Permit 1114 a CITY OF TIGARD PLUMBING PERMIT
Permit_ COMMUNITY DEVEL P #: PLM2021-00378
O MENT
T i G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/21/2021
Parcel: 1 S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY X
Project: Jersey Mike's Subdivision: None
Lot: None
Project Description: Interior plumbing for new tenant:Capping(1)sink and(1)water closet;Adding(1)2"hub drain, (3)3"floor sinks,
(1)ice maker,and(4)sinks; Replacing(1)sink and(1)water closet; Installing(5)backflow preventers, (1)
expansion tank,(1)grease trap,(1)primer, (1)water heater, (1)tea brewer, (1)bread oven,and (1)mixing valve.
Contractor: DP PLUMBING INC Owner: PACIFIC CROSSROADS PROPERTIES INC
15825 NE SPRINGBROOK BY WYSE INVESTMENT SERVICES CO
NEWBERG, OR 97132 810 SE BELMONT ST#100
PORTLAND, OR 97214
PHONE: 503-537-9492 PHONE:
FAX:
FEES
Quantity Description Date Amount
5 ea Backflow Preventer 12/15/2021 $156.35
Specifics: 1 ea Expansion Tank 12/15/2021 $12.51
2 ea Fixture/Sewer Cap 12/15/2021 $50.04
Type of Use: COM 4 ea Floor Drain/Floor Sink/Hub 12/15/2021 $100.08
Class of Work: ALT 1 ea Ice Maker 12/15/2021 $12.51
Type of Const: 1 ea Interceptor/Grease Trap 12/15/2021 $25.02
Occupancy Grp: 1 ea Primer 12/15/2021 $12.51
Stories: 5 ea Sink 12/15/2021 $125.10
1 ea Water Closet 12/15/2021 $25.02
1 ea Water Heater 12/15/2021 $37.52
75 Misc Other Fee 12/15/2021 $75.06
1 Plan Review 12/15/2021 $157.93
1 12%State Surcharge- 12/15/2021 $75.81
Plumbing
Total $865.46
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
Issued By: Hotly VaAI, Dc We.gc- Permittee Signature:
O w AY ,o-w
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 ApplicationRECEIafE 0 - -or
Building Fixtures 1:0lz oFFicl: i SE ovI
City of Tigard SEP 01 2021 Received *
Date/B 'P.-AV w Permit No L
ill13125 SW Hall Blvd.,Tigard,OR 97223( y Z� 003 7d
g Phone: 503.718.2439 Fax: 503.598.1.2Gt)��OF TiGARD Plan Revie ,y��j
Inspection Line: 503.639.4175 13. ! ,.DINGLiIVIS►Q •fDateRe 9-e�aO.ZI Q Other PermitNo.:���/` �+ldaa
['WARD Date Ready/By „pi; la See age 2 for
Internet www.tigard-or.gov Notified/Method: y i I 1 rJ 11;! Supplemental Information
F
Y�5 zt�, f::h�- a,� , n,a_O�� Q �, .. ,'� Y s�it'�v: '1 tl r�..�,. f% A 1 NJ�'.
2.
❑New construction 0 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)
i :t ?'�.ti ` ( i k'4 ta?14-,. SFR(1)bath 312.70
❑1-and 2-family dwelling Qg Commercial/industrial SFR(2)bath 437.78
ElAccessory building 0 Multi-family SFR(3)bath 500.32
0 Master builder Each additional bath/kitchen 25.02
❑Other Fire sprinkler( sq.ft.) Page 2
(i)::.Ls'1 a 1 Z t OM1/441 /,N t t _(yi i a4. _ Site utilities:
Job site address:11705 SW Pacific Hwy. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: X I Project name:Jersey Mike's Subs Manufactured home utilities 50.03
Cross street/directions to job site: Pacific Crossroads Retail Center. Cross Manholes 18.76
St. is SW 78th Ave. 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: J Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
' `4" I® v Backwater valve 12.51
Clothes washer 25.02
Interior TI for a fast casual restaurant. Previous use was a restaurant. Dishwasher 25.02
Work includes plumbing, grease interceptor, Drinking fountain 25.02
Ejectors/sump 25.02
,,, Expansion tank 12.51
Name: Daniel Watts/Watts World dba Jersey Mike's Subs Fixture/sewer cap 25.02
Address:5204 P St.
