Permit ,.,. CITY OF TI G ARD PLUMBING PERMIT
I °'-1 2 ' p. COMMUNITY DEVELOPMENT Permit #: PLM2010 -00229
13125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Date Issued: 11/30/2010
�, Parcel: 2S102CB01802 •
Jurisdiction: Tigard
Site address: 13407 SW PACIFIC HWY
Project: AutoZone Subdivision: Lot: 0
Project Description: Interior plumbing for new building. (1) backflow preventer, (2) drinking fountains, (1) 2" floor drains, (1) hose bib,
(4) roof drains, (2) sinks, (2) water closets, and (1) water heater.
Contractor: CH KRUSE PLUMBING Owner: BAR -AM, LLC
1527 SE 104TH CT BY GODFATHER'S PIZZA
VANCOUVER, WA 98664 1416 THIRD AVE
SEATTLE WA, 98
PHONE: 360 - 573 -4337 PHONE.
FAX: 360- 573 -5303
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/17/2010 $31.27
Specifics: 2 ea Drinking Fountain 11/17/2010 $50.04
1 ea Floor Drain /Floor Sink/Hub 11/17/2010 $25.02
Type of Use: COM 1 ea Hose Bib 11/17/2010 $25.02
Class of Work: ALT 4 ea Roof Drain (Commercial) 11/17/2010 $50.04
Type of Const: 2 ea Sink 11/17/2010 $50.04
Occupancy Grp: 2 ea Water Closet 11/17/2010 $50.04
Stories: 1 ea Water Heater 11/17/2010 $37.52
1 12% State Surcharge - 11/17/2010 $38.28
Plumbing
Total $357.27
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
or direct ques • UNC by calling 503.232.1987 or 1.800.332.2344.
6: ..--
Issued By. A ��✓�` Permittee Signature:
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.
Nov 171009:27a CH Kruse Plumbing 3605735303 p.1
11/17/2010 08:16 5035961960 CITY OF TIGARD PAGE 02/02
JUL -20 -2010 TUE 12 :08 PM FAX MO. 6DR ,9, 02
Plumbing Permit Application _ r .i 1 41 �. 5 • _i 1 1 RG;
Building ��+
lding D fixtures I 7 4) r i.l a t, ii.. . I. it l 1 \-1 1
City of Tigard I �� ~ k �� • 14 �' i. i � >Zetalvea "7M/ ,1 Pcrmit'Na: r 1
H A!?1�' (4C)��' 1
13125 SW ILA 131%.5„, Tigard, OR 97223
Mane: 503,6394171 Fax; 503 - 591.11LDiti.TD)1 S.
91 fj Otlaa &N OW • d q
I ,s,, .: 1 r ,. 1ntpactto t Line 503.639.4175
Internet: www,dgerd- es.gov I. au RaSdy/4y FJ et PaEa T
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•. TYPE OF WORtt. ... .. - ...?;� •a • - • / FEE. ..
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Ei .,...thion Iry i oPa grlan umncharklna.
Dete••irtion _gis•. I Ea. Toad
1 Q AdditiaaialtcratiOa rcplectmroot her, Maw 1- 2-bogy dwe includes 100 Et ibr tavch utility nosmect )
CATMORY $8 • c •, _ .. (f) bets 31.270
FR E:1 1- and 2- family dwelling ®C4mmetciaVi dustria1 '' barb 43738
El Acco i ory building 5FR (3) bath 500.32
Q , ul trfstidl)+ Each **Wend bath/kitchen
1 25.01 -
(..1 Master batida ❑ a Fire syrinitlet (_ sq. ft) 1111111
JOB.-SITE Q�1' OP.MA71ON- : ' . f LOCAT OT - - • - „ • Silo at11 ties:
Job site ad dress; 12.405 5W Pacific 1llgbwo Cau1f bash or area drain
Drywol , leach hoc, or much drain
CitytstatelblP:Tigard/0Rt47721 Fontiog ergo (no. linear ft. - . _.,,.) Pao2 NMI
Sultelblag hips no.; • Ptojeet name: An • • se Store ido.3TS6 Mattu£aetatel borne uaGties 50 MINIM
Cross street/direetiorta to job site Walt cf SW Pat(9lc • Msusboles 18.76 Mill
. South of 5W Park Street: East and North of SW W .. Agin &tin oarmectar 111.76
Sa slfstty sewer (to. linear It: ,_) Page Z al
Swim sewer (no. llneir ft; _...„) Page 2
Water servlee (do. Sour ft: ) Page2
Subdivisiedt: - !! 11„ot no.; Muse ejtgvlt
1.
