Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00160
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/22/2009
Parcel: 2S104BB07900
Jurisdiction: Tigard
Site address: 14300 SW BARROWS RD
Subdivision: RUSSELL'S SCHOLLS FERRY SUB Lot: 2
Project: Albertson's
Project Description: Backflow preventer
Owner: FEES
NEW ALBERTSON'S INC Quantity Description Date Amount
ATTN: 70428 - CORPORATE TAX, PO BOX 20,
250 PARKCENTER BLVD 1 ea Backflow Prevention - 06/22/2009 $46.40
COM
PHONE: 1 12% State Surcharge - 06/22/2009 $8.70
Plumbing
26 ea Minimum Fee Adjustment - 06/22/2009 $26.10
Contractor: Plumbing
COMMERCIAL PLUMBING SERVICES
21185 NW EVERGREEN PKWY, STE 106
HILLSBORO, OR 97124
PHONE: 503 - 439 -9999
FAX: 503 - 439 -1999
Type of Use: COM
Class of,Work: ALT 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800 332.2344.
Issued By: } Permittee Signature:
9
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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06/19/2009 11:13 Mechanical Services, Inc. (FAX) P.002 /002
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Plumbing Permit Application g�
Building Fixtures RECEIVED - F OR OFFICE USE ONLY
::, City of Tigard Received r '
e 'my Date/By: Permit No.: PLA �a a Co
13125 SW Hall Blvd., Tigard, OR 97223 JUN 19 ?.009 Plan Review r
' Phone: 501639.4171 Fax: 503.598.1960
inspection Line: 503.639.4 ] 75 Datc /By:
ins Other Permit No.:
111 GARD Internet: Line: 03 . 63 .gov RR CITY OF TIGARD Date Ready /By: RIM: SI See Page 2 for
TYPE 'OF IVOR G o i se ethn . rEt S tan
ILDIN DIVISION. N t 1f d/M d
Supplemental Informai'
: F . CHEDUL.E :;,.
❑ New construction ❑ Demolition For special information use checklist
Description j Qty. ! Ea. ] Total
® Addition /alteration/replacement ❑Other: New 1- 2- family dwellings (includes 100 R. for each utility comtection)
- • • CATEGORY'_OFCONSTRUCTION. •
SFR (1)bath 249.20
❑ I - and 2- family dwelling ® Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
I=1 Master builder Each additional bath/kitchen 45.00
❑ O her' ire sprinkler ( 9 )
OB, S 1ATION :AND LOCATION. F' spri ie r s . ft.) Page 2
_ ;.., , ._- • . J 1TE-_INEORD ' O -
.. ,..; Site utilities
Joh site address: 14300 SW Barrows Rd Catch basin or area drain 16.60
City /State /ZIP: 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: A lbertsons #576 Footing drain (no. linear ft.: ) Page 2
Cross Manufactured home utilities 1 10.00
ross 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 II: ) Page 2
Tax map /parcel no.:
Fixture or item
- Absorption valve 16.60
_ . DESG721PT1ON OF IV_ORK_ : Backflow preventer I Page 2 46.40
Replacement of one backflow device in the seafood department Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
' 12 PROPERTY OWNLR,. ::- Drinking fountain 16.60
.
❑,TENANT
Ejectors/sump 16.60
Name:
Expansion tank 16.60
Address:
Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink /hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
l'' ;:API'L( ANT {- Ilase bib 16.60
-,..- .. C_ - "vim =I] -C .... : PER
Ice maker 16.60
Business name: See Contractor
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin /lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
- Urinal
-- - --- - 16.60
a er closet
16.60
W
Business name: Commercial Plumbing Services Water heater 16.60
Address: 21185 NW Evergreen Pkwy Ste 106 Other:
City /State /ZIP: Hillsboro, OR 97124 Subtotal 46.40
Minimum permit fee: 572.50
Phone: (503) 439 -9999 Fax: (503) 439 -1999 Residential backflow minimum permit fee: 536.25 72.0
CCB Lie.: 126015 _`_ nbin• . c. no.: 37 -421PB Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
Authorized signature: '_ TOTAL PERMIT FEE 81.20
Print name: Natalie Partipilo Date: 6/19/09 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.
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
•
Site:_Utilities- Qty Fee (e "). Total Square Footage:::: Permit Fee
Footing drain - l ' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00
7201 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
Valuation: = -- Permit' _ •
Storm & Rain Drain - 1st 100' 55.00 $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
F1xtUre`OC jtelll Qty Fee,(ea):.;; =Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 1 ~ a 46.40 46.40 $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 136.25) 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:
Commercial Fixture Work: • • ReViery 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
Quantit 'by- (Fixiui e) : :3Vork;Performrd greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous ` Gipped ' �i17ed : Caisiiiig •- ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR9I8 -780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool El Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR91 8-780-0040.
-Drive Thru
Cuspidor water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic •
Drinking Fountain Isometric or Riser'Diagrall]'s
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 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: