Permit a CITY OF TIGARD PLUMBING PERMIT
IN I. COMMUNITY DEVELOPMENT A I Permit#: PLM2013-00285
T(CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2013
�d 9 <01,,A 01,,A Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10330 SW GREENBURG RD
Project: Red Lobster Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Plumbing fixtures for restaurant remodel. 10/9/13:REPRINT permit to revise number of plumbing fixtures
r permitted. See attached for a detailed list of all new plumbing fixtures.
Contractor: TOM ALLENDER PLUMBING LLC Owner: LINCOLN CENTER LLC
PO BOX 23753 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97223 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 971-219-9313 PHONE.
FAX: 503-213-5993
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 10/07/2013 $18.76
Specifics: 5 ea Drywell,Leach Line or Trench 10/07/2013 $93.80
• Drain
Type of Use: COM 100 If Storm and Rain Drain 10/07/2013 $62.54
Class of Work: ALT 2 ea Backflow Preventer 10/07/2013 $62.54
Type of Const: 1 ea Dishwasher 10/03/2013 $25.02
Occupancy Grp: 2 ea Expansion Tank 10/07/2013 $25.02
Stories: 42 ea Floor Drain/Floor Sink/Hub 10/07/2013 $1,050.84
4 ea Hose Bib 10/07/2013 $100.08
6 ea Ice Maker 10/07/2013 $75.06
3 ea Primer 10/03/2013 $37.53
12 ea Roof Drain(Commercial) 10/07/2013 $150.12
10 ea Sink 10/03/2013 $250.20
11 ea Lavatories 10/07/2013 $275.22
1 ea Urinal 10/03/2013 $25.02
5 ea Water Closet 10/07/2013 $125.10
2 ea Water Heater 10/03/2013 $75.04
Total $4,695.91
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: 4054zer.../c___ 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.
a CITY OF TIGARD PLUMBING PERMIT
; a COMMUNITY DEVELOPMENT Permit#: PLM2013-00285
•
T f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2013
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10330 SW GREENBURG RD
Project: Red Lobster Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Plumbing fixtures for restaurant remodel: CAP(1)water closet and(1)lay;replacing or relocating(1)backflow
device,(3)dishwashers,(1)expansion tank,(12)3"floor drains,(3)hose bibs,(3)ice makers,(8)primers,(4)roof
drains,(13)non-food related sinks,(1)food related sink,(1)urinal,(3)water closets and(2)water heaters.
Contractor: TOM ALLENDER PLUMBING LLC Owner: LINCOLN CENTER LLC
PO BOX 23753 BY SHORENSTEIN PROPERTIES LLC
PORTLAND,OR 97223 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO,CA 94104
PHONE: 971-219-9313 PHONE:
FAX: 503-213-5993
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/19/2013 $31.27,
Specifics: 3 ea Dishwasher 08/19/2013 $75.06
1 ea Expansion Tank 08/19/2013 $12.51
Type of Use: COM 2 ea Fixture/Sewer Cap 08/19/2013 $50.041
Class of Work: ALT 12 ea Floor Drain/Floor Sink/Hub 08/19/2013 $300.24'
Type of Const: 3 ea Hose Bib 08/19/2013 $75.06
Occupancy Grp: 3 ea Ice Maker 08/19/2013 $37.53
Stories: 8 ea Primer 08/19/2013 $100.08
4 ea Roof Drain(Commercial) 08/19/2013 $50.04
14 ea Sink 08/19/2013 $350.28
1 ea Urinal 08/19/2013 $25.02
3 ea Water Closet 08/19/2013 $75.06
2 ea Water Heater 08/19/2013 $75.04
1 12%State Surcharge- 08/19/2013 $150.87
Plumbing
Total $1,408.10
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 expi e 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 952-001-1190 T- may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ■ 1
Issued By: Permittee Signature: �,.
Call 503.639.4175 by 7:00 a.m.for the next available inspection •:te.