Taitmap)pareel Ten.: 1994507 9aek>5owpre-venter 1 3127 3127
DESCRI PTD0M OF • tilt} 1ltokwerervaIve 1151
Mess washer 25.42
PlttmbiaF Ter a out story AotoZono Retail Store Di skier 25.02 •
Drloicna Toaatsb) i 2 25.02 50.04
•
- Aieetorstsurao i 25.02
- [;) PROP RTY -: 0 38111A1irr. - , 1'xwait:a=1i 12.51
Name; e ,
Wa rs:Ismer cap 2.5,02
dtainrfloor slakfiub 1 25 -02 25.02
Address:
Garbage diepoaal 25.02
City1State2/2; (ta11e • Hose hill 1 2502 25.02
Phoaa( ) rm.( ) 1'°•` 100 rocker 1 12 ,5I
.. ' E APPLICANT ..' •. • i(- 0 COI�•C 9'1ar:0 - 7 Y rntmaepror /grmecsap I 25.02
ram
Business Ts: Auto2aae - „ Medical gas (value 5 _ ) 1 Page 2
Co mae! name: Mitch 13ramlkt Primer _ ]2 sl
Address: 123 Soot]) Freest Stmt ;) u y! D .. drain (uotturtetekl) . 4 12.51 50.04 ;
f 1 ..e Sink hasi valay 1 25,E 50,04
City fStat&Z1P :Adlearphio,TNV.38113 p er . 1 , Sowuaita (potable sneer)
ph 62.54 !I
one. 901) 495 -9714 I F -• .; _ (001) 498-9941 a ,T 'Mhl1howetfsb pee awcr _ 12.51
E -mail: mltetl.b tt�m
aurtme.com Urinal 25.02 _
COZ ITRACTO� , ater closet 2 25.02 a r✓ut 5 p'
Ws= heaver 1 37.52 37.52
Business - . : Ti4� C N � - t t ; t. o-( tI■JC� Wage plpistp/Dwv 50.29
Address' N� 5 ',�'
A I . �' Wert 25,0:a
City /State/ZIP: ' rJ r`O bt J i Q- 1 14.34 /Q Subtotal 3j I - ' (
Phone: ( ) 573" I/ S • Fa : (? -s7 s 303 Minimum permit fee 57250
9 , Plan review (2s% of permit fee)
CC:B Lis.: • '� E NV Lie. Tro.: ,,,� ,�� a - , � � -
Authorized i Stateeum 1 1 17T (1 e1L F8p2.11TFa1' 3 } }
Fruit name S C ' ,��/+ !, male: I Ms amain app a It h t o mama!, d a t titalrird w1th 1N day, c tnt� I J *Fee e8obty vet ty 711 Ceuray 8n+161ae iaealty 5erfiro salted.
1 noid'ierraosamses.Rvtehaallosee lorotot 4 am ma/Aesal
•
JUL -20 -2010 TUE 12:08 PM FAX NO, P. 03
PlumbingPermit Ap - Ci of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Su' . ression S stems:
• Site Utilltiea
Qty. ee (ea) Total , S . uare Foota t e: Permit Fee:
Footing drain - 1' 100' 50.03 0 to 2,000 5121.90
Footing drain 2 001 to 3,600 5169.69 each additional 100' 37.52 3,601 to 7.200 5233,20
Sewer - 1st 100' - ' 62.54 7,201 and • rester $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' - ' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Yaluati011:. Perm _..
