Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2009 -00006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 .503.639.4171 DATE ISSUED: 1/16/2009
5136
PARCEL: 1S136
SITE ADDRESS: 11746 SW PACIFIC HWY ZONING: C -
SUBDIVISION: DUTCH BROTHERS COFFEE LOT: JURISDICTION: TIG
PROJECT: DUTCH BROS. COFFEE
Project Description: Site plumbing for new coffee drive -thru. Other fixtures are (5) manholes.
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 5
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: 100 ft
Owner: FEES
Comas A 1404 Lv ..r
,21340 r am f by 12-b Description Date Amount
` dN - ��� 0 2 [PLUMB] Permit Fee 1/16/2009 $248.76
No [TAX] 12% State Surch 1/16/2009 $29.76
Phone : Total $278.52
Contractor:
DALKE CONSTRUCTION CO. •
P.O. BOX 5170
SALEM, OR 97304 REQUIRED ITEMS AND REPORTS
Contact # :. PRI 503 -585 -7403
FAX 503 -585 -1978
Reg #: LIC 63080
PLM PB282
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 - 0010 through OAR 952 - • 0100. ou may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: '
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
11 7 (6 Pact ci e. •I ku j. •
'` -Iiiih6ing Permit Applicatio
Site Utilities DECEIVE FOR OFFICE USE ONLY
City of Ti and JN Q p Received -� ry ����/
g /H O 2009 Date /By: I' a • 04 VA Perm No.: p Lrn 2 o09 • W +1
111 a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �},
M : Phone: 503.639.4171 Fax: 503.598 v OF Ti 1 Other Permit No. 8(1 2cic .noon
i /AA!•1 Date /By:
Inspection Line: 503.639.4175 �Ngy Date Read /B Juris: ® See Page 2 for
TIGARD Internet: www.tigard- or.gov 6� �'��� �� Notified/Method: 1 Supplemental Information
TYPE OF WORK ��/ � ,1 FEE* SC EDULE
For special information use checklist
lk<ew construction 0 Demolition
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site addtess:1.172 . 5W - - - 1 C 14 Catch basin or area drain 16.60
11
City/State /ZIP: a OR -1 ', 2.2.-5 RQ 5 r)n Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: outth _ Footing drain (no. linear ft.: _ ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: sw -n Ave,. � C) ' q Ma nholes 5 16.60 6a
' rY `� • Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 1005 1 Page 2 Oa
Storm sewer (no. linear ft.: /A r) 1 Page 2 gy •'
Subdivision: N/Q Lot no.: 21f� Water service (no. linear ft.: MO') \ Page 2 j •�
1 `1 g ^� Fixture or item
Tax map /parcel no.: ;� (;
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
e uch f /3h wort t � � t Backwater valve 16.60
it IC a q 60/41 94 abo ,/.
(/ im:m/ Clothes washer 16.60
J Dishwasher 16.60
1 Drinking fountain 16.60
(PROPERTY OWNER 0 TENANT
Ejectors/sump 16.60
Name: gig/ liztAkins Expansion tank 16.60
Address: //8'240 /„ � tjfl iew &R � 7 Fixture/sewer cap 16.60
C
City/State /ZIP: / ,neerod ie 97140- �"' Q 7710 Floor drain/tloorsink/hub 16.60
Phone: ( 5o3)_ 1, Fax: ( ) Garbage disposal 16.60
❑ APPLICANT [}CONTACT PERSON Hose bib 16.60
Ice maker >� 16.60
Business name: Mu/h EnT 1 P•e-rl Interceptor /grease trap 16.60
Contact name: d f.( J Medical gas (value: $ ) Page 2
Address: II 5 5 13tti 5t 5E. Primer 16.60
City/State/ZIP: sakern c . 6)7302 Roof drain (commercial) at 16.60
Sink/basin/lavatory 41 16.60
Phone: (6o3) ?J(:::t - ct2 -2.7 Fax: : (50,3) &04.1.- S 2400 Tub /shower /shower pan 16.60
E -mail: Vic,b q�MU. L1i l'!.WS Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: y I ke o J u C 11 eo. Water heater VI 16.60
Address: PO D 5110 Other:
City /State /ZIP: aztexr, OR q7 Subtotal a �$ • 7
Minimum permit fee: $72.50
Phone: ( 503) 585_ 7403 Fax: ( 503) 5%6 - i c y 7g Residential backflow minimum permit fee: $36.25
CCB Lie.: (0 SO go I. 2 Z • OR Plumbing Lic. no.p0 2 Sn Plan review (25% of permit fee)
Authorized ' \ j� .) �., - f j 11 State surcharge (12% of permit fee) • cq(„,
JG r TOTAL PERMIT FEE
Print na Date: Ye /S� 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.
I:\ Building \Permits\PLMU- PermitApp.doc 12 /27/06 440- 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 - I 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 1 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' ' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $ 1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
_ Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
-Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
http: / /www.tigard- or.gov/ city_hall / departments /cd/docs/PLM U- PetmmitApedoc
CITY OF TIGAR® P0-1036 9- k o 4
BUILDING DIVISION PERMIT #:
AR 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 i
Inspection Requests (24 Hrs.): (503) 639 -4175 `'f -L
INSPECTION WORKSHEET FOR DATE: — 3//(, /0 9 TIME: PAGE:
SITE ADDRESS: //1Y /2 u L /- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
(
Corrections /Comments /Instructions:
r (
ti/ , r
* ) ,i <
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ��' Date: -3 / / (0/ 6 9 Phone #: (503) 718 -�1/4/4
CITY OF TIGARD
BUILDING DIVISION ( ilk , PERMIT #: 10009•00006
13125 SW Hall Blvd., Tigard, OR 97223 5 DATE ISSUED: 1/16/2009
Phone: (503) 639-4171 ,.1144A1'.
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 3/2/2009 TIME: 7:00AM PAGE: 16
SITE ADDRESS: 11746 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: DtJTCH BROS, COFFEE LOT #: TYPE OF USE:
PROJECT NAME: DUTCH BROS. COFFEE
DESCRIPTION: Site plumbing for new coffee drive-thru. Other fixtures are (5) manholes.
OWNER: GRUNBAUlvl FAMILY TRUST, PHONE #:
CONTRACTOR: DALKE CONSTRUCTION CO. PHONE #: 503-586-7403
Inspection Request Scheduled For: Date: 3/20009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 080912-01 503.932-0336
Corrections/Comments/ Instructions:
(2) (,ti .a-VJ
14 n
*
Eli PASS c1 APPROVAL n CANCEL El NO ACCESS
1 FAIL I1 CALL FOR INSPECTION Lil ADDITIONAL FEES ASSESSED
•
Inspector: (5 Date: Phone #: (503) 718- (2-"q
CITY OF TIGARD
v 1
BUILDING DIVISION ( .� / PE RMIT #: PI l�920043.00006
13125 SW Hall Blvd., Tigard, OR 97223 f v DAT ISSUED: 1/16,12009 Phone: (503) 639 -4171 • , ,e' �'
Inspection Requests (24 Hrs.): (503) 639 -4175 s ` ._ !'" I. /(3
INSPECTION WORKSHEET FOR DATE: 2/20/2008 TIME: 7:OOAM PAGE: - 12
SITE ADDRESS: 11746 SW PACIFIC l CLASS OF WORK:
SUBDIVISION: DUTCH t3ROS. COFFEE LOT #: TYPE OF USE:
PROJECT NAME: DUTCH BIOS. COFFFE
DESCRIPTION; Site plumbing for new coffee drive- t.hru. Other fixtures are (a) manholes.
OWNER: GRUNBAUM FAMILY TRUST, PHONE #:
CONTRACTOR: C)ALKE CONSTRUCTION CO. PHONE #: 503 585
Inspection Request Scheduled For: Date: 2/20/20(19 6 � Pour Ti e: i 0 O A-,A
Code # Inspection Description It y Confirm # Contact # Mes.
395 Misc. inspection i I% 080672-01 503-932-0335 Y
Corrections /Comments /Instructions:
4 ' p i' s_&._.-
PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:
V1) t/ ''
Date: 217/1) i In Phone #: (503) 718 - 2/L42/‘1(