Floor drain/floor sink/hub 3 25.02 75.06
Garbage disposal 25.02
City/State/ZIP:Washougal, WA 98671 Hose bib 25.02
Phone:(661 )623.3809 Fax:( ) Ice maker 1 12.51 12.51
of ti l w �
,.�,� r }�,. ►t t � r r- - Interceptor/grease trap 25.02
.-x.,_t.t;.�u._x-..' x_.._..,i.-. .,,..5 .;«�:.�7�F,�;u. rri}ts s' ...1...�'9: �.�.:.,.1��o��
Business name:GA Miller Architecture PC Medical gas(value:$_) Page 2
Contact name:Glen Miller Primer 12.51
Roof drain(commercial) 12.51
Address: 141 Del Prado St. Sink/basin/lavatory 25.02
City/State/ZIP:Lake Oswego OR 97035 Solar units(potable water) 62.54
Phone:(503 )636.7979 Fax: :(503)636.9898 Tub/shower/shower pan 12.51
E-mail: glen@gamillerarchitecture.com Urinal 25.02
p 1 ,, te Water closet
25.02
:3F d Water heater 37.52
Business name:Tee �\_,m&t tri) Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.11, Lig �/ Plumbing Lic.no. Zv"A
Plan review (25%of permit fee)
x � of State surcharge(12%of permit fee)
Authorized signature: 1.1A' -( ,t TOTAL PERMIT FEE
Print name:Glen A. Miller Date:8/27/21 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.
1:1Bulldmg\Permits\PLMU•PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
e ,54 _6.04 11N s_c__
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information •
Fee Schedule: Residential Fire Su I .ression Systems:
S>< i Iifie , r *: .,P. e. t'roow (ATM:a . _ ermi .,.ee',:.
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 yy i a t 9' 1 a . 41^ 1LL
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
- each additional$100.00 or fraction thereof,to
e • s r; - 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*. > ear
Quantrqr by Fixture Type Plan review is required for any of the following.
Fixture Type for x .. '�°` :.Replace/ Please check all that apply.
WorkPerformed C Pp a Added , -,I Relocate,` ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
Domestic ❑ 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"
-4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains
Comments regarding fixture work:
Oil Separator(Gas Station) Will be replacing existing grease interceptor.
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
1 Sink: -Lay/Bar non-food related 1 2
-Bradley
-Com/Serv/Util food related 1
-Service 1 *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet 1 plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
'Numbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received / 1 (�
. Date/By: a /�i Permit No.: pCrl�OoZ I-�3 /13125 SW Hall Blvd.,Tigard,OR 97223 J
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review �t D
Date/By: -204- 1/ 0�{ Other Permit No' a Lal--„� 4 S
T 1 G A R D Inspection Line: 503.639.4175 Date Read /B Jt�/LQa tJC�M'
Internet: www.tigard-or.gov y y' ,,,,,,,..``.. Juris. H See Page 2 for
Notified/Method: 4 �/I.({J Supplemental Information
TYPE OF WORK �✓p-_ -t dre ��"',""`""''•�/%%rrr FEE* SCHEDULE
❑New construction ❑ Demolition ` iJ'� For special information use checklist.
Description Qty. Ea. 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
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: 1 trio S 5.Lj. ' c«.i-.� 1-1-co.1
Drywell,leach line,or trench drain 18.76
City/State/ZIP: `["4,1x4\ of',
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: 1_rS-] (VI;kt. S(A.
Manufactured
bs 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:
Tax map/parcel no.: Backflow preventer 5 31.27 156.35
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
r L ice t- %� fesAc..4`r-o_ t` Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER ❑ TENANT Expansion tank 12.51 /a,5'
Name: Fixture/sewer cap 25.02 50.0y
Floor drain/floor sink/hub I/ 25.02 t(0.0 8
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker
j 12.51 j ,5/
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 1 25.02 .25,OA
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 1. 12.51 ,a.57
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory S 25.02 /a540
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet , 25.02 .25..C12.
Water heater I 37.52 39,52
Business name:
Water piping/DWV 56.29
Address: Other:7 Q�.e ,.a t 6,64 oue.ht 3 25.02 /5.0 6
City/State/ZIP: en/Xih..1 Vt.lut Subtotal 631,72
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) /59, 73
State surcharge(12%of permit fee) 95.8 r
Authorized signature: TOTAL PERMIT FEE RCS,y6
This permit application expires if a permit is not obtained within 180 days
Print name: Date:
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 Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-l 100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees and including$10,000.00.
Inspection of existing plumbing or lbr $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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" - 1" ---4-'
3» Isometric or Riser Diagram
4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related 7 gob d r-4.1 NS '" A/O- ezi ,4. 400%t 4,77
-Industrial food related //
Ice Mach./Refrig.Drains I omments regarding fixturer work:
Oil Separator(Gas Station) incti vied-I. I-ap httbdrwn -for.haw{S;nik
Rec.Vehicle Dump Station /..31t Faon'rSink Pt Drink Dist), Rnd %C2. 6in de-con
Shower: -Gang
/- 3" Floor 3;4k(r vejt c ,S nk
-Stall
Sink: -Lav/Bar non-food related I a /-si' rt'oc r Sink .fo:- ha. dJ;4k.t ( ,3-Cenv.Si4k_
-Bradley
-Com/Serv/Util food related el.
-Service I *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet-Toilet i
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tall
3
_ Tenant Name: JERSEY MIKE'S SWR# 2021-00265
TIGARD Site Address: 11705 SW PACIFIC HWY X PLM#2021-00378
Parcel#: 1 S 136CD00100
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 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3inch 5 0 0 3 15 3 15
-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 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lay/Bar-Non-Food Related 2 0 1 2 1 2 0 0
-Bradley 5 0 0 0 0 0
-Com/Serv/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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 8 4 17 2 9
Current Fixture Value 9 divided by 16= 0.563 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 9 divided by 16= 0.563 over (under) $ 3,407.60
Enter EDU Change Here 0.560 *
*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:(1)ICE MACHINE,(1)FOOD RELATED SINK,(1)HAND SINK,AND(1)THREE COMPARTMENT SINK WERE NOT COUNTED AS
ADDED FIXTURES SINCE(3)3"FLOOR SINKS HAVE A HIGH FIXTURE VALUE FOR INDIRECT WASTE.
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 9/30/2021
Building Division
Note: 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.
I:\Building\Sewer Tally\SewerTallySheet_6085_070121.xlsx
Branden Taggart
From: #Building Permit Technicians
Sent: Thursday, September 30, 2021 10:15 AM
To: GA Miller Architecture PC
Subject: Jersey Mike's Interior Plumbing: PLM2021-00378 - 11705 SW Pacific Hwy Suite X
Attachments: Jersey Mikes Invoices & Sewer Tally.pdf
Hello Glen,
The Plumbing and Sewer permits for Jersey Mike's are ready to issue now. I have attached invoices above for you to
reference, and the fees due are as follows:
Jersey Mike's
Permit# Fees Due
PLM2021-00378 $ 865.46
SWR2021-00265 $ 3,407.60
Total: $ 4,273.06
The above fees can be paid online through our website: https://aca.accela.com/TIGARD/Default.aspx. From there, click
on the Building tab, enter the permit numbers in the Record Number field, and click Search. Once paid, please notify us
at tigardbuildingpermits@tigard-or.gov so that we may issue these permits and place them in our open Permit Center
conference room for someone to pick up between the hours of 8:00 a.m. and 5:00 p.m., Monday through Thursday. We
are closed on Fridays. Furthermore, the permit fees for both permits will need to be paid before we can issue either of
them, and we will also need the plumbing contractor's license information prior to issuance. Please let me know if you
have questions.
Thank you,
Branden Taggart
71 ..., ill City of Tigard
irl4 Senior Permit Technician
.„fi 4 Community Development
13125 SW Hall Blvd
Tigard„ OR 97223
(503)718-2449
brandent 'tigard-or,gov
1