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 . FoR OFFICE USE ONLY
City of Tigard AUG 19 2013 Received _ / Permit No. 2�2D/3_00
n 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �� �� ' /�' �/ �/
C • Phone: 503.718.2439 Fax: 503.598.1�8�'I Y OF TIGARD
D
Plan ate/By:Review Other Permit U
Da[eBy: ����� O/p
P I G A It D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris: El 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 Qty. . Ea. I Total
XAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-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: 1 d 3 30 S(,J V K c:0,3 D U e RD, Catch basin or area drain 18.76
l�A 2� Footing 1,leach line,or trench drain 18.76
City/State/ZIP: -L
t Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: go LOB ( Manufactured home utilities 50.03
Cross street/diredions 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer I .7 31.27
DESCRIPTION OF WORK Backwater valve 12.51
,p �
j - Clothes washer 25.02
ALl. NG+. , r nsw Dishwasher I/ 3 ,/ 25.02
EX f M `I b ZE-4, Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ,❑ TENANT Expansion tank l ,✓ 12.51
Name: Fixture/sewer cap ✓ ✓ 25.02
Floor drain/floor sink/hub ./ )Z ✓ 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bibj ✓ 25.02
Phone:( ) Fax:( ) Ice maker ✓ 3 ✓ 12.51
• ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) _ Page 2
Primer 9 ✓ 12.51
Contact name:
Roof drain(commercial) ✓ 12.51
Address: Sink/basin/lavatory ,/ lii ,- 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
Urinal ,✓ I ✓ 25.02
E-mail: -
GONTRACTOR Water closet 3 ✓� 25.02
Water heater Z ,/ 37.52
Business dame: u ENO 191,VAi(F2 I 1.1--(__ Water piping/DW V 56.29
Address: r U BOK 23 4 8 3 V Other: 25.02
City/State/ZIP: 196(trifINO 1-225 Subtotal 4o?.S7 e2 3
Phone:(cp.))2101•X313 Fax:(503)- Minimum permit fee: $72.50
CCB Lie.: l" I C-(9` A of �/y Plumbing Lic.n cl7L-I g Plan review (25%of permit fee)
u State surcharge(12%of permit fee) 15O,f7
Authorized signature:.411111i �_ / TOTAL PERMIT FEE"Noe, /O
Print name:` A/NS C L E C Date: g11 .201 3 I This permit application expires if a permit is not obtained withit 180 days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:\BuildingermitsPLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) �.+/
\P \
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-Is'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer- 1st 100' 62.54 3,601 to 7,200 $233.20
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 $50,001.00 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 fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture-Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 3 / ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" 12. ✓ Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station) 3 rUd /WO• all-v, ED( -7 • T D 1A_I
Rec.Vehicle Dump Station -EivIneL�e I2 1 flcCy - I (Al L 1 i'1►/ 3
Shower: -Gang
-Stall ✓
Sink: -Lav/Bar non-food related t %/ i 3
-Bradley
-Com/Serv/Util food related j
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet j f 3 ✓ plumbing permit can be issued.
Urinal 1 /
Other Fixtures: .
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
-
IN
a
T'tnant Name: Red Lobster Accumulative Sewer Tally
SWR# N/A
" ' p Site Address: 10330 SW Greenburg Rd. PLM#,2013-00285
T CrA l 1�1
aAI r_ Parcel#: 1 S135AB01003
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptistry/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 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 1-IP) 16 0 0 0 0 0
-Commercial(to 5 1-IP) 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 0 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Scrv/Util-Food Related 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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TO'T'ALS 0 0 2 8 0 0 -2 -8
Current Fixture Value -8 divided by 16= -0.500 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -8 divided by 16= -0.500 over (under) $ (2,400.00)
Enter EDU Change Here[ -0.500
Notes: ***EDU CREDIT***
Authorized Name/Signature:i Dianna Howse Date:! 08/19/2013
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\Sewer 1'allyShect_4800._0701I3.xlsx
CITY OF TIGARD .
BUILDING DIVISION PERMIT#: .
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171 �'',�,i,>J�'
Inspection Requests (24 Hrs.): (503) 639-4175 .' "I I..
INSPECTION WORKSHEET FOR DATE: U.- f 5...- j/ TIME: PAGE:
SITE ADDRESS: t 0 336 S 14/ Ca co.) U 0 V„ 121c, CLASS OF WORK: ,-
SUBDIVISION: LOT#: TYPE OF USE:
PROJECT NAM / ,,y.,
DESCRIPTIO : rk / ) . O13 - CCU 0--
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
.3L iv • s yv�rz ,1 _ 1-Ail -
0 PL c-t2o fc PA ss
Corrections/Comments/Instructions: '
31100 00 ‘, / -,i; ?0 P 06 14/ G C ..�4.h0(r7 OP) 0 r7- f l 3 c_
I! a/_ /0 - )----/l/0 /D./ 5
3-2 0 P/63G- 11214 bk-1-111J1D4--S
. J
El PASS E] PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS' '''
❑ FAIL ❑ CALL FO INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ✓ Date: //r 5-- Phone #: (503) 718-
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10330 SW GREENBURG RD, TIGARD, OR, 2013 -12 -04 00:00:00
97223
Record Type: Record ID:
Commercial - Plumbing PLM2013 -00285
Inspection Type: Result:
399 Plumbing final FAIL
Comments:
NOTE did walk thru with plumbing contractor for final plumbing. Will call for final when
ready.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10330 SW GREENBURG RD, TIGARD, OR, 2013 -11 -27 00:00:00
97223
Record Type: Record ID:
Commercial - Plumbing PLM2013 -00285
Inspection Type: Result:
399 Plumbing final FAIL
Comments:
Dry run on kitchen fixtures only. Water turned off. Looked at installation of fixtures.
