Permit (36) CITY OF TIGARD PLUMBING PERMIT
8 COMMUNITY DEVELOPMENT Permit#: PLM201600323
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/28/2016
TIGARD g Parcel: 2S104BB07900
Jurisdiction: Tigard
Site address: 14300 SW BARROWS RD
Project: Albertsons Subdivision: RUSSELL'S SCHOLLS FERRY Lot: A
Project Description: Adding(8)2"floor drains,(1)primer&(1)water heater. Replace/relocate(2)2"floor drains&(1)sink
Contractor: EVOLUTION PLUMBING LLC Owner: SPIRIT SPE HG 2015-1 LLC
7715 NE 33RD DR SUITE D BY HAGGEN OPCO SOUTH LLC
PORTLAND, OR 97211 2211 RIMLAND DR, STE 300
BELLINGHAM,WA 98226
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
10 ea Floor Drain/Floor Sink/Hub 06/27/2016 $250.20
Specifics: 1 ea Primer 06/27/2016 $12.51
1 ea Sink 06/27/2016 $25.02
Type of Use: COM 1 ea Water Heater 06/27/2016 $37.52
Class of Work: ALT 1 12%State Surcharge- 06/27/2016 $39.03
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $364.28
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may ob,'in a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / -Permittee Signature: ' r
OW 411111PF
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures � �E Folz 0141 C E U SI. 011 \
City of Tigard BEG
'" Received permit No.:
41 III
13125 SW Hall Blvd.,Tigard,OR 97223 qC Date/By: 612-7 i 0 C3.Qj �/6-0°3.23
g Phone: 503.718.2439 Fax: 503.59 '6'1 �j 1 r� Z01� Plan Review
Other Permit No.: e_g,0/6__cc C)
Inspection Line: 503 639 4175 ,,, -
T I UA RD r s ' r L y Date Ready/By. Jens ® See Page 2 for
Internet: www.tigard-or.gov 1 t
d le Notified/Method: SupplementalInformatton
.� # -
a+z' rvTYPE"I =t®44,�g,�. ti 0', I** t 11 x+., L ''� 'b
❑New construction 0 Demolition For special information use checklist cg
Description I Qty. I Ea. I Total
Xi Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
;,;.1; r Y :of 1(t -;1:14;;;A, ,. SFR(1)bath 312.70 0
❑ 1-and 2-family dwelling XI Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
.O$ Sr>�11': �' L.� 5 Site utilities: _
Job site address: I L b so) Earro �, Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: f (0)4(2 Dr.- 0112.2-6 -
"�"° ) 1�,.�p �{ ��r Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 7\l ls(-v 15U I' FJ1+2- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
I 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.: .5 to(I 48 O 7940 Backflow preventer 31.27
7-1,7,.',' D 11I 1'j orifi t 1*,cam{7 Backwater valve 12.51
C UmY7\(\ ) YQrnocw\ 4: Q�CI1 6`pe1c.e. Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
D PitOPEIt O c3 t` Expansion tank 12.51
. . ..x
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 10 25.02 2_60_2O
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
A1pPLIcAlA1 C] co/0Am pERSoN Interceptor/grease trap 25.02
Business name: C
/_..V OlU{ UV " u i Lei Medical gas(value:$ ) Page 2
Primer I 12.51 11_.rl
Contact name:J\VIA V\)(Xt(Y\t1' Roof drain(commercial) 12.51
Address: 11\c ‘ ,-.3tr..el Dy, slAii , 1) Sink/basin/lavatory t 25.02 2c a�
City/State/ZIP: Toy'+b�I 1 fir ''i 211 Solar units(potable water) 62.54
Phone:(S05) tp S .-' Fax::(5-0 y3(6 Tub/shower/shower pan 12.51
E-mail: 611(1(tdl/R - {�a� Q yt�(m ,1-
C 't f !t Urinal 25.02
Water closet 25.02 1
-' Water heater I 37.52 . .i ,,-
Business name: 6V D\11�'ilol/1 Wom moo\ u„C Water piping/DWV 1 56.29
Address: '116 k 'JJtl O . (\IA14(. ) Other: 25.02
City/State/ZIP: --Pu y-} I a ) DO_ i ]2-I 1 Subtotal •j• 1
Phone:( ) ) (}tjc.6Sn( • Fax:(53) ,)s-Cl.) 1 Minimum permit fee: $72.50
CCB Lic.: 1?C.1 7 1110t.
lci Plumbing Lic.no.: -P6,7� Plan review (25%of permit fee)
-�, State surcharge(12%of permit fee) --41-Q
Authorized signature: L/ r > TOTAL PERMIT FEE
Print name: I' fl y'l-� p4 h Date: � (j 21 I I f) 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 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire
� eY Suppression rsS stems:s
� f .0k , .
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-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 r 74, 3
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
f t Total each additional$100.00 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
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
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*.
n Qasniitysture Type �'.�Ij itcsietly for PlimblugiiititallationiN,
Fixture Type for Rte /
Work Performed: ".Capped' Relocate Plan review is required for any of the following.
Please check all that apply.
Baptistry/Font pP Y•
Bath Tub/Shower
0 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 Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 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.
Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food 0 Isometric or riser diagram is required for new buildings
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
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
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: j ,.s-mss
http://www.tigard-or.gov/document center/Building/PLMF PermitApp.db2