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Permit CITY OF TIGARD PLUMBING PERMIT - COMMUNITY DEVELOPMENT Pe rmit#: PLM2013 00246 e Date Issued: 08/08/2013 TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503 718.2439 � Parcel: 1S135BC00202 Jurisdiction: Tigard Site address: 10763 SW GREENBURG RD 120 Project: Subway Subdivision: HILLSBORO Lot: PTS 1-2 Project Description: Add new fixtures' (1)expansion tank,(3)floor drain/sink,(1)interceptor/grease trap, (3)primers,(4)non-food related sinks,(2)food related sinks,(1)service sink,(2)water closets and(1)water heater 8/19/2013 REPRINT permit to correct suite address from 100 to 120 9/17/13, reprinted to add water supply for future soap dispenser Contractor: WEST COAST CENTRAL PLUMBING LLC Owner: BELANICH, ROGER M 12714 SE MAJESTIC LN 22020 17TH AVE SE#200 HAPPY VALLEY, OR 97086 BOTHELL,WA 98021 PHONE: 503-298-0435 PHONE: FAX: 503-855-3264 FEES Quantity Description Date Amount 1 ea Expansion Tank 07/23/2013 $12 51 Specifics: 3 ea Floor Drain/Floor Sink/Hub 07/23/2013 $75 06 1 ea Interceptor/Grease Trap 07/23/2013 $25 02 Type of Use: COM 3 ea Primer 07/23/2013 $37 53 Class of Work: ALT 3 ea Sink 07/23/2013 $75.06 Type of Const: 4 ea Lavatories 07/23/2013 $100 08 Occupancy Grp: 2 ea Water Closet 07/23/2013 $50 04 Stories: 1 ea Water Heater 07/23/2013 $37.52 1 12%State Surcharge- 07/23/2013 $49.54 Plumbing 25 Misc Other Fee 09/17/2013 $25.02 0 12%State Surcharge- 09/17/2013 $3.00 Plumbing Total $490.38 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of 0=. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if • • is not started within 180 days of issuance, or if work is suspended for more the 180 days ATTENTION: Oregon law requires you to olio the rules adopted by the Oregon Utility Notifi - .•n en - Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00'0. ou '-y obtain a copy of the rules or direct••estions to OUNC • cling 503 232 1987 or 1 800.332 2344. / ' Issued :y: ' Permittee Signature: l! �^ 1� Call 503.639.4175 by 7:00 a.m.for the next available inspect'• date. This permit card shall be kept in a conspicuous place on the job site until 6mpletion of the project. Approved plans are required on the job site at the time of e• inspection. CITY OF TIGARD PLUMBING PERMIT 1 COMMUNITY DEVELOPMENT Permit#: PLM2013-00246 T[G AR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013 Parcel: 1 S135BC00202 Jurisdiction: Tigard Site address: 10763 SW GREENBURG RD 100 Project: Subway Subdivision: HILLSBORO Lot: PTS 1-2 Project Description: Add new fixtures: (1)expansion tank,(3)floor drain/sink,(1)interceptor/grease trap,(3)primers,(4)non-food related sinks,(2)food related sinks,(1)service sink,(2)water closets and(1)water heater. Contractor: WEST COAST CENTRAL PLUMBING LLC Owner: BELANICH, ROGER M 12714 SE MAJESTIC LN 22020 17TH AVE SE#200 HAPPY VALLEY,OR 97086 BOTHELL,WA 98021 PHONE: 503-298-0435 PHONE: FAX: 503-855-3264 FEES Quantity Description Date Amount 1 ea Expansion Tank 07/23/2013 $12.51 Specifics: 3 ea Floor Drain/Floor Sink/Hub 07/23/2013 $75.06 1 ea Interceptor/Grease Trap 07/23/2013 $25.02 Type of Use: COM 3 ea Primer 07/23/2013 $37.53 Class of Work: ALT 3 ea Sink 07/23/2013 $75.06 Type of Const: 4 ea Lavatories 07/23/2013 $100.08 Occupancy Grp: 2 ea Water Closet 07/23/2013 $50.04 Stories: 1 ea Water Heater 07/23/2013 $37.52 1 12%State Surcharge- 07/23/2013 $49.54 Plumbing Total $462.36 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of 0' Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if