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10330 SW GREENBURG RD, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
2013-12-06 (null)
PLM2013-00285
FAIL
1. Provide approved thread compound on all cleanout plugs exterior cleanouts.
2. Provide threaded c/o cap on c/b c/o.
3. attach all cow tongues to structure.
4. Correct mens urinal not working.
5. Provide air gap on mezzanine indirect drains.
6. Provide air gap on back bar indirect drains.
7. Provide access to interior cleanout.
8. All outside vendor equipment required to be installed for inspection.
9. Eco Lab soap dispensing equipment air gap cannot have sheathing. Air gap needs to
have clear space.
10. Kitchen sink by soda fountain not caulked.
Violation Summary:
Inspector Contractor
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard t Received p J /
`J ll I ` ) DateBy:O2/ 9t %9. for Permit No.: ,L.�AO/5
a 13125 SW Hall Blvd.,Tigard,OR 97.'1 Plan Review
: 0 Phone: 503.718.2439 Fax: 503.598 1960 N 3. Other Permit No.:
DateBy: /���� CT 1
Inspection Line: 503.639.4175
1 A i D Date Read B y Juris: 121 See Page e 2 for
Internet: www.ti ardor ov 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: /e)3 50 ,351,0 age .1.)6-uL a Catch basin or area drain 1 18.76
City/State/ZIP: Drywell,leach line, trench draii) 5- 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: g77 L• ,/ ,5r 2. 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.:kW (p0 f Page 2 U
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
` .� (� p Clothes washer 25.02
C�/r�-+^�- \�¢--CXU-0Z_- O-Yv1 Dishwasher ` 25.02
(1.9-.4-.)-1-1. Drinking fountain 25.02
Ejectors/sump 25.02
❑ 'PROPERTY OWNER I ❑ TENANT Expansion tank t2-- 12.51
Name: Fixture/sewer cap '•25.02
Floor drain/floor sink/hub, ,Lhh 1/2- 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib q . 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 3 12.51
Contact name:
Roof drain(commercial) . 17- 12.51
Address: Sink/basin/lavatory L'l/ , 5'10 ,.21 25.02
City/State/ZIP: Solar units(potable water) 62.54 '
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal / 25.02
Water closet 5 25.02
CONTRACTOR
Water heater 37.52
Business name: Water Pi tP in WV 56.29
Address: Other:( f- ,:trf"R-LH E D 39 25.02
City/State/ZIP: 1--1 5r > Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) •
. State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Date: 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 10/01/09 440-4616T(l0/02/COM/WEB)
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: esc�e ><allir Suppression Systems:
Site Utilities Qty. Fee,(ea) Total • Permit Fee:
Footing drain-151 100' 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-I st 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 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) I 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
El CCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4' ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally r::::2/
/ �
v � #
p, cnant Namc: Rcd Lobster � 8 i SWR 2 013-00188
I'Site Address: 10330 SW Grecnburg Rd Pl,NI # 2013-00285
P G:AI
Parcel#: 1S135AB01003
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptistry/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 1 4 1 4
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
I',ye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 38 76 38 76
-3inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 I II)) 16 0 0 0 0 0
-Commercial(to 5 I II)) 32 0 0 0 0 0
-Industrial(over 5 UP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 3 3 3 3
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
-l,av/Bar-Non-Food Related 2 0 0 11 22 11 22
- Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 6 18 6 18
Swimming Pool I:ilter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water I?xtractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 5 30 5 30
Urinal 6 0 0 1 6 1 6
Previous I?DU Count 0 0
Capped I:DU Credit 8 128
TOTALS 0 0 0 0 65 159 65 31
Current Fixture Value 31 divided by 16= 1.938 Current I?DU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous ICU •
Change 31 divided by 16= 1.938 over (under) S 9,312.00
Enter EDU Change Here 1.940
Notes: (4) food prep sinks,(3)ice bins and(6) floor drains not counted as they arc indirect
Per UB,this address was being billed for 8 DU's,all plumbing was demo d during remodel,so this figure is used as capped credit.
