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Permit
CITY OF TIGARD PLUMBING PERMIT `• ! COMMUNITY DEVELOPMENT Permit #: PLM2012 -00217 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/02/2012 Parcel: 1S 134BC00300 Jurisdiction: Tigard Site address: 12280 SW SCHOLLS FERRY RD Project: Little Caesars Subdivision: WINDSOR PLACE Lot: 32 Project Description: Plumbing fixtures for TI: ADD (3) 2" floor drains, (1) grease trap, (1) primer, (2) non -food related sinks, (1) commercial food - related sink, and (1) water heater; CAP (1) breakroom sink. Note: No SWR permit required as 12.7 EDU credit from previous tenant applied to EDU charges for this permit per Utility Billing. Contractor: MIKE SMITH CONSTRUCTION & PLUMBING INC Owner: FW OR - GREENWAY TOWN CENTER LLC 455 N 10TH STREET PO BOX 790830 ST. HELENS, OR 97051 SAN ANTONIO, TX 78279 PHONE: 503 - 397 -7749 PHONE: FAX: .502 - a96 - at FEES Quantity Description Date Amount 1 ea Fixture /Sewer Cap 08/02/2012 $25.02 Specifics: 3 ea Floor Drain /Floor Sink/Hub 08/02/2012 $75.06 1 ea Interceptor /Grease Trap 08/02/2012 $25.02 Type of Use: COM, 3 ea Sink 08/02/2012 $75.06 Class of Work: ALT 1 ea Water Heater 08/02/2012 $37.52 Type of Const: 1 12% State Surcharge - 08/02/2012 $28.52 Occupancy Grp: Plumbing Stories: Total $266.20 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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: /Jit/ 15 — T /O 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. 1� CITY OF TIGARD PLUMBING PERMIT ` COMMUNITY DEVELOPMENT Permit#: PLM2012 00217 IIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/02/2012 . Parcel: 1 S134BC00300 Jurisdiction: Tigard Site address: 12280 SW SCHOLLS FERRY RD Project: Little Caesars Subdivision: WINDSOR PLACE Lot: 32 Project Description: Plumbing fixtures for TI: ADD(3)2"floor drains, (1)grease trap, (1)primer, (2)non-food related sinks,(1) commercial food-related sink,and(1)water heater;CAP(1)breakroom sink. Note: No SWR permit required as 12.7 EDU credit from previous tenant applied to EDU charges for this permit per Utility Billing. Contractor: MIKE SMITH CONSTRUCTION &PLUMBING INC Owner: FW OR-GREENWAY TOWN CENTER LLC 455 N 10TH STREET PO BOX 790830 ST. HELENS, OR 97051 SAN ANTONIO, TX 78279 PHONE: 503-397-7749 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Fixture/Sewer Cap 08/02/2012 $25.02 Specifics: 3 ea Floor Drain/Floor Sink/Hub 08/02/2012 $75.06 1 ea Interceptor/Grease Trap 08/02/2012 $25.02 Type of Use: COM 3 ea Sink 08/02/2012 $75.06 Class of Work: ALT 1 ea Water Heater 08/02/2012 $37.52 Type of Const: 1 12%State Surcharge- 08/02/2012 $28.52 Occupancy Grp: Plumbing Stories: Total $266.20 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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: 1 ' L/ Permittee Signature: /`V / '/(2-7(2 A j C 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 RECEIVED Building Fixtures 1\1L1t/ D FOR OFFICE: USE ONLY Received City of Tigard Al1G 0 2 2012 Date/By: try /-Z "/ Permit No./00-42042 �OOa2 /9 L) Iii a 13125 SW Hall Blvd., Tigard,OR 97223 Plan Revie / �,� o �� C Phone: 503.718.2439 Fax: 503.598 Other Permit • d' TYOFTIGARD D a t e B y: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Tun : See I l i nternet: www.tigard - or.gov RI1ILDINGDIVISION Notified/Method: ' 64 S0 upplemental Page 2 far Information T YPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist 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 (1) bath 312.70 ❑ l- and 2- family dwelling OCommerciallindustrial SFR (2) bath 437.7 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ) 22.86 £'h/ s'e.iui.L -..5 A/W) i Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/State /ZIP: 716-11114, • 0 9 V 2-1-3 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: - I Project name: LI TTLIa ce>✓ Manufactured home utilities 50.03 Cross street/directions to job site: 5 L p 11.4 �'la I Si dT Manholes 18.76 GlieEaJ W #3 To i Al C-14• • 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.: /f l3 f i C O O 300 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 A�b -$"s ' ,� 1 t- 1 Clothes he sher 25.02 ��Gln S � �', �)G WJO e Dishwasher 25.02 Aq IC. t •6 -t P1 7- 49 8' s i44. d . Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I TENANT Expansion tank 12.51 ,25,0d" Name: M �/�L ff',IC 040 Fixture /sewer cap 0Qfks �� c9r, f' 25.02 Z3 -� c/ Floor drain/floor sink/hub 25.02 Address: /940/ d �U. 3 14/ vli( dp-- Garbage disposal 25.02 75 06 City /State /ZIP: A-1411#0 Ol • 17 00 4 Hose bib 25.02 Phone: 64.3 ) (00 $- 1 Fax: (6"b3 (0 Yom• - 3 3 - 2- • t- Ice maker 12.51 ❑ APPLICANT jar CONTACT PERSON Interceptor /grease trap f' 25.02 ?g OZ Business name: LaT - >L& Co CSO4-3 Medical gas (value: $ ) Page 2 Primer / 12.51 /2... S Contact name: /►9l 6414 ei_. ogitovi Roof drain (commercial) 12.51 Address: / (4V tw Ttu9?M'7inl t/€ r Ha Sink/basin/lavatory 9 25.02 7 S • OG City /State/ZIP: `}- loo (P i Cit. r 1100 b Solar units (potable water) 62.54 cf Phone: (9 (po ✓ _ 70 $'rte I Fax:: (9 3) (12(2 - 172-1- Tub /shower /shower pan 12.51 E -mail: /yam: k.e. .r+•b�o - Gp ✓� • Gpt..n Urinal 25.02 CONTRACTOR Water closet .. .„1.1" ------ 25.02 Water heater 1 37.52 37.$ 2-- Business name: M 1 (a Syyt C114- r 121 Water piping/DW V 56.29 Address: F 1 • j 0't % .52r. Others . 25.02 City/State /ZIP: Sf Le .i OA-. 4 i 7 05 ) Subtotal .200, `� p Minimum permit fee: $72.50 Phone: (�) 3�l • '7 -• '7-7 T ( Fax: (��) �- �P `-'� �1 P U CCB Lic.: I 1 y (008 g(,�3 Plumbing Lic. no.: Plan review (25% of permit fee) �O (7 7 Q State surcharge (12% of permit fee) Authorized signature: 7// / TOTAL PERMIT FEE Print name: IAA( at4Y 1.. �GN'7fU1 I Date: it - 1 '2 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 - Building Industry Service Board. C\ Building \Pennita\PLMU- PermitApp.doc 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: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: 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 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $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 Other Inspections or Fees Qty Fee (ea) Total each additional $100.00 or fraction thereof, to p 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 $50,00 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 Plumbing Installations " • Fixture Type for Replace/ . an Plan review is're uired for of the following. Performed: Capped Added Relocate q any g' • Baptistry/Font Please check all that apply. Bath - Tub /Shower ❑ Any new commercial building with water service 2" and - Jacuzzi/Whiripool 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" Su 2 sets of plans with any of the above. ,, , • 4 " Isometric or Riser Diagram Car Wash Drain , ❑ I or riser diagram buildings m is required for tiew buildin Garbage - Domestic -nen -food q g Disposal - Domestic -food related that meet the qualifications above. - Commercial-food related - - Industrial -food related • Ice MachiRefrig. Drains Oil Separator (Gas Station) Comments regarding fix tu r e work: • . Rec. Vehicle Dump Station a l" Shower -Gang , �,,�j Py • �� -Stall fat'r" Sink/Lav - Non -food related 0 l A1+ ) , _ . - Bradley - Commercial-food related / - • • • - Service � , , • , , . P . h Swimming Pool Filter *Note: If the fixture work under this permit in an Washer - Clothes W ctor increase of sewer EDUs, a sewer permit will be issued and ucater t - �&'et_. He caw, ' fees assessed for the sewer increase must be paid before the plumbing permit can be,issued. Other Fixtures: Jig,. DR.q1 / IABuilding\Permits\PLMF- PermitApp.doc 02/24/2011 2 Accumulative Sewer Tally • 11111 4 p Tenant Name: Little Caesars SWR # 2012 -00173 TI G A R D Site Address: 12280 SW Scholls Ferry Rd PLM # 2012 -00217 Parcel #: 1S 134BC00300 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped #s value count added # added value total #s total 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 i 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain /Sink: - 2 inch 2 0 0 0 0 0 - 3 inch 5 0 0 2 A) 10 2 10 - 4inch 6 • 0 0 N 0 0 0 - Car Wash 6 0 0 A\ 0 0 0 • Garbage Disposal: - Domestic (to 3/4 HP) 16 0 0 V 0 0 0 - Commercial (to 5 HP) 32 0 0/ 0 0 0 - Industrial (over 5 HP) 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 1 , 6 P 0 0 0 - Stall 2 0 0 0 0 0 Sink: - Lay/Bar - Non -Food Related 2 0 1 2 3 6 2 4 - Bradley 5 0 0 0 0 0 - Com /Serv/Util - Food Related 3 0 0 1 3 1 3 Swimming Pool Filter 1 0 0 0 0 0 Washer - Clothes 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet - Toilet 6 0 0 0 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 1 2 6 19 5 17 Current Fixture Value 17 divided by 16 = 1.063 Current EDU 1 EDU = $4,665.00 Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU Change 17 divided by 16 = 1.063 over (under) $ 4,944.90 Enter EDU Change Here 1.060 Notes: Authorized Name /Signature: Dianna Howse Date: 8/2/2012 Building Division ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges. r I: \Building \Sewer Tally \SewerTallySheet- 4665.xls 07/01/12 / 1 Accumulative Sewer Tally ._- REVISED SEWER TALLY 08/02/2012 p a Tenant Name: Little Caesars SWR # 2012 -00173 T I G A IZ U Site Address: 12280 SW Scholls Ferry Rd PLM # 2012 -00217 Parcel #: 1S 1 34BC00300 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped #s value count added # added value total #s total 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 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain /Sink: - 2 inch 2 0 0 0 0 0 - 3 inch 5 0 0 2 10 2 10 - 4 inch 6 0 0 0 0 0 - Car Wash 6 0 0 0 0 0 Garbage Disposal: - Domestic (to 3/4 HP) 16 0 0 0 0 0 - Commercial (to 5 HP) 32 0 0 0 0 0 - Industrial (over 5 HP) 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: - Lav /Bar - Non -Food Related 2 0 1 2 3 6 2 4 - Bradley 5 0 0 0 0 0 - Com /Serv/Util - Food Related 3 0 0 1 3 1 3 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 0 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 12.7 203.2 TOTALS 0 0 1 2 6 19 5 -186.2 Current Fixture Value -186.2 divided by 16 = - 11.638 Current EDU 1 EDU = $4,665.00 Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU Change -186.2 divided by 16 = - 11.638 over (under) $ (54,300.60) Enter EDU Change Here - 11.640 EDU Credits Notes: 9/16/2005: PLM2005 -00466 capped fixtures to convert space from laundrymat to a bank for a total of 12.7 EDU credits as verified in the field by Brian Blalock, Building Division. EDU credits applied on 8/2/2012 to new plumbing permit leaving a current balance of 11.64 EDU credits. Authorized Name /Signature: Dianna Howse Ja Date: 8/2/2012 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If 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: \Building \Sewer Tally \ SewerTallySheet-4665.xls 07/01/12 Dianna Howse From: Jamie Greenberg Sent: Thursday, August 02, 2012 4:28 PM To: Dianna Howse Subject: 12280 SW Scholls Ferry Rd -- arararaz,rrten a I I I I r—= Q' OREGON COMNTY CREDIT UNION (031459-000) -12280 SW SCHOLLS FERRY RD File Window Help L- Se' e rb Refresh U ® New Comment [© Delete Comment I ' ,. Print Comments 114 Letter • b 0 Exit 4 Help j, P Q Overview Comments Drag a column header here to group by that column. Account 1 Status I Status Description 19 Creation Date 19 Close Date I Creator Eeople _ Closed Closed Status 8/27/2010 827/2010 debbies E _ Closed Oosed Status 4/102006 4/102006 Brooke c Ij Service Rates ■ F Closed I Oosed Status 1 11/17/2005 11/17/2005 Jamie C _ Closed Closed Status 10/182035 10/18/2005 Jamie V Q WiinterAverage t~ Lot _ (' P Devices P a C ' �j 'Containers . L : Histor Comment Body DECREASED D . BY 12.7 PER PLM2005-00466. BR ' BLALOCK WENT OUT TO VISIT THE SITE THIS Service Requests COUNT. WIL : ILL FROM THIS DATE FORWARD. , ..14 Oomments v G' � V Q al ,� , J Audit Trail f/ � ��' I to' er 0`'- t; 1 %, P E OREGON COQVINTY CREDIT UNION - 12280 SW SCHOLLS FERRY RD TIGARD OR 97223 Jamie Greenberg Sr. Accounting Assistant City of Tigard 503 - 718 -2492 1