Permit y p CITY OF TIGARD PLUMBING PERMIT
I '1 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00295
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/11/2012
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Starbucks Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Relocation of Starbucks kiosk inside Fred Meyer. Relocating: (1) backflow preventer, (1) expansion tank, (1) ice
maker, (1) water heater, (3) sinks and water supply for coffee, filter & dipperwell.
Contractor: RAY'S PLUMBING DBA PIPER MECHANICAL Owner: FRED MEYER INC
PO BOX 685 STORE #375
BRUSH PRAIRIE, WA 98606 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE. 360 - 892 -8700 PHONE:
FAX. 360 - 892 -9644
• FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/11/2012 $31 27
Specifics: 1 ea Expansion Tank 10/11/2012 $12 51
1 ea Ice Maker 10/11/2012 $12.51
Type of Use: COM 3 ea Sink 10/11/2012 $75.06
Class of Work: ALT 1 ea Water Heater 10/11/2012 $37 52
Type of Const: 75 Misc Other Fee 10/11/2012 $75 06
Occupancy Grp: 1 12% State Surcharge - 10/11/2012 $29 27
Stories: Plumbing
Total $273.20
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 folio the rules adopted by the Oregon
Utility Notif - • - - ter Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 • may obtain a copy of the rules
or di - questions to OU • • a i , g 83.232.1987 or 1 800 332.2344.
ssued By: ll . � ; 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.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received
Date/By (D." O Perm No PC101299- H'ib5. ' 0. RR � /A�/
IIIII q 13125 SW Hall Blvd., Tigard, OR 97223 _� °� DO
{r .� `► �E
C Plan Review
Phone 503 718.2439 Fax: 503.598.1960 Date/By. Other Permit No
TIGARD Inspection Line: 503.639.4175 Date Ready/By 4 ®See Page 2 for
Internet: www.tigard- or.gov Notified/Method (/ Supplemental Information
TYPE 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
❑ 1- and 2- family dwelling ® Commercial /industrial SFR (2) bath 437.78
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 11565 SW Pacific HWY Catch basin or area drain 18.76
W
City /State /ZIP: Tigard/OR/97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Fred Meyer - Starbucks kios 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 1 31.27 2 /. A-7
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Plumbing for new Starbucks kiosk inside of the Fred Meyer store
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 1 12.51 0.'5
Name: Fred Meyers Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 11565 SW Pacific HWY
Garbage disposal 25.02
City/State /ZIP: Tigard/OR/97223 Hose bib 25 02
Phone: ( ) Fax: ( ) Ice maker 1 12 51 n, . S7
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Piper Mechanical Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Peter Levanen
Roof drain (commercial) 12.51
Address: POB 685 Sink/basin/lavatory 3 25.02 `7 5067
City /State /ZIP: Brush Prairie/WA/98606 Solar units (potable water) 62.54
Phone: (360) 892 -8700 Fax: : (360) 892 -9644 Tub /shower /shower pan 12.51
E -mail: peter .levanen @pipermechanical.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 1 37.52 37. S y
Business name Piper Mechanical Water piping/DWV 56.29
Address: POB 685 Other: Coffee, filter,
tpaMe.ii a 25.02 - ]`j.
City/State /ZIP: Brush Prairie/WA/98606 0 - u-fjc� Subtotal A lj• q3
Phone: (360) 892 -8700 Fax: (360) 892 -9644 Minimum permit fee: $72.50 �,
Plan review (25% of permit fee)
CCB Lic.: 33217 if 3 Plumbing Lic. no.: 37 -149PB State surcharge (12% of permit fee) -
if fl� a5 7
Authorized signature: TOTAL PERMIT FEE A-75 - ,R■V
Print name pFra,, ,i,, t ...■ Date: Len A z This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
I \Buddm° \ Permit s\ PI MI I_Prrmu Ann tin, 10/0 I/09 440- 4C1fiTlin /02 /COM/WFRI
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr. Fee (ea) Total Square Footage: _ Permit Fee:
Footing drain - 1' 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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
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
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing futures? 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/ Plan review is required for any of the following. Performed: Capped Added Relocate 9 y g
Baptistry/Font Please check all that apply.
Bath Tub /Shower El Any new commercial building with water service 2" and
Jacuzzi/Whirlpool 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" Submit 2 sets of plans with any of the above.
4 " Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic - non - food q g
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related ?3
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor + p
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
R:\Proiect Manaaine\Active Jobs \OC 1219 Fred Meyer Tieard\Permits \Stdrbucks Permit Aoolication.docx