Permit •
CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit#: PLM2009-00158
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/26/2009
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Fred Meyer
Project Description: Replace (4) floor drains, (4) urinals, (13) w /c, and (8) lays. Add (1) lay.
Owner: FEES
FRED MEYER STORES, INC Quantity Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO
BOX 35547 4 ea Floor Drain/Floor Sink/Hub 06/26/2009 $66.40
PHONE: 9 ea Lavatories 06/26/2009 $149.40
4 ea Urinal 06/26/2009 $66.40
13 ea Water Closet 06/26/2009 $215.80
Contractor: 1 12% State Surcharge - 06/26/2009 $59.76
PMSI LLC Plumbing
21195 NW EVERGREEN PKWY #204
HILLSBORO, OR 97124
PHONE: 503 - 466 -2222
FAX: 503- 466 -2211
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $557.76
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: ( 1.. ) 0 t n adi Permittee Signature:
QS/ Ap
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.
From: 06/17/2009 11:55 4373 P.001 /003
E
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE O\l_l
City of Tigard Received
1,1 g I InI Permit No.: 4r .
1312 SW Hall Blvd., Tigard, OR 9d 17 2009 aY M ��■ ��, •
Plan Review o g
Phone: 503.639.4171 Fax 503.598.1960 Pan Review Other Permit No.:
T l V -4 RD Inspection Liss 503.639.4175 CITY OF TIGARD Rue Ready/By: r H see Page z for
Internet www.tigard-or.gov BUILDING DIVISION Notified/Method. (i) Supplemental Information
TYPE OF WORK FEE• SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty.
® Addition /aheration/replacement ❑ Other. Total
New 1-2-family 2- ran,vy dwellings (includes 100 R 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
❑ Master builder Each additional bath/kitchen 45.00
❑ Fire sprinkler (___ sq. R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address:-HISSITSW Pacific Hwy 11 ( Catch basin or area drain 16.60
City /State/ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldgJapt no.: l Project name: Fred Meyer restroom rented Footing drain (no. linear ft: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
• 1 F C)1.t in eJ ease Rain drain connector 16.60
• Sanitary sewer (no. linear IL: _J Page 2
Storm sewer (no. linear R: _) Page 2
Subdivision: I Water service (no. linear IL: ) Page 2
Lot no.:
Tax map /parcel no.: I S 13eooa Oo ao i Fixture i .
Absorption valve valve 16.60
DESCRIPTION OF WORK Back low prevents- Page 2
Plumbing for restroom remodel Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I 0 TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name:
Expansion tank 16.60
Address: FixtureJsewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub q 16.60 tip , q 0
Phone: ( ) Fax ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business name: Ice maker 16.60
Interceptor /grease trap 16.60
Contact name:
Medical gas (value: S ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: Sink/basin/lavatory 16.60 t g l . L f c7
( ) Fax:( )
E -mail: Tub/shower /shower pan 16.60
Urinal Lj 16.60 (p & Li 0
CONTRACTOR Water closet / 3 16.60 A l S e0
Business name: PMSI LLC Water heater 16.60
Address: 21195 NW Evergreen Pkwy Suite 204 Other.
• City/ State/ZIP: Hillsboro, OR 97124 r Subtotal i y eit
Minimum permit fee: $72.50
Phone: (503) 466 -2222 Fax (503) 466 -2211 Residential backflow minimum permit fee: $36.25
CCB Lie.: 158286 Plumbing Lie. no.: 34-434PB Plan review (25% of permit fee)
r I State surcharge (12% of permit fee) 5ti(
Authorized signature: r / Iv ??ii(e j � ,
t TOTAL PERMIT FEE
Print name: Lanell Robinson Date: 6/15/09 This permit application expires it a permit Is not old/tit-led J
ithin
180 days after it has been accepted as complete.
•Fee methodology set by Tri- County Building Industry Service Board
t:\Buildin aitstvt.MF -2)e itApp.doe 12)27/06 440- 4e16r(10/02/COM/WEB) G10.00
' ` From: 06/17/2009 11:55 #373 P.002/003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
•
Site Utilities Q F0e (ea) Tom Square Footage: Permit Fee:
Footing drain -1 100' 55.00 0 to 2,000 5115.00
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.E
Valuation: Permit Fee:
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
Q ty. Fee (ea) Toad additional $100.00 or fraction thereof, to and
Fixture or Item 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 $1.54 for
Residential Backtlow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 2755 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial 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
Future 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 El 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 MachJRefrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory f
$
- Bradley *Note: If the fixture work under this permit results in an
-Commercial increase of sewer EDUs, a sewer permit will be issued and
- mac _ 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 , " 1 3
Other Fixtures:
i:\B n14ing\Perntib\PLM- PemriIApp.doc 12/27/06