w• is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to fo ow the rules adopted by the Oregon Utilit 'oification --nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y• m- obtain a copy of the rules or• rect questions to O C by •:(ling 503.232.1987 or 1.800.332.2344. Is ued By: A II, l� / , Permittee Signature: i Call 503.639.4175 by 7:00 a.m.for the next available inspection dat= This permit card shall be kept in a conspicuous place on the job site until complet ,n of the project. Approved plans are required on the job site at the time of each inspe; ion. Plumbing Permit Application Building Fixtures RECEIVED F(i)i OFFICE USE ONLY City of Tigard r� Received Permit No �/ g E P 1 7 2013 Date/By 9 /7 / 3 1 Ll l&x13.60.9 4l� n 13125 SW Hall Blvd,Tigard,OR 9723C Plan Review ' Ill Phone 503.718.2439 Fax. 503.598.1960 DateBy Other Permit No l'I G A R D Inspection Line: 503.639 4175 CITY OF TIGARD Date Ready/By runs See Page 2 for Internet: www tigard-or.gov BUILDING DIVISION Notified/Method Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist. Description I Qty. I Ea. Total ❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(l)bath 312 70 ❑ I-and 2-family dwelling ❑Commercial/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: )0 76 3 vw l� ti tstt�('p 1«j Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: Footing drain(no.linear ft.• ) Page 2 Suite/bldg./apt.no.: i30 I Project name: c..4_16 Lue,y Manufactured home utilities 50 03 Cross street/directions to job site: Manholes 18 76 Rain drain connector 18.76 Sanitary sewer(no.linear ft• ) Page 2 Storm sewer(no.linear ft. ) Page 2 Water service(no linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31 27 DESCRIPTION OF WORK Nu rUe`� Backwater valve 12.51 n Clothes washer 25.02 �}a7� LOAT -' 1'p�—y L+ �,� d°/9P Dishwasher 25.02 *--1- 1 S b')f*2 , Drinking fountain 25.02 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: 25.02 City/State/ZIP: ( Sink/basin/lavatory 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: L 3 T 0,t5-r C f NT724 c_ p,..,,,,,,,,,NIG Water piping/DWV 56 29 Address: Other. 1.047 /2 3`cc/i-Y 25.02 gS62-- City/State/ZIP: /cv2- l rd'/Li_ .4P TitsAYA-) Fr2— Subtotal Phone:( ) Fax:( ) Minimum permit fee $72 50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) r., 7.--- State surcharge(12%of permit fee) 5-°(:)Authorized signature: TOTAL PERMIT FEE 96/.0 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 Tn-County Building Industry Service Board I\Buiiding\Permits\PLMU-Perm •pp doc 10/01/09 440-4616T(1 0/02/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 dram-151 100' 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-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $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 Inspections or Fees Qty. Fee(ea) Total each additional$100 00 or fraction thereof,to p 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 greater,except systems designed and stamped by licensed Ba th:pti Tub/Shower engineer. -Jacuzzi/Whirlpool El Car Wash Each Stall New exterior plumbing site utilities for any complex structure Drive Stall as defined in OAR918-780-0040. El Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial El 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" 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 paid before the Water Extractor WaterCloset-Toilet plumbing permit can be issued. Urinal Other Fixtures: 1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Plumbin. Permit A• •lication , __ kx, 44,. ': OR 1_Building Fixtures , : ... .__. . -_ 0 _ rlI i ,�---- City of Tigard / .. reece;�ed �.r ti 13125 SW Hall Blvd..Tigard,OR 9722 L If 2013 Plan Re 7 /� PermitNopLi/o2(j/3 0 oa y� Phone: 503.718.2439 Fax: 503.598.1 plan Review Inspection line: 503.639.4175 DateRez Other Pertnitt 4/ 0/�D�,1G y TLGA F D CITY TIGARD Gate Aeady.By: l3 See Page 2 for / Internet: www.tigard.or.gov ��°f' !, {/��} Hunt-le:Method: , //(f Supplemental laformation TYPE OF LJfN(,DIVISION FEE* SCHEDULE ❑New construction 0 Demolition For special information use checklist Addition/alteration/replacement Description 1 Qty. I Ea. 1 Total ❑Other; New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 kM ❑ 1-and 2-family dwelling Commercial/industrial • SFR(2)bath 437.78 0 Accessory building ❑Multi-family - SFR(3)bath 500.32 J Cr 0 Master builder Each additional bath/kitchen 25.02 O ❑Other: • Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 10" I4 �\r( (i� -RA- Catch basin or area drain 18.76 C City/State2lP: r----;/` , j�`�l UUUWWWWWW� Drywell,leach line,or trench drain Suite/bldg./apt.no.: �-_M� t(1 l Footing drain trio,linear R.: ) Page 2 y Manufactured home utilities 50.03 Cross street/directio .•site: v Manholes 18.76 r Rain drain connector 18.76 Sanitary sewer(no.linear ft: ) Page 2 Storm sewer(no.linear ft.:- ) Page 2 Subdivision: I Water service(no.linear ft.: ) Page 2 Lot no.: Fixture or item: Tax map/parcel no_: Back flow preventer 1 I 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 • �, '��� Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank f 12 51 tit _5/ vl Name Fixture/sewer cap 25.02 / Address: Floor drain/floor sink/hub /3 25.02 ig5,10 Ciryress: ZIP: Garbage disposal 25.02 Hose bib 25.02 Phone:( ) Fax:( ) k maer Ice • 12.51 ■:t APPLICANT ❑ CONTACT PERSON Interceptor/grease trap ( 25.02 "L„...�,d� • Business name: ► - Medical gas(value:$ ) _ Page 2 \ • .. 4 �a • llr. t . •L I t4 ',' Contact name: Primer 3 12.51 31-5-3 ✓ is e rte- Roof drain commercial Address: ,, (commercial) _ 12.51 �A L Sink/basinilavatory 1 25.02 am► ♦, t Solar units(potable water) 62.54 I, , I. _ Tub/shower/shower pan 12.51 ,t L./ Urinal :� '� 25.02 E-mail: 'A r TRACTOR Water closet ./ 25.02 25O V 'r Water heater I 37.52 3'r,57_ ✓ 1+i, _ik . ' 1 i Water piping/DV�V Address: i� 56.29 fL. ! `i■ Other. 25.02 City/State/LIP: I /,. ter/ ►►.. .. ,�.' .. 0�� 1 r Subtotal ' Phone.( :-. alai - CCB Lie.: • �,i ` t ! ! Minimum permit fee: $72.50 • a , 3042 Plumbing Lic.no.: ► ^ Plan review (25%of permit fee) yy; �� State surcharge(12%of permit fee) Authorized signature: -4.....111 i t_ a -1 r MJ1`,�Ld" TOTAL PERMIT FEE + .✓ Print name: per. /w This permit appliradone:expires � li - -r/ 6/ p permit is not ofrtainedwi16 1&�dapar ` after it has been accepted as complete �(p a 6 *Fee methodology set by Tri-County Building Industry Service Board. Z'd b9Z£998 EO9 Ouigwnld o3M d6L:l L 26 9L In(' Plumbing Permit Application - City of Tigard . , Page 2 -Supplemental Information I. qr Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total " Square Footage: Footing drain-1"100' Permit Fee: 50.03 0102000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 Sewer-1st 100' 62 3,601 to 7,200 $233.20 Sewer-each additional 100' , 7,201 and greater $327.54 37.52 Water Service-1st 100' 62.54 Water Service-each additiarsl!00' 37.52 Medical Gas Systems: Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: Storm&Rain Drain-each additional 100' 51.00 to$5,000.00 Minimum fee$72.50 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Inspection of existing plumbing or for and