Permit (42) CITY OF TIGARD PLUMBING PERMIT
i; ' COMMUNITY DEVELOPMENT Permit#: PLM2018-00118
Date Issued: 04/04/2018
G T I A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136DA00700
Jurisdiction: Tigard
Site address: 11530 SW PACIFIC HWY Lot: None
Project: Lu's Sports Bar&Lounge Subdivision: None
Project Description: Interior plumbing for TI:Capping(1)dishwasher and(2)sinks;Adding(1)sinks and(1)water closet;Relocating(3)
sinks,(4)water closets,and(2)urinals.
Contractor: LEGACY PLUMBING Owner: LU,XU JIAN
8985 SW HAZELVERN WAY HUANG,WEN HUI
PORTLAND, OR 97223 4798 AUBURN LN
LAKE OSWEGO, OR 97035
PHONE:
PHONE: 503-816-8887
FAX: 503-297-4587
FEES
Quantity Description Date Amount
3 ea Fixture/Sewer Cap 04/04/2018 $75.06
Specifics: 4 ea Sink 04/04/2018 $100.08
2 ea Urinal 04/04/2018 $50.04
Type of Use: COM 5 ea Water Closet 04/04/2018 $125.10
Class of Work: ALT 1 12%State Surcharge- 04/04/2018 $42.03
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $392.31
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.
mittee Signature: //,'"\.., �
Issued By: .4.---.1 -
f-j
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 Application6 Ai40Building Fixtures .; FOR OFFICE USE ONLY t
City of Tigard MAR 2 1 2 018 Date/By:Received /.i/ i1977.-- Permit No.: Q O 4�✓ i
III 111 13125 SW Hall Blvd.,Tigard,OR 97223 G L Plan Review !
_ Phone: 503.718.2439 Fax: 503.598.1940A - l''''/..1Date/By: Other Permit No
�"a�f�ry F - Date Read/B Juris: ® See Page 2 for
T t G A R D Inspection Line: 503.639.4175 t � iReady/By:
Internet: www ti and-or. ov 9 A! P-,¢B E li 1. P c' �1�tified/Method: Supplemental Information
g g � �el��`? f� FEE* SCHEDULE
`''TYPE OF WORK .a.
0 Demolition For special information use checklist.
❑New c nstructionEa. Total
Description Qty.
ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
'. v SFR(1)bath 312.70
CAT AOR i' OF CONSTRU ON
❑ 1-and 2-family dwelling ommercial/industrial
SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2` Site utilities:
� �; �:JQ$ SITE �1VF®RMATI�N AND,LOCATION
Catch basin or area drain 18.76
Job site address: ,-s- j(; So) 76_,(41: c `•-1,--0 y Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7T r�� LIYe ( Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:t ,J Project name: Z_L,t 5, air vt 1;44.4 anufactured 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:
Backflow preventer 31.27
Tax map/parcel no.: 12.51
a ," k Backwater valve
' I , QEF 'OT 4 . ,. 4 , Clothes washer 25.02
Dishwasher 25.02
��y�� `•�;,5~Yy�Je An" Dishwasher
Drinking fountain
Ejectors/sump 25.02
Expansion tank 12.51
I QNV ..; .7.,m.,.:,,„ .❑ T AN`i' �, .. - 25.02
�" Fixture/sewer cap 3 75,0(4.)
Name: 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
.:1',.- l'r APP/4C= .4 , .t i❑ ON`I'ACT, ?ERBOti", � Interceptor/grease trap 25.02'
Medical gas(value:$ ) Page 2
Business name: 12.51
a "E Primer
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory25.02 100 V
City/State/ZIP: Solar units(potable water) 62.54
Tub/shower/shower pan 12.51
Phone:( ) Fax::( ) Urinal 25.02 IA. i"1
E-mail: 25.02 ' tl
r7 ate.: r Water closet ,;,� � , i W _
.Y c* ;CSR, Water heater 37.52
Business name: L E.L A6) t.)/(N3 1 y_,J Water piping/DWV 56.29
Address: '.75 1 .4 5-t,L.1 oc t s 7 Other: 25.02
City/State/ZIP: ---7),L.Z lr. k.':7 LCL; 1223 Subtotal 35d
Minimum permit fee: $72.50
Phone:(S.,3) 5/0 --c 2- 0 Fax:( ) o
Plan review (25/o of permit fee)
CCB Lic.: Plumbing LiZ(.0 '-,. /
-S-1 q � 1
j ]5'2 o j c.no.: State surcharge(12%of permit fee) J `O
Authorized signature: 2/14":_ir2.______, TOTAL PERMIT FEE �
, This permit application expires if a permit is not obtained with 180 days
,, :,
Print name: M. A(( 1�)=4�Sa aJ Date:-.:3 z J 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 Suppression Systems:
Site Utilities= >:. ty. ;.Fee(ea) > Tore Square Footage: ler tit 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
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
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 . :
Storm&Rain Drain-1st 100' 62.54 Valuation Permit a@ .
