Permit CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit #: PLM2012 -00293
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/09/2012
Parcel: 1 S126CA01000
Jurisdiction: TIGARD
Site address: 9009 SW HALL BLVD 142
Project: Sushi Hanna Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Disconnect kitchen waste pipe connected to storm line and plumb to sanitary sewer & reconnect.
Contractor: RIVER CITY ENVIRONMENTAL Owner: CAFARO NORTHWEST PARTNERSHIP
PO BOX 30087 PO BOX 422
PORTLAND, OR 97220 FLORHAM PARK, NJ 07932
PHONE 503 - 252 -6144 PHONE.
FAX 503 - 288 -3658
FEES
Quantity Description Date Amount
100 If Sewer Service 10/09/2012 $62.54
Specifics: 1 12% State Surcharge - 10/09/2012 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment - 10/09/2012 $9.96
Plumbing
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 n• started within 180 days of
issuance, o ' suspended for more the 180 days. ATTENTION: Oregon law requires you to • II hw the r adopted by the Oregon
Utility • ification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -01 =0 You may • stain a opy of the rules
or d' ect questions to OUNC b . . - /3.232.1987 or 1.800.332 2344.
Iss ued By: � Permittee Signature: / \ '
Call 503.639.4175 by 7:00 a.m. for the next available inspe • • •te.
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
Building Fixtures
City of Tigard Received
Date/By l� 7 / Permit No / al /A �0?
74 a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
11 Phone: 503 718.2439 Fax. 503.598.1960 DateBy Other Permit No
T I G A R U Inspection Line: 503 639.4175 Date Ready/13y Juns ® See Page 2 for
Internet: www tigard- or.gov Notified/Method , Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ Nei . construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
[_'
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (Includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- and 2- family dwelling Ik6 mmercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq ft.) Page 2
' JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 9 009 su p 1�(( F5 1 v t0 Catch basin or area drain 1 8.76
Drywell, leach line, or trench drain
City/State /ZIP: 7 j:1020 D 2 s 9 r/2-23 F ootin
2 3
I I 4 Footing drain (no. linear ft.: ) Page age 2
2
Suite/bldg. /apt. no.: y I Project name: S US P, l 1A& Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
CA) A-s 1c-k. j N -1-p.,J e Nt.. a s Vit.y W f a-e � Rain drain connector 18 76
'e_ )n^ 1 / 1 Sanitary sewer (no. linear ft.: //D) Page 2 �a,$�/
, , n e ' " ` L tJ ' Storm sewer (no linear ft.: ) Page 2
S' . N '-- Water service (no linear It ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
n Clothes washer 25.02
0i5C_O K)Y.err 1Li - [ems (tip 6 1 - 1" 1 - a) ` �'� - e<0 Dishwasher 25.02
l 97 _ bt. Livl,-e- -4- ��Uen 13 '4 D 514x( /-447 Drinking fountain 25.02
S �ti■-- 4— 12,E exi k.).i_A • Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Name: Fixture /sewer cap 25.02
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
❑ APPLICANT ❑ , CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25 02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name \ je / 0-,..L. zOV) &Q i J NL -1.,p L. Water piping/DWV 56.29
Address: N o go f E z V I A A - N , L T o , Other 25.02
City/State /ZIP: 7o [14- O 02 • S 1-222_,c) Subtotal
Phone: (so-3 2fj (p (
/ Fax: ( ) Minimum permit fee $72.50 2A-S
CCB Lic.: l L` 17 3 c fir t' Plumbing Lic. no.: 24, - 7S 5 Pa, Plan review (25% of permit fee) '
State surcharge (12% of permit fee) $, 70
Authorized signature: LL. U `/� / f p TOTAL PERMIT FEE' WI • a'�
�
Print name: , �(Z —
S S. y , vs P Date: This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
'Fee methodology set by Tn- County Building Industry Service Board.
I \Building'Permiis\PLMU- PermilApp doc 10/01/09 440- 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 - 1 100' 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' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - Ist 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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
Other ec
Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspections 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 charge - 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 charge - 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 charge 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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
Bashi - Tub /Shower greater, except systems designed and stamped by licensed
- Jacuzzi/Whirlpool engineer.
Car Wash. Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink - 2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
- Car Wash Drain
Garbage Domestic non - food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non -food related
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be aid before the
Water Extractor p
WaterCloset - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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