including$10,000.00, which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 S148.50 for the first$10,000.00 and$1.54 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to Inspections outside of normal business 90.00Ar and including$25,000.00. hours(minimum charge-2 hours) $25,001.00 to$50,000.00 $379.50 for the first 525,000.00 and$1.45 for Reinspection Fees 90.D0/hr each additional$100.00 or fraction thereof,to and including 550,000.00. Additional plan review for revisions 90.00/hr 550,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-I/2 hour) , each additional$100.00 or fraction thereof. t Subtotal: r - 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*. Quantity by Fixture T ce/ Plan Review for Plumbing Installations Fixture Type for Repla Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath Tub/Shower - ❑ Any new commercial building with water service 2"and lacu�i/Whiripool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru CI New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial Cl Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain El Any complex structure as defined in OAR918-780-0040. Wash Floor Dra sin -2".5,NgiDR9� eL,u ../ - Submit 2 sets of plans with any of the above. -3" s'/r�/� -4" • Car Wash Drain - Isometric or Riser Diagram Garbage I?omestio-pore-food ❑ Isometric or riser diagram is required for new buildings Disposal -Domestic-food related I that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains .1 Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang " -Stall - Sink/Lav -Non-food related Iji '' ' -Bradley -Commercial-food related - 13-Service lf2 t Swimming Pool Filter Washer-Clothes - *Note: If the fixture work under this permit results in an Water Extractor increase of sewer EDUs,a sewer permit will be issued and WaterCloset-Toilet Z ✓ fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: £'d 179Z£998£09 6uigwnld DoM d6l L l £L 9 L Inf 11 CITY OF TIGARD PLUMBING PERMIT t " COMMUNITY DEVELOPMENT E -- ISED Permit#: PLM2013-00246 V Date Issued: 08/08/2013 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 4003 Parcel: 1S135BC00202 Jurisdiction: Tigard Site address: 10763 SW GREENBURG RD 120 Project: Subway Subdivision: HILLSBORO Lot: PTS 1-2 Project Description: Add new fixtures: (1)expansion tank,(3)floor drain/sink,(1)interceptor/grease trap,(3)primers,(4)non-food related sinks,(2)food related sinks,(1)service sink,(2)water closets and(1)water heater. 8/19/2013: REPRINT permit to correct suite address from 100 to 120. Contractor: WEST COAST CENTRAL PLUMBING LLC Owner: BELANICH, ROGER M 12714 SE MAJESTIC LN 22020 17TH AVE SE#200 HAPPY VALLEY, OR 97086 BOTHELL,WA 98021 PHONE: 503-298-0435 PHONE: FAX: 503-855-3264 FEES Quantity Description Date Amount 1 ea Expansion Tank 07/23/2013 $12.51 Specifics: 3 ea Floor Drain/Floor Sink/Hub 07/23/2013 $75.06 1 ea Interceptor/Grease Trap 07/23/2013 $25.02 Type of Use: COM 3 ea Primer 07/23/2013 $37.53 Class of Work: ALT 3 ea Sink 07/23/2013 $75.06 Type of Const: 4 ea Lavatories 07/23/2013 $100.08 Occupancy Grp: 2 ea Water Closet 07/23/2013 $50.04 Stories: 1 ea Water Heater 07/23/2013 $37.52 1 12%State Surcharge- 07/23/2013 $49.54 Plumbing Total $462.36 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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / Issued By: Permittee Signature: D" .3 /e 9770,/ _.. A47:;if ____Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept In a conspicuous place on the job slte until completion of the project. Approved plans are required on the job slte at the time of each Inspection.