Storm&Rain Drain-each additional 100' 37.52 $1.00 to$5,000.00 Minimum fee$72.50
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Fee(ea) 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*. g
�rI'tan� eul<ew-fir Plumbfn nsia n�'
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that a 1
Work Performed: Capped Added Relocate=" pp y
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
-Drive Thiu as defined in OAR918 780 0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic 0 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" ;� u 4so1n tr1 of Riser.Diagram k v, ,.
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
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: -Lav/Bar non-food relatedcA -. Gr "
-Bradley I 'i gf r r
-Com/Serv/Util food related
-Service '�
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet ; u plumbing permit can be issued.
Urinal Z
Other Fixtures: �Jh+`�"
I:\Building\Permits\PLMF_PermitApp.doe 08/04/2011 � �"t
111 Accumulative Sewer Tally
a Tenant Name:LU'S SPORTS BAR&LOUNGE SWR# SWR2018-00075
T I G A R D Site Address: 11530 SW PACIFIC HWY
Parcel#: 1S 136DA00700 PLM# PLM2018-00118
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0
0 0 0
Bath: -Tub/Shower 4 0 0
0 0 0
-Jacuzzi/Whirlpool 4 0 0
0 0 0
Car Wash: -Each Stall 6 0 0
0 0 0
-Drive through 16 0 0
0 0 0
Cuspidor/Water Aspirator 1 0 0
0 0 0
Dishwasher: -Commercial 4 0 1 4
0 -1 -4
-Domestic 2 0 0
0 0 0
Drinking Fountain 1 0 0
Eye Wash 1 0 0 0 0
0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0
0 0 0
-3inch 5 0
0 0 0 0
-4 inch 6 0 0 0
0 0
-Car Wash 6 0 0
0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0
0 0 0
-Commercial(to 5 HP) 32 0 0
0 0 0
-Industrial(over 5 HP) 42 0 0
0 0 0
Ice Machine/Refrigerator Drain 1 0 0
0 0 0
Living Unit 16 0 0
0 0 0
Oil Sep(Gas Station) 6 0 0
0 0 0
Rec.Vehicle Dump station 16 0 0
0 0 0
Shower: -Gang(per head) 1 0 0
-Stall 0 0 0
2 0
0 0 0 0
Sink:
-Lay/Bar-Non-Food Related 2 0 2 4 1
2 -1 -2
-Bradley 5 0 0
0 0 0
-Com/Sery/Util-Food Related 3 0 0
0 0 0
Swimming Pool Filter 1 0 0
0 0 0
Washer-Clothes 6 0 0
0 0 0
Water Extractor 6 0 0
0 0 0
Water Closet-Toilet 6 0 0 1
Urinal 6 0 0 0 6 01 6
0 0
Previous EDU Count 0
Capped EDU Credit 0
TOTALS 0
0 0 3 8 2 8 -1 0
Current Fixture Value 0 divided by 16= 0.000 Current EDU
1 EDU= $5,500.00
Previous Fixture Value 0
divided by 16= 0.000 Previous EDU
Change 0 divided by 16= 0.000 over (under) $ -
Enter EDU Change Here 0.000 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: 4/3/18:ADDED CAPPED FIXTURES,WHICH RESULTED IN NO FEES DUE.
Authorized Name/Signature: BRANDEN TAGGART X2449
Date: 3/21/2018
Building Division
ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.IN
I:\Building\Sewer Tally\SewerTallySheet_5500_070117.xlsx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11530 SW PACIFIC HWY, TIGARD, OR, 97223 June 11 , 2018 at 2:17:55 PM
Record Type: Record ID:
Commercial - Plumbing PLM2018-00118
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor