Permit (5) CITY OF TIGARD PLUMBING PERMIT
I - COMMUNITY DEVELOPMENT Permit#: PLM2023-00080
Date Issued: 4/27/2023
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY J1
Project: Chipotle Mexican Grill Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: Site utilities for a new restaurant: (1)catch basin,25 ft.of sanitary sewer,and 2 ft.of storm sewer.
Contractor: RECON INC Owner: SN PROPERTIES PARTNERSHIP
PO BOX 822964 1121 SW SALMON ST
VANCOUVER,WA 98682 PORTLAND, OR 97205
PHONE: 360-772-8149 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 04/25/2023 $18.76
Specifics: 25 If Sanitary Sewer 04/25/2023 $62.54
2 If Storm Sewer 04/25/2023 $62.54
Type of Use: COM 1 Plan Review 04/25/2023 $35.96
Class of Work: ALT 1 12%State Surcharge- 04/25/2023 $17.26
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $197.06
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: Permittee Signature: •
.2 CCG,71/4
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
Site Utilities FOR OFFI('E I'SE ONLY
City of Tigard RECEIVED Received
Date/By: Permit No.
13125 SW Hall Blvd.,Tigard,OR 97223 3�� �'�''3 - �
$ Phone: 503.718.2439 Fax: 503.598.19t AR 1 2023 Plan Review
Date/By: 41/1 41 27 AL,- '1 Other Permit No/5/4140 _000
Inspection Line: 503.639.4175
7 I G A I l� Date Ready/BY': : ._ Juris. El See Page 2 for
Internet www.tigard-or.gov Notified/Method:7 0,S d Supplemental Information
.ash $' Z+ Oii,,' �`1�� s "4�C ��* �f t i t.
�V nW� .JI ���.�. , 4 #. .,..¢,. .. r., .„[ ^ ham`.
❑New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. Total
IIII Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
-CATEOPRY 0 NSTt2Iuc`ilON , " SFR(1)bath 312.70
❑ 1-and 2-family dwelling 111 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other:
Fire sprinkler( sq.ft.) Page 2
" JOB 1TE ORMATION Air;LOCATION' Site utilities:
Job site address: 16200 SW PACIFIC HWY. Catch basin or area drain 1 18.76 $18.76
Drywell,leach line,or trench drain 18.76
City/State/Z1P: TIGARD, OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.noSUITE J1 I Project name: CHIPOTLE MEXICAN GRILL Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ¢ 25' 1 Page 2 $62.54
Storm sewer(no.linear ft.: .) 2' i Page 2 $62.54
Water service(no.linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: 2S 115AB01900 Backflow preventer 31.27
lll RI ON OF WORK;
'' Backwater valve 12.51
Clothes washer 25.02
Alteration of an existing freestanding building for a new fast casual
dining restaurant. Scope of work includes reconstructed sewer Dishwasher 25.02
lateral with grease interceptor and new water quality catch basin. Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY 08,0014, C3 11zNA .,..,'' Expansion tank 12.51
Name: SN INVESTMENT PROPERTIES, LLC Fixture/sewer cap 25.02
Address: 1121 SW SALMON ST. STE 500 Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: PORTLAND, OR 97205 Hose bib 25.02
Phone:(503) 450-0806 Fax:( ) Ice maker 12.51
* APPLICANT' 0 CoNTACT PERSON Interceptor/grease trap 25.02
Business name: INTERIOR ARCHITECTS Medical gas(value:$ ) Page 2
Contact name: MELISSA STONIKINIS Primer 12.51
Roof drain(commercial) 12.51
Address: 2300 CHESTNUT STREET, SUITE 250 Sink/basin/lavatory. 25.02
City/State/ZIP: PHILADELPHIA, PA 19103 Solar units(potable water) 62.54
Phone:( 267)439 4887 Fax::( ) Tub/shower/shower pan 12.51
E-mail: M.STONIKINIS@INTERIORARCHITECTS.COM Urinal 25.02
Water closet 25.02
:CO lT CTOR ; Water heater
p� 37.52
/I
Business name: MANZCO PLUMBING Ace)), 1J - Water piping/DWV 56.29
Address: PO BOX 822964 Other: 25.02
City/State/ZIP:VAN000VER, WA 98682 Subtotal $143.84
Phone:( 360)772 8149 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 181318 Plumbing Lie.no.: PB523 Plan review (25%of permit fee) $35.96
State surcharge(12%of permit fee) $17.26
Authorized signature: /�',j (- n,.C,� TOTAL PERMIT FEE $197.06
Print name: MELISSA STON I KIN IS Date:1/6/23 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:\Building\Permits\PLMU-PermitApp.dor 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:
i� �O 3,, ,,< �, :-
S>l>ke�t ,s 74uitre ovt gee x„ Permit +
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
3,601 to 7,200 $233.20
Sewer-1st 100' 25' 62.54 $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 ,..
iaat><an: 'Permit
Storm&Rain Drain-1st 100' 2' 62.54 $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
Q� �� llotal each additional$100.00 or fraction thereof,to
" �
Other-inspections o>l"„fees , ;: 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
Review for PlumbingInstallation•
s
Fixture Type for « Replace/ Plan review is required for any of the following.
Work performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ 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.
-3"
4„ Isometric or Riser Diagram
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
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:
1:\Building\Permits\PLMU_PermitApp.doc 2
,rl DELIVERY NO. 1-5015852
1732 NW Johnson St.
Portland, OR 97209 DATE 02/28/23
503-227-3424 RECEIVE(
WO# 2336039
DELIVERY TICKET MAR 1 2023 6 ATTN: 503.718.2439
CITY OF TIGARD a Building Division
co vi 13125 SW Hall Blvd.
BUILDING DIVISION Tigard, OR 97223
111111111110111111111111111111111111111111111111111 JOB DUE: 03/01/23 at 10:00
CONTACT PHONE PURCHASE ORDER# SALES REP
Carlos Castaneda/Interior Architect s 2068689652 Cody Rodakowski
JOB# JOB NAME BILLER LOC
24CMGX.0014.000 CMGX - Chipotle Tigard OR Joseph Greathouse 12004o
NO.OF TOTAL UNIT
OP CODE
DESCRIPTION ORIGINALS COPIES SIZE UNITS UM PRICE AMOUNT
Order processed at location:
Portland 503-227-3424
Please mail payments to our NEW
remit address:
PO Box 511579
Los Angeles, CA 9005 1-8 1 34
Thank you
SUB TOTAL DISCOUNT SALES TAX TOTAL DEPOSIT BALANCE DUE
TERMS: