Permit .1 v CITY OF TIGARD PLUMBING PERMIT
111 o
'' . COMMUNITY DEVELOPMENT Permit #: PLM2010 00341
T [G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2010
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13560 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Starbucks
Project Description:
Owner: FEES
13500 PACIFIC CORP Quantity Description Date Amount
BY CAPOZZOLI ADVISORY FOR PENSIONS
INC, 21500 HAGGERTY ROAD, SUITE 100 1 ea Fixture /Sewer Cap 10/21/2010 $25.02
PHONE: 1 ea Floor Drain/Floor Sink/Hub 10/21/2010 $25.02
1 ea Interceptor /Grease Trap 10/21/2010 $25.02
4 ea Sink 10/21/2010 $100.08
Contractor: 1 ea Water Heater 10/21/2010 $37.52
DCS PLUMBING 1 12% State Surcharge - 10/21/2010 $25.52
PO BOX 2721 Plumbing
BATTLE GROUND, WA 98604
PHONE: 360 -852 -6890
FAX: 360- 686 -3730
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Stories:
Total $238.18
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 N i enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or di ct questiions to OUNC by c ling 503.246.6699 or 1.800.332.2344.
L _____,. Ism, d By: 4 i Permittee Signature: k. ...„7
Call 503.639.4175 by 7:00 a.m. for an inspection that busi , - ss da .
This permit card shall be kept in a conspicuous place on the job site unti compl ion of the project.
Approved plans are required on the job site at the time of ea . • action.
20/10/2010 13:01 Page 1/3
Plumbing Permit Applicati 64 Paiefes -eo / 35
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Building Fixtures :.,- .. ,‘ ,..:‘;: '-:::'; FOR OrriCr..:;USE.
City of Tigard N'' ..'• '. ' ' '..:- ' '
_ . _ , . , , , .., . r , - . • , , , , . ,,.
r _
le 0 A , pmemir
.,i , 13125 SW Hall Blvd.. Tigard. OR 9720r
T ,. ..
Rao Re■ira•
503.598.196I)' Z 0 2010 . 1 OthxrPertait 'Mc...A.4,900 °CO/ ) /
1 ria 1- K 1 :la : JO
. Inspirtion I,ine: 563.639.4175 n
orY OF iv,. I Stni, 1 Si See Page 2 for I
:,,-.: - ' 1 ,-... . •.: Internet www.tigand-or.gov RI .... _ i , twA,FID I Notified' NietW: 1 _LSItEetnetatal Information 1
piPE OF VOW% DI VISA
1 -
. FEE* 'SCBEDULE
0 New construction 1 U Demolition
t ,.., Far special inftrazatran use checklist.
cir AdditionlaIterationireplacemoit I 1_1 Other:
. 1h:script:on 1 Qty. 1 Fa. j Total
CATEGORY OF CONSTRUCTION New I - 2 dwellings fincluder 1006. for each tit iiity connection)
....„_______.. - 1 SFR i 1 l bath 312.70
EI t- and 2-family dwelling $ Commercial;industrial
- i 1 SFR (2.i bath 437.78
0 Accessary.: building 0 Multi-family I
SFR (3) ixith 500.32
r
t.-.4 Master builder I 0 Other: Each additional batlikitehen 25.02
JOB SITE INFORMATION AND LOCATION Fire sprinkler ( sq. 113 Page 2
Site utilities:
Job site address: /35 0 54) ,Pote. 1-/o
Catch basin or ama drain 18.76
City/State/VP: 2
3 t
Dry:well, leach line. or trench drain
Suiteibltiglapt. no.: I Project name: . 5 i ti . . a.
Footing drain (no liner fr.: 3 L_Pla8ge.726
Cross strecidirections to job site: Manufactured home utilities 1 50.03
Manholes 18.76
RaM draM connector 18.76
Sanitary seer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) 1
..... Page 2
Subdivision: I Lot no.: Water service (no. linear 6.: ) 1 Page 2
1
Fixture or item: ....
Tax mapiparcel no.: •
Back flow preventer 31.27
'DESCRIPTION OF WORK
Backwater valve 12.51
..,,,,,,
44 (4, .(1.„,i-e 71, -.40 / ee /"; i'.4.1..- iCv..k."7< 1 Clothes washer 111111111E31
I
1 Dishwasher I 25.02 1
1 Drinkine fountain 25.02
I I
0 PROPERTY OWNER ' 0 TENANT Ejectors/suntp 1 5.02
', Expansion tank 13.51
Name: fi i Z •&-4._,,
1 Fix turewtver cap / 25.02 2.1 t 2
Address: . 5 . 7) s it ! i ,a 6 ,; .. -
i Floor drainilloor sinklhub / 1 5.02 Z C ‘e
C.ity/StatelZIP: )4 eie., 4", 00 o f , ! Garbag.e disptisal 1111111111ral
Phone: ( .Ne3 .3 2 .2.y_ >y 1 Fax: ( 7 ) I Hose bib 25.02
• I
0 APPLICANT 0 CONTACT PERSON Re maker 12.51
Interceptor; se trap 1 F 15.02 7.5
f3usiness naine: $k.,"el. „,.‘,. 4 6 1 4,, i ,
Medical gas tvalue: $ _ ) Page 2
P
r
COIltaCI nitme. /24,..1. CAA.- CA 4
Primer , 12.51
Address: z,5/47/ te ,4 / 1 drain (commercial) 1
City:StateiZ1P: f ,..._, IA) I 0/7t rTkesinilayatory e ( 25.02 i co t8
Phone: 0 4) ,„ - Fax: : ( )
Solar units (potable water) i 62.54
4 j ? 2 ■70' 0 I
Tub pan I 12.51
E-mail:
i !