Storm & Rain Drain 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee 572.50
Storm & Ruin Drain - each additional 100' . 37.52 $5,001.00 to $10,000.00 572.50 for the first $5,000.00 and $1.52 for
Q ty. fee (ea) Total each additional 5100.00 or fraction thereof, to
.. Other Inspections or Fees . _ and including 510,000.00.
Inspection of existing plumbing or for 510,001.00 to 525,000.00 $145.50 for the first $10,000.00 and 51.54 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 - 190.00/hr ' 525,001.00 to 550,000.00 5379.50 for the first 525,000.00 and 51.45 for
hours (minimum charge -2 hours) _ - each additional $100.00 or fraction thereof, to
Reinspection Fees '90-00/1.- and including 550,000,00.
Additional lan review for revisions .90.00/h r 550,001.00 and up 5742.00 for the first 550,000.00 and 51.20 for
p cash additional 5100.00 or fraction thereof.
(minimum charge -1 /2 hour)
Subtotal:
-
•
•
•.■m.1 _.
-
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review: for Plumbing Installations
please indicate work performed by fixture. Failure to Nan review is required for any of the following.
accurately report fixtures could result in i 'creased sewer fees Please check all that apply.
Quantity by (Flxtur i) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped j Added £ %piing , engineer.
Baptistry /Font ❑ New exterior plumbing site utilities for any complex structure
Bath Tub /Shower as defined in OAR918 -780 -0040.
- Jacuzzi /Whirlpool ❑ Medical gas and vacuum systems for health care facilities,
Car Wash -Each Stall ❑ Any multipurpose fire sprinkler system. •
.Drive lhru .. ❑ Any complex structure as defined in OAR918 -780 -0040.
Cuspidor /Water Aspirator
Dishwasher - Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain : x .. ..
E e Wash ' . . • . Isometric or Riser Diagram ' -
Floor Drain/sink 2" i Isometric or riser diagram is required for new buildings
- - that meet the qualifications above.
• 4 " ' - • 1
Car Wash Drain
Garbage - Domestic
Disposal - Commercial ,'
- Industrial Comments regarding fixture work:
Ice Mach./Refrrk Drains H. ,_
Oil Separator (Gas Station) _I
Rec. Vehicle Dump Station
Shower -Gang ,
-Stall
Sink - Bar /Lavatory A
- Bradley
- Commercial Note: If the fixture work under this permit results in an
- service _ increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter - fees assessed for the sewer increase must be paid before the
Washer - Clothes ,. plumbing permit can be issued.
Water Extractor r►
Water Closet - Toilet _ „ aS
Urinal •
Other Fixtures; , -
•
]:\ Stores \OR\3756- TIGARD \DOGSWRE -CON\I LMF- PemiitApp.doe 2
Accumulative Sewer Tally Parcel # 2S102CB01802
Tenant Name: AUTOZONE This SWR# N/A ,
Site Address: ` 13405 SW PACIFIC HIGHWAY - ' This PLM# PLM2010 -00229
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s 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 2 2 2 2
Iyc Wash 1 0 ' ' 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 • 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 1 6 1 6
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -IP) 16 0 . , , -- - 0 0 0 0
- Commercial (to 5 I IP) 32 0 0 0 0 0
- Industrial (over 5 I -IP) 42 0 ' . 0 , ,,, . 0 0 0
Ice Machine /Refrigerator Drain 1 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 - Bar /Lavatory 2 0 0 2 4 2 4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 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 0 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count - 0 0
Capped EDU Credit 5 80
TOTALS 0 0 0 0 7 24 7 -56
Current Fixture Value -56 divided by 16 = -3.5 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -56 divided by 16 = -3.5 over (under) $ (14,350.00)
Enter EDU Change Here -3.5
Notes: * * *5 EDU credits from previous structure to be demo'd * **
Authorized Name /Signature: Brariden Taggart :x2449 Date: .7/21/2010
Building Division
Note: 'Ube property owner shall retain the ORIGINAL sewer tally record. 1f 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:A Building \ Sewer Tally \SewcrfallyShect- 3600.xls 06/25/08