Permit (37) CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT
Permit#: PLM2016-00404
Date Issued: 08/02/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S102AA00600
Jurisdiction: Tigard
Site address: 12045 SW HALL BLVD
Project: 7-Eleven Subdivision: TIGARD HIGHWAY TRACTS Lot: 12
Project Description: Add(1)new hand sink(non-food related)
Contractor: S&S SEARS INC Owner: ALPROP LLC
PO BOX 446 6149 SW SHATTUCK RD
GLADSTONE, OR 97027 PORTLAND, OR 97221
PHONE: 503-650-8200 PHONE:
FAX: 5023-650-8203
FEES
Quantity Description Date Amount
1 ea Sink
08/02/2016 $25.02
Specifics: 1 12%State Surcharge- 08/02/2016 $8.70
Plumbing
1
Type of Use: COM 47 ea Minimum Fee Adjustment- 08/02/2016 $47.48
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 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.ation 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 dire questions to sUNC b -fling 503.232.1987 or 1.800.332.2344.
Iss ed By: / 4 j Permittee Signature: k
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 FixturesFOF2 OFF10E t S1. Oyl,v
RECEIVED Re�„� ��nw
City of Tigard Date/By: f l Permit No.: �/,�/�/� erg Q�
13125 SW Hall Blvd.,Tigard,OR 97 It{GO Ilei
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Phone: 503.718.2439 Fax: 503.59:. • 2 2016 Plan Review Other Permit No.:
Date/By: 070
Inspection Line: 503.639.4175 CITY OF TIGARD Date Read/B ]oris: H See Page 2 for
T I( nRDReady/By:
Internet: www.tigard-or.gov� � Notified/Method: Supplemental Information
0 New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGOR' OF coNsTRuerioN SFR(1)bath 312.70
0 1-and 2-family dwelling XCommerciallindustrialSFR(2)bath 437.78
❑Accessory building 0Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
3oB aie 1N ijoit oj4 ANI) WeATIoN Site utilities:
Job site address:(21 qc � ,( boy I'e�-d,. Catch basin or area drain 18.76
_.� x y� Drywell,leach line,or trench drain 18.76
City/State/ZIP: . CL C 1 , q.72-2-
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: 7-- LEGE✓f- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
(
,a'Ci�i •
Rain drain connector 18.76
or
1+V Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
ter service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fix a or item:
Tax map/parcel no.: A rj lO?-'r(- 00 C OC) Backflow preventer 31.27
Backwater valve 12.51
istOoIPU OF W
Clothes washer 25.02
C-Veti d L. 4 11/1540teel Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
LI,PROI9KRW 0/ 1114 ., A Expansion tank 12.51
Name: Et. 1 Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: t' s7 ' , Garbage disposal 25.02
City/State/ZIP: C��� C.92__. -�
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT . ; ':r0T+,1-TA 1i)C+ N 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 1 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
( ,�,^ ` ` (" ,�s, / Water heater 37.52
Business named 'S kL� 1, N24 6 IMI1 Aii i (`� Water piping/DWV 56.29
Address: I V ,"f kW Other: 25.02
City/State/ZIP: ''//ee � i/ 1c--E4_,, /,, Subtotal
Phone: Minimum permit fee: $72.50 q�.5-0
O h ,� � Fax:(i� ) `� � /
i CCB Lic.: t G 1I Plumbing Li no.: 132_, Plan review (25%of permit fee) -
I State surcharge(12%of permit fee) 5(.70
Authorized signature: s' 4 TOTAL PERMIT FEE b f•
Print name: G (0A/1/1 l V 1 ! a`, Date: ( - , This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pemtits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities ^ Fee(e$) rotia►l Square Footage: Permit Fee:
Footing drain- 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: remit 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 Fie ) 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 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 iteview farPluobinginstallatians
FixWork Type for xeplaeer Plan review is required for anyof the following.
Performed: Capped Added Relocate 4
Baptistry/Font Please check all that apply.
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 ❑ 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.
Car Wash Drain launtettie'or Riser Diagram'
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:
C:\Users\ShannonS\Downloads\PLMF PermitApp.doc 2
Location:
Record Type:
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Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12045 SW HALL BLVD, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00404
Don Sylvester
Violation Summary:
Inspector Contractor