. 1 urinal
I 1 25.02
, CONTRACTOR
1
, yiater cl 25.02 os..et 1 1-
Business name: pc; P4, ,„„ i,, ./..t. c .
i Address: ir:;k) „tec x . 7 2,/ Water heater
Water piping,DWV 1 / j 37.52 ? ? . (
1 I 56.29
City/State/ZIP: 8t 6/ 40/19 9 C r Other. I I /C.111
t - -
Subtotal 2- 616
[ Phone: (1t) ,p - 69 4 0 I Fax: (s60 ) ‘e6 -373 e.:
N3ininium permit fee: S72.50
I
CCI3 Lie.: /75 I Plumbing tic. no.: t , 23 .; i
Plan review (25% of permit fee)
Authorized signature: 4‘. State surcharge t12% of permit fee) 2, 1 5
I Prim name: ,1.94../e 6.:Z. If's"' '
I Date: /ev 0.,/, I_---i TOTAL PERMIT FEE 2 34i, , 1%
I'' doc 13.%,1•■:K• 4•;(1-4i:11.1;i::■1311.',.A1.'WFR;
20/10/2010 13:01 Page 2/3
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
.. - . • ...
l ....Siii•Uilliiiiii . ..: - -.:' ::..,: :::::.::::.. :-'. : .' .'. .91'... ..•,:!*(,) i Total ' I Square Footage ,T.PerMit Fee:. • :•.- .... ,:- ;. : . •
. .......... .
Footing drain - 1' 100' 50.03
1 0 to 2 5121.90
Footing drain - each additional 100' , 37.52 I 2.001 to 3.600 $169.69
I I 3.601 to 7.200 $233.20
1 Sewer - 1st 100' 62.54 1
I 7.201 and greater $327.54
I Sewer - each additional 100' 37.52
1 1
Water Service - Is; 100• 62.54 1
Water Service - each additional 100' 37,52 Medical Gas Systems:
. . . .. . . .
• . • • . .. .
Storm &. in Drain - 1st 100 62.54 Valuation Permit'Yee:.:... : -. . - • .. , ,
Storm & Rain DraM - each additional 100' 37.57 1
53.00 to $5.000.00 Minimum fee 572.50
$5.001.00 to 510.000.00 $72.50 for the first 55.000.00 and 51.52 for
Othet,Insiiections Fees I : :,.QtY. Fe•(ea) MLA cad, additional 53 0000 or fraction thereof to
Inspection of OZiSiiI11.1 plumbing or for and including $10.000.00 .
which no fee is specifically indicated
I minimum chisr,ge -. 1!?. hour) 90.00/hr S10.001.00 to 525,000.00 SI4g.50 for the first 510,000.00 and $1.54 for
each additional $100.00 or fraction thereof. to
i Inspections outside of normal business 90.00/hr :
I and including 525.000.00.
I hours (minimum charge - 2 hours) $25 001.00 to 530,000.00 $379.50 for the first 525,000.00 and $1.45 for
I Reinspection Fees t 90.00/hr 1 each additional 5100.00 or fraction thereof to
Additional plan review for
I revisions i 90.00.1h and including 550.0
r
$50.001.00 and up 00.00.
S742.00 fc)r the first $50.000 0) and $ !.20 for
<minimum charm -112 hour)
Subtotal:
1 each additional $100.00 or fraction thereof
. . . .., . . . ., ... . , , . .. . . .
Commercial Fixture Work: ,..-Plan,RevieW.lor:Phim.hIno Installations • :,..: - • •
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any oldie following.
please indicate work performed by fixture. Failure to Please cheek all that apply.
0 Any new commercial building with water service 2" and
accurately report fixturm could result in increased sewer ft-es*.
Quantis by (Fisture)•AVork Performed greater, except systems designed and stamped by licensed
.. • . -•- • . • .' • .',..* .'
1,:ittareTy 0 engineer.
pe: • • - .. •V 1 • .:: • .: .. - . . .• " . - • •••• ••1 - Replace.
• ••••- '-.- •••-' • • • •- • _••:•Previlotts • • CePPed - : :Added • • Existing . New exterior plumbing site utilities for any complex structure
Baptistry/Font 1 as defined in OAR918-7804)040.
, Bath -TabiShower 1 0 Medical gas and vacuum systems for health care facilities.
1 -JacuairWhirlpool t 1 0 Any multipurpose lire sprinkler system.
1 Car Wash -Each Stall 1 0 Any complex stnicturc as defined in OA R918-780-0040.
i -Drive 'Dim L i
Cuspidor/Water Asninnor I
Submit 2 sets of plans with an of the above.
m
Dishwasher -Comercial , i
i 1
1
-Domestic
Drinkine Fountain 1
. . .. :ISontetric.or.:Itiser:Diagram., ' .. ,•,- • -
Ev Wash U Isometric or riser diagram is required for new buildings
e
- I
Floor - /
r Drain/sink 2 i / / that meet the qualifications above.
- 3" 1
I
Car Wash Drain
Garbage -Domestic
I -Commercial
Comments regarding fixture work:
Disposal
-Industrial .
• Ice lviach./Refrie. Drains
00 Separator (Gas Station)
Rec. vehicle Dump Station I
Shower -Gane - I
-Stall 1 a , I
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
Swimmin fees assessed for the sewer increase must be paid before the
g Pool Filter
Washer - Clothes I plumbing permit can be issued.
Water Extractor 1
Water Closet - Toiler .
Urinal
Other Fixtures' 1 1 -