Permit CITY OF TIGARD PLUMBING PERMIT
°F1 4 COMMUNITY DEVELOPMENT Permit#: PLM2013 00306
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/03/2013
Parcel: 1S1 26CA00900
Jurisdiction: Tigard
Site address: 9009 SW HALL BLVD 200
Project: Subdivision: FAIRVIEW PLACE CONDO Lot: 20
Project Description: Repair/replace approximately 380'of storm water and(1)manhole. Located behind the the Macy's store in the rear
parking lot.
Contractor: RIVER CITY ENVIRONMENTAL Owner: HUDESMAN TIGARD LLC
PO BOX 30087 BY GOOD GUYS CALIFORNIA INC
PORTLAND, OR 97220 ATTN: GEROGE HECHTMAN
1600 HARBOR BAY PKWY STE 200
ALAMEDA, CA 94502
PHONE: 503-252-6144 PHONE:
FAX: 503-288-3658
FEES
Quantity Description Date Amount
1 ea Manholes 09/03/2013 $18.76
Specifics: 380 If Storm and Rain Drain 09/03/2013 $175.10
1 12%State Surcharge- 09/03/2013 $23.26
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $217.12
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 Notifi - -- ter. 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• estions to O by c- " • 503 32.1987 or 1.800.332.2344.
Issued :y: " / / Permittee Signature:
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 site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit ApplicatiorREcENED
Site Utilities J 1 V FOR OFFICE USE ONLY
City of Tigard ti - � 3 13 Received Q d p
Date/By: /
Permit No.: Ct-fe9.613_eif,30
li . a 13125 SW Hall Blvd.,Tigard,OR 97223 W
Phone: 503.718.2439 Fax: 503.59 an Review
I 'Y OFTIGARD D Date/By: Other Permit No.:
Inspection Line: 503.639.4175
T I G A K D BUILDING DIVISION NDaotte i fReead e/tB hy od: Juris: ® See Page e 2 for
Internet: www.tigard-or.gov Supplemental Inf
ormation
TYPE OF WORK FEE* SCHEDULE .
❑New 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(1)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accesso ry g ❑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:9009 sw Hall Blvd Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:tigard Or 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Cafaro wasington circle Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 1 18.76 /f..74)
behind Macys Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
- Storm sewer(no.linear ft.:380) I Page 2 175.10
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION WORK Backwater valve 12.51
Storm Water repair 400 ft Clothes washer 25.02
Dishwasher 25.02
SEE attached Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Hudesman Tigard,L.L.C/Cafaro Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:3500 South Meridian
Garbage disposal 25.02
City/State/ZIP:Puyallup wa 98373 Hose bib 25.02
Phone:( )253-840-4349 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:River City Environmental Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Patrick Speer
Roof drain(commercial) 12.51
Address:po box 30087 Sink/basin/lavatory 25.02
City/State/ZIP:Portland Or 97294 Solar units(potable water) 62.54
Phone:(503)252-6144 Fax::(503)288-3658 Tub/shower/shower pan 12.51
E-mail:pats @rivercityusa.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:River City Environmental Water Pip 1 in DWV 56.29
Address:po box 30087 Other: 25.02
City/State/ZIP:Portland Or 97294 Subtotal
Phone:(503)252-6144 Fax:(503)288-3658 Minimum permit fee: $72.50
CCB Lie.:147355 Plumbing Lic.no.:26-789PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) A3.4
Authorized signature:
TOTAL PERMIT FEE iY. t 7 /).
Print name: Date: --- -.I''' 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\PLMU-PermitApp.doc 10/01/09 4404616T(t0/02/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-1st 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 and including 10,0.0. or fraction thereof,to
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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Performed: Capped Added Relocate Y g•
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thnr ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4" Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings-Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Conunercial-food related
-Service
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
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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