Authorized Name/Signature: Debbie Adamski Date: 10/2/2013
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. I f 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 filly\Sewer I'allyShect_4SOO._070113.xlsx
City of Tigard - Building Division
9/19/2013
Permit#: PLM2013-00285
Project Name: Red Lobster
Site Addres: 10330 SW Greenburg Rd
Description Quantity Each Total EDU
Catch basin (trash enclosure) 1 $ 18.76 $ 18.76 N
Trench drain (storm) 5 $ 18.76 $ 93.80 N
Storm sewer, 100' 100 $ 62.54 $ 62.54 N
Backflow preventer 2 $ 31.27 $ 62.54 N
Dishwasher 1 $ 25.02 $ 25.02 y
Expansion tank 2 $ 12.51 $ 25.02 N
Floor drain/sink- 2" 42 $ 25.02 $ 1,050.84 Y
Hose bib 4 $ 25.02 $ 100.08 N
Ice maker 6 $ 12.51 $ 75.06 N
Primer 3 $ 12.51 $ 37.53 N
Roof drain (commercial) 12 $ 12.51 $ 150.12 N
Sink/basin/lavatory 21 $ 25.02 $ 525.42 Y
Urinal 1 $ 25.02 $ 25.02 Y
Water closet 5 $ 25.02 $ 125.10 Y
Water heater 2 $ 37.52 $ 75.04 N
Other fixtures*: 39 $ 25.02 $ 975.78 N
Subtotal: $ 3,427.67
State surcharge (12%of permit fee): 0.12 $ 411.32
Plan review (25%of permit fee): 0.25 $ 856.92
Total: $ 4,695.91
*Other fixtures include the following:
(3) Island oasis, (4) drain boards, (1) bottle well, (1) mixing valve,
(1) PRV, (2) circulating pumps, (1) water softner, (1) freezer coil, (2)cooler coils,
(1) beer tower, (3) soda towers, (4) soda guns, (1) hose reel, (2) dipper wells,
(4) water filters, (2) mechanical cold pans, (1) spray hose (cook line), (1)tea maker,
(1) coffee maker, (1) pitcher filler, (1) service pouring station, (1) ECO lab station,
I:\Building\Public Record Request\Building Records\PLM2013-00285_PermitFixtureDetail.xlsx
FOR OFFICE USE ONLY–SITE ADDRESS: /D 33o J��
' This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
•
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
II Transmittal Letter
T I c_,AR D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: i' ' DATE RE�CE�IE�D:RECEIVED
. DEPT: BUILDING DIVISI O �JG N JGl V
SEP 5 2013
,(D C rr
FROM: a—et CITY OFTIGARD',
COMPANY: _ e42-. .414 - BUILDING DIVISION
PHONE: �VD a . ' iy 4-I 9- -
RE: I o 330 Airi.A_,g Q c M �/ 3 - GYM o'�8�
(Site Address) 6 Permit Number)
•`01 I I •
•roject name or su.,'vision name an' of num I er
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: _ Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain): --��11 � 1� n
REMARKS: (-,,, JQLA_x lJ .�Le.c�t�Q 2P V pi > iase;,(_.A.
Eip---oc...---..:..,Th„„,--_ -_.4.:..-0_---622..v--- ------ - i_a
FOR OFFICE USE ONLY
Routed .. 'e• it . ec ' ician: Date: Initials:
Fees i ue: A Yes ❑No Fee Description: Amount Due:
Pui ..e_AL..„. $ Sig S7• g/
la
u312.-- ` moo $ 9, 31 A.od •
$
$
Special
Instructions:
Reprint Permit (per ): 1Yes ❑No [Done
Applicant Notified ! . • IL),./f- 64 # Initials(1
// ✓4 zafti .
3 1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
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IN IAccumulative Sewer Tally
g . Tenant Name: Red Lobster S /R# N/A Site Address: 10330 SW Greenburg Rd. V/A9A5 U PI.1\1 # 2013-00285 ^VOI D
TIGARD
Parcel#: 1S135AB01003
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#5 value count added# added value total#s total values
Baptistry/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: - I ach 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 0 0 0
-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 0 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 8 0 0 -2 -8
Current Fixture Value -8 divided by 16= -0.500 Current[DU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
•
Change -8 divided by 16= -0.500 over (under) S (2,400.00)
Enter EDU Change Here' -0.500 .
Notes: -"EDU CREDIT;.,
Authorized Name/Signature: Dianna I-Iowse Date:' 08/19/2013
Building Division
Note: The property owner shall retain the ORIGINA 1.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.
l:A Building\Sewer Tally\Sewcr'I'allySheet_481111._0711113.xlsx