Permit q CITY OF TIGARD PLUMBING PERMIT
°� COMMUNITY DEVELOPMENT Permit#: PLM2021 00189
Date Issued: 6/14/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S103DD00700
Jurisdiction: Tigard
Site address: 13769 SW PACIFIC HWY
Project: Dutch Bros Coffee Subdivision: None Lot: None
Project Description: Site utilities for a new coffee building.
Contractor: KOEHLER GENERAL CONTRACTING LLC Owner: GROUND 99 LLC
3336 COUNTRYMAN CIRCLE NW 610 SW ALDER ST STE 1221
ALBANY, OR 97321 PORTLAND, OR 97205
PHONE: 541-231-6009 PHONE:
FAX:
FEES
Quantity Description Date Amount
7 ea Catch Basin or Area Drain 05/27/2021 $131.32
Specifics: 1 If Footing Drain 05/27/2021 $50.03
1 ea Manholes 05/27/2021 $18.76
Type of Use: COM 1 ea Rain Drain Connector 05/27/2021 $18.76
Class of Work: NEW 300 If Sanitary Sewer 05/27/2021 $137.58
Type of Const: 300 If Storm Sewer 05/27/2021 $137.58
Occupancy Grp: 100 If Water Service 05/27/2021 $62.54
Stories: 1 Plan Review 05/27/2021 $139.14
1 12%State Surcharge- 05/27/2021 $66.79
Plumbing
20 ea Info Process/Archiving-Lg 05/27/2021 $40.00
$2.00(over 11x17)
Total $802.50
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: j 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 Application l J
Site Utilities RECEIVED
City of Tigard Received Permit No.: /�/M
ZOZ1 Date/By. S"�(A� / _-. r.J 7? '-WIri
• 13125 SW Hall Blvd.,Tigard,OR 97223AY plan Review �yy
lm Phone: 503.718.2439 Fax: 503.598.196 „j .t 1 G(n Other Permit No.: Q
DateBy: �/� � A. ,�' W�,
Inspection Line: 503 639 4175 CITY �y Date ReadyBy: Juris: ® Se age 2 for
T 1 C, h Internet: www.tigard-or.gov V ITY OF TIGARD Notified/Method: " i j j, L,, Supplemental Information
ena. b".. �" .ems t..,.-
Ill New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
► , s 0 p :• SFR(1)bath 312.70
0 1-and 2-family dwelling 111 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 L_sq.ft.) Page 2
p ; s N - d 1 i s a Site utilities:
Catch basin or area drain 7 18.76 131.32
Job site address:1 • SW Pacific Hwy
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97224
Footing drain(no.linear ft.:_) 1 Page 2 50.03
Suite/bldg./apt.no.: Project name: Dutch Bros. Coffee Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 1 18.76 18.76
Rain drain connector 1 18.76 18.76
Sanitary sewer(no.linear ft.: 3 Page 2 137.58
Storm sewer(no.linear ft.: 3 Page 2 137.58
Water service(no.linear ft.:_) ' Page 2 62.54
Subdivision: I Lot no.: Fixture or item:
IN V Tax map/parcel no.: Backflow preventer 31.27
4 Backwater valve 12.51
`: Clothes washer 25.02
ItInstall site plumbing for new Dutch Bros. Coffee building. New Dishwasher 25.02
water and SS service per plans. New gas service and meter. Drinking fountain 25.02
' Ejectors/sump 25.02
"I ". Expansion tank 12.51
ir. Fixture/sewer cap 25.02
Name: Ground 99 LLC
Floor drain/floor sink/hub 25.02
Address: 13640 Birdshill Rd
Garbage disposal 25.02
City/state/ZIP: Portland, OR 97219 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 , 8 Interceptor/grease trap 25.02
Medical gas(value:$__) Page 2
Business name: Studio 3 Architecture, Inc. 12.51
Primer
Contact name: Matt Johnson
Roof drain(commercial) 12.51
Address: 275 Court St NE Sink/basin/lavatory 25.02
City/State/ZIP:Salem, OR 97301 Solar units(potable water) 62.54
Phone:(503) 390-6500 Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
matt@studio3archtitecture.com ,,, L. ,S'._
Water closet 25.02
r,f Water heater 37.52
Business name: Luna Desi.n . d Construction _UCJGti(t,/ p✓ i vvi'tr., Waterpiping/DWV 5629
Address: 1709 NE C•- er Blvd 3336 C, ,.,.�y„ �;, er: 25.02
City/State/ZIP:C. allis, OR 97330
�/ i-.. 73�' Subtotal $556.57
Phone:(54 224-8257 Fax:( y )/ Minimum permit fee: $72.50
/ �/�7 `� / Plan review (25%of permit fee) $139.14
/ CCB Li . 200358 aelll /3 0 Plumbing Lic.no.: e
/// State surcharge(12/0 of permit fee) $66.79
Au orized signature: TOTAL PERMIT FEE $762.50
Print name: Date: This permit application expires if a permit is not obtained within 180 days
Matt Johnson 5/4/2021 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
l4/•/4 1-0 ' Plyrnblv�f' t 17.�.J e-� f e- Cevw, -F ear/Pe t -kr-6 '11.4 --/A• -/ 67.
1:\Building\Permits\PLMU-Perm4App.doc 10/0 9 440- 16T(10/02/COM/WEB)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su s 1 ression S stems:
. t :;� the
Footing drain-1"100' 1 50.03 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' 1 62.54 62.54 7,201 and greater $327.54
Sewer-each additional 100' 2 37.52 75.04
Water Service-1st 100' 1 62.54 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 ' m ;
Storm&Rain Drain-1st 100' 1 62.54 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 2 37.52 75.04 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*.
a ry 4'1 Quantity b,,,,„ re Type - - `' 1 a` !1 Q • g f
t a sl y a,lu,Replscel -'
>ixtu e y fur � y� rs� r d " A1.tlocat Plan review is required for any of the following.
Work ' fvrrned. +,t, . , .�r, ..: � .. 0.11f444. Please check all that apply.
Baptistry/Font
Bath -Tub/Shower El Any new commercial building with water service 2"and
-Tub/Sower 1pool 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 El 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.
3"
4" s ! ' s
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -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
-Commercial-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
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU_PermitApp.doc 2
Branden Taggart
From: Branden Taggart
Sent: Wednesday, May 26, 2021 3:53 PM
To: Matt@studio3architecture.com
Cc: Josh Schlesinger
Subject: Dutch Brothers Plumbing Permit: PLM2021-00189 - 13765 SW Pacific Hwy
Attachments: Invoice.pdf
Matt,
The Site Utilities Plumbing permit for Dutch Brothers, located at 13765 SW Pacific Hwy, is ready to issue now,. The
balance due is$802.50, and I have attached an invoice above for you to reference. These fees can be paid online now at
https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record number PLM2021-00189 under
the Building tab. There is a 3%service fee for credit cards, but e-checks do not have a service fee.
Once paid, please email the Permit Technicians at TigardBuildingPermits@tigard-or.gov so that we may issue this
permit and make it available for pick up.
Also, please note that we were unable to verify that Luna Design and Construction's possesses a plumbing license. Since
water service work is associated with this Site Utilities Plumbing permit, a plumber with a plumbing license is required to
complete this work. Please let us know if you have additional questions.
Thank you,
Branden Taggart
_-■ City of Tigard
1114
a , Senior Permit Technician
Community Development
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or.gov
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