Permit (6) ; ---
111 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2023-00088
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/18/2023
Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY J1
Project: Chipotle Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: Interior plumbing for TI:Adding(1)dishwasher,(6)2"floor drains/sinks,(11)3"floor drains/sinks,(2)ice makers,
(9)sinks,and(2)water closets; Installing(2)backflow preventers,(1)expansion tank;(2)hose bibs,(1)grease
trap,(2)water heaters,and(7)water piping/DWV.
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
2 ea Backflow Preventer 05/17/2023 $62.54
Specifics: 1 ea Dishwasher 05/17/2023 $25.02
1 ea Expansion Tank 05/17/2023 $12.51
Type of Use: COM 17 ea Floor Drain/Floor Sink/Hub 05/17/2023 $425.34
Class of Work: ALT 2 ea Hose Bib 05/17/2023 $50.04
Type of Const: 2 ea Ice Maker 05/17/2023 $25.02
Occupancy Grp: 1 ea Interceptor/Grease Trap 05/17/2023 $25.02
Stories: 7 ea Sink 05/17/2023 $175.14
2 ea Lavatories 05/17/2023 $50.04
7 ea Water Piping/DWV 05/17/2023 $394.03
2 ea Water Closet 05/17/2023 $50.04
2 ea Water Heater 05/17/2023 $75.04
1 Plan Review 05/17/2023 $342.44
1 12%State Surcharge- 05/17/2023 $164.37
Plumbing
Total $1,876.59
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: 50-- it?'005 ,
/10.Z
air /
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.
4 ,: ,,,.14 « far l /3. .rt ''AP ' a447
k Plumbing Permit Application
Building Fixtures Fo►z OFFICE LSE ONLY
City of Tigard Q�(1 E1� ;Bye:: /� s Q�S-- Permit No.: P) i.n 'l 00 r?w,
13125 SW Hall Blvd.,Tigard,OR 97223 fl �/ Plan Review6 7 tifTtj
Date/By:: A j Other Permit No.: �o
Phone: 503.718.2439 Fax: 503.598.1960 y 5ten �l'!f t7►L� 3 Gl[
Inspection Line: 503.639 4175 MAR 1 2024 Date Ready/By: 66 See Page 2 for
Ti G A R D Internet www tigard or gov Notified/Method. ,CHAT' Jur' Supplemental Information
. l ' TTPE''OP WORK. ,+ f' 4.41 h °FIE* SCIIEDIX: ( ..0:
0 Demo� ING DIVISIO For special information use checklist
❑New constructionDescription Qty. I Ea. I Total
II Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
,i SFR(1)bath 312.70
e ,' '�� i;.+Ge�"`�F,,ir~*QR'I' �� 0ONBTRIJCT;�O`N
SFR(2)bath 437.78
❑ 1-and 2-family dwelling II.Commercial/industrial
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
I. JOB i IT !kili4O 1llA°TI1ON' iiiPto A.TIo'1r1: d " Site utilities:
Catch basin or area drain 18.76
Job site address: 16200 SW PACIFIC HWY.
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 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.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Backflow preventer 2 31.27 $62.54
Tax map/parcel no.: 2S115AB01900,- .,, Ffl, 'N OF'1ORK i_ Backwater valve
12.51
- I I �U "
Clothes washer 25.02
Alteration of an existing freestanding building for a new fast casual dining restaurant. Dishwasher 1 25.02 $25.02
- Scope of work includes new waste/vent piping,new hot/cold water piping,new hot 25.02
water heats,and new gas piping.Water,waste and gas will tie into existing lines. _ Drinking fountain
- Ejectors/sump 25.02
Expansion tank 1 12.51 $12.51
LROPERTY1Q 'k❑ T A T i, piry
Fixture/sewer cap 25.02
Name: SN INVESTMENT PROPERTIES, LLC Floor drain/floor sink/hub 17 25.02 $425.34
Address: 1121 SW SALMON ST. STE 500 Garbage disposal 25.02
City/State/ZIP: PORTLAND, OR 97205 Hose bib 2 25.02 $50.04
Phone:(503)450-0806 Fax:( ) Ice maker 2 12.51 $12.51
� t11PF)<,+i+L".ANT '.,' s �{ �oNTAGT PI+ItSQ15
Interceptor/grease trap 1 25.02 $25.02
Medical gas(value:$ ) Page 2
Business name: INTERIOR ARCHITECTS Primer 12.51
Contact name: MELISSA STONIKINIS Roof drain(commercial) 12.51
Address: 2300 CHESTNUT STREET, SUITE 250 Sink/basin/lavatory 9 25.02 $225.18
City/State/ZIP: PHILADELPHIA, PA 19103 Solar units(potable water) 62.54
Phone:( 267)439 4887 Fax: ( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: M.STONIKINIS@INTERIORARCHITECTS.COM Water closet 2 25.02 $50.04
1 cO TRAa`f-,- '' ' Water heater 2 37.52 $75.04
Business name: MANZCO PLUMBING rr=-- Water piping/DWV 7 56.29 $394.03
Address: PO BOX 822964 Other: 25.02
Subtotal $1357.27
City/State/ZIP:VANCOUVER, WA 98682
Minimum permit fee: $72.50
Phone:( 360)772 8149 Fax:( ) Plan review (25%of permit fee) $339.32
CCB Lic.: 181318 Plumbing Lic.no.: PB523 State surcharge(12%of permit fee) $162.87
Authorized signature: th ,,; ; - TOTAL PERMIT FEE $1 . 6
1/6/23 This permit application expires if a permit is not obtained wit ' 80 days
Print name: MELISSA STONIKINIS I Date: I 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/C'OM/WEB) it if 7 51
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
.Site Utilities o i_ . 3iv . Tv--ljetz i° ;i Total- Square Footage: ,,4''i 1 ermi .��Fee:9:T n .
