 0 Cuspidor /Water Aspirator 1 0 0 0 0 0 Dishwasher - Commercial 4 0 0 0 0 0 - Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain /Sink - 2 inch 2 0 0 1 2 1 2 - 3 inch 5 0 0 0 0 0 - 4 inch 6 0 0 0 0 0 - Car Wash Drn 6 0 0 0 0 0 Garbage Disposal - Domestic (to 3/4 HP) 16 0 0 0 0 0 - Commercial (to 5 HP) 32 0 0 0 0 0 - Industrial (over 5 HP) 42 0 0 0 0 0 Ice Machine /Refrigerator Drain 1 0 0 0 0 0 Oil Sep (Gas Station) 6 0 0 0 0 0 Rec. Vehicle Dump station 16 0 0 0 0 0 Shower - Gang (per head) 1 0 0 0 0 0 - Stall 2 0 0 0 0 0 Sink - Bar /Lavatory 2 0 0 0 0 0 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 2 6 2 6 - Service 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer - Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet - Toilet 6 0 0 0 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 0 3 8 3 8 Current Fixture Value 8 divided by 16 = 0.5 Current EDU 1 EDU = $ 3,100 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 8 divided by 16 = 0.5 over (under) $ 1,550.00 Enter EDU Change Here 0.5 Notes: Authorized Name /Signature: Debbie Adamski Date: 7/7/2008 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges. I: \Building \Sewer Tally \SewerTallySheet- 3100.xls 06/19/08 leasf4_. CITY TIGARD PLUMBING PERMIT ' COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00287 TIGARD.: 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/7/2008 PARCEL: 2S 102CC -00500 SITE ADDRESS: 13600 SW PACIFIC HWY ZONING: C -G SUBDIVISION: TIGARD MARKETPLACE LOT: JURISDICTION: TIG PROJECT: H MART Project Description: Installation of (2) sinks and (1) 2" floor sink. 7/9/08, ALTERING PERMIT, 2" FLOOR SINK TAKEN OFF PERMIT, CAPPING 3- COMPARTMENT SINK. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS; 0 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 3 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES 13500 PACIFIC CORP BY CAP ADVISORS Description Date Amount 38345 W TEN MILE RD, STE 170 [PLUMB] Permit Fee 7/7/2008 $72.50 FARMINGTON HILLS, MI 48335 [TAX] 12% State Surch 7/7/2008 $8.70 Phone : Total $81.20 Contractor: FAR WEST PLUMBING PO BOX 597 ESTACADA, OR 97023 REQUIRED ITEMS AND REPORTS Contact # : Reg #: LIC 78959 PLM 3 -246PB 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 Signatur . d't 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.