Footing drain-l`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 lu 1
Val atio#: Term! Fe . , ol,
:
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
Fee total each additional$100.00 or fraction thereof,to
tither"Inspection !or Fees_ ! ,Qt'.-k t, 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*. Plan Review foI''Pl1A mbbinng-tnstdllatiQns
Quant y 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
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: -Commercial 1 0 Any multipurpose fire sprinkler system.
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain
Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" 6
3" 11 "' , Isg et;ric or Riser!„Diagram ' , ,,
4" 0 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 2 Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related 2
-Bradley
-Com/Serv/Util food related 6
-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 plumbing permit can be issued.
Water Closet-Toilet 2
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
. Piembing Permit Application
Building Fixtures FoR tlrrlcE FsE ()Nix
Cityof Tigard ReceiveDated
g By: 3/4 �_ / `��
y -' Permit No.. ''1 .:) ; ;'
41 13125 SW Hall Blvd.,Tigard,OR 97223
II Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
DateBy: S- 1 �� Other Permit No.: (
�
T 1 C n R D Inspection Line: 503.639.4175 Date Read/B kris:
Internet: www.tigard-or.gov y y See Page 2 for
Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑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)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
❑Accessory building El Multi-familySFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION'< Site utilities:
Job site address: f6'1,,,',ic, 1, ,1 1.^,.1‘-I (- i,. 44, E --1Catch basin or area drain 18.76
Drywell,leach line,or wench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured 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 31.27 6 +
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher f 25.02 ;,5 . c;2.
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT- Expansion tank ) 12.51 a,_'- .5 1
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub i 7 25.02 /_d.,2y' 3.4
Garbage disposal 25.02
City/State/ZIP: Hose bib '7 25.02 5 G:z, ..,!
Phone:( ) Fax:( ) Ice maker .'..- 12.51
0 APPLICANT Interceptor/grease aS O'�
❑ CONTACT PERSONtrap j 25.02 ,:),5",�; '2„
Business name: Medical gas(value:$ ) Page 2
Contact name:
Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory C.; 25.02 1,41 y ,q,'
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 t.' ,',..j
Business name: Water heater 37.52 7 y 0,,,/
Water piping/DWV -7 56.29
Address: Other:
25.02
City/State/ZIP: Subtotal 136G1. 7$
Minimum permit fee: $72.50
Phone:( ) Fax:( )
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) 3ya,y
State surcharge(12%of permit fee) 1614.3
Authorized signature:
TOTAL PERMIT FEE i S 76 ( S1
Print name: 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.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
t
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-1s`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: 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 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*. 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 0 Any multipurpose fire sprinkler system.
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3„ Isometric or Riser Diagram
4" 0 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) k '-r' >s r.1r� - _ z.``.`` .',4�'
Rec.Vehicle Dump Station di'Y?i' 5;w?C -. !='a c,,,;' ,,,r't-I/<.
Shower: -Gang :r i j,4.NI? ,5,'. y/. ,7 l' .. ,
_ , _c.0 .Yi 5 r/.itE(
-Stall , .
Sink: -Lay/Bar non-food related f �' + r"�¢'�' /' '< 7r
-Bradley j i - ;' j-:c G;,';2, ..` J.i,ix:5
-Com/Serv/Util food related
